Men Struggle with Eating Disorders Too and Stigma Deters Treatment
This is personal.
I am a man who has battled an eating disorder for 40 years. It bleeds into every seam, every second, every moment of my life. It is real. It is brutal. It does not go away without help.
I am being deliberate in not loading this essay with data and statistics. This is a personal story based on my own experience; however, the data supports this: more than a million men in the U.S. have an eating disorder.
Many men are ashamed of having an eating disorder, which is in fact a mental illness that can kill them — so, like me, they avoid treatment. Even today much of the literature on eating disorders refers to women. There is a dearth of literature on atypical sufferers and men, but eating disorders are the second most fatal mental illness, second only to Opioid Use Disorder.
I believe there is a straight line from the childhood gender tropes that form lasting impressions of what it means to be a “man” to a level of shame that develops in male sufferers of eating disorders.
Men are “supposed” to be big, strong, muscled, athletic, etc. As with women, boys are taught that they must have a particular kind of body. Health and well-being have nothing to do with it. You cannot simultaneously be too heavy or too light and still be a real man.
Ironically eating disorders are often rooted in attempts to achieve the ideal masculine body. I see it every day in my gym — high school boys fill the free weight area — all trying to become big and strong. Flexing their muscles in the mirror, obsessing about their progress toward this end. Nobody wants to be skinny. It’s, of course, shameful. So, when, in an effort to become “big” without becoming “fat”, boys can spiral into restrictive eating and purging.
I was one of those boys
I decided to take up running in 1983 when I was 16 years old. Running and triathlon became my obsession soon to be followed by an obsession with what went into my body.
The late 1980s and 1990s were the era of Snackwells and fat-free everything. My triathlon heroes seemed to avoid all sources of fat. I did everything I could to mimic them. My obsession carried me down the road to food restriction and purging through exercise – Anorexia Nervosa. I developed an inner voice that anyone with an eating disorder is familiar with: it distorts our perception of self, convinces us to define ourselves by a number on a scale and cunningly convinces us that maintaining strict control of everything that goes into our body is the only way to obtain the always slightly out of reach perfection we seek. The eating disorder voice convinced me that severely restricting my eating was a demonstration of beneficial discipline. Moreover, it ensured that the discipline never flagged by convincing my eyes that the image in the mirror was always in dire need of improvement (i.e., more weight loss).
In high school I self-isolated, had few friends, and did my best to ignore the overheard insults hurled at me because my emaciated body did not conform to the standards of manliness. I justified it as the cost of being a good triathlete. Moreover, few boys my age participated in the sport in those early years so I did well and this reinforced the feedback loop.
Seeking treatment was the furthest thing on my mind. I was aware of eating disorders, but my limited knowledge was that only females had eating disorders. For me, the control I exhibited was a demonstration of the manly discipline needed to be both healthy and good at a sport.
My mother, to her credit, noted my plummeting weight and did bring me to two so-called eating disorder specialists. I felt I was fine — fit and getting fitter. I did not think I needed any help. Moreover, the medical team’s idea of help was telling me to gain weight or they’d hospitalize and force-feed me. That was the end of my medical intervention. I never went back.
At some level, I was embarrassed and humiliated by my condition. It was not manly. However, this could not overcome the fear of losing control and the resulting, yet only vaguely defined catastrophe looming if I relaxed my rules. Certainly, acknowledging that I had an eating disorder was absolutely unthinkable. Again, only females had eating disorders…
It will not go away on its own
I thought it would. I thought it did. It most definitely did not.
Not seeking and persevering in effective evidenced-based treatment will at best leave you afflicted for life. At worst it will kill you. But the reality is that in addition to the usual barriers to any medical intervention in the United States (access, cost, adequate evidence-based treatment practitioners, etc.), men who have the resources to find and participate in recovery programs often do not because of the stigma.
Only in the last couple of years did I have the courage to acknowledge that I have been suffering from an eating disorder for the last 40 years.
I was married for 10 years and told my former wife everything — except that I had an eating disorder. I told her recently, years after our divorce. Naturally, she had already figured it out. Even now there are many people in my life who likely do not know and frankly, I still don’t feel comfortable telling them. Yes, I still fear judgment, alienation, and odd looks when I am out with them — especially where food is involved.
Concluding Thoughts
The thing about eating disorders that is hard for those who have not experienced them to believe is the incredibly powerful cognitive dissonance it creates in their victims.
We convince ourselves we are engaging in a behavior (be it purging via food or exercise, restricted eating, etc.) to look good, perform better and be healthy. Yet we are not convinced that our behavior is destructive even when faced with hard evidence of damage. That said, we do have a weak rational inner voice telling us so — it just cannot compete with the eating disorder’s megaphone. We are not convinced by:
A glance in the mirror that can sometimes tell us we are malnourished.
The constant thoughts about food are the thoughts of a person starving.
Always being cold, tired and often irritable.
Blood panels and physical symptoms that confirm testosterone or estrogen deficiency (starving bodies stop producing hormones that don’t directly contribute to survival).
Severe long-term outcomes like osteoporosis.
To this day I have experienced all of this. Yet the eating disorder voice continues to dominate. Yes, I go through periods where the rational voice breaks through — but typically not for long.
Men avoid treatment for a variety of reasons:
Stigma
Fear
Lack of access to an evidence-based recovery program
Lack of fellowship in a program (we often feel alone as the lone male)
Lack of support for men with eating disorders in general (literature, online, treatment options)
The need to cede control of diet and exercise (core to our universe of control and control is the root of the eating disorder)
The costs can be significant. If you survive, you will be consumed by it for life — as have I. Suffer physical degradation — as have I. See impacts to jobs, relationships, and suffer mental distress — as have I.
At a minimum, I hope a few men suffering alone find this essay and feel less lonely. It will be better though if the stigma is reduced and more treatment addressing men becomes available.
I can’t make much headway on the issue of stigma reduction, but I can credibly convey to anyone who happens to read my essay how destructive it is, and how pursing recovery is worth it and imperative.
