Title/Topic: Body Perfect: Boys and Men Not Immune to Serious Eating Disorders
Posted On: 11/6/2007
Nov 6, 2007 (JournalNow.com) – When Charles Atlas warned boys in the 1930s not to let bullies kick sand in their faces, he advertised his bodybuilding program alongside other novelties in comic books.
As they gave up the funnies, young men usually left their dreams of a Mr. Universe physique behind.
It was easy enough to do then. Matinee stars such as Clark Gable and Humphrey Bogart were no musclemen, and they still got the girls. Even into the 1960s, pop-culture icons were more brain than brawn. The toy G.I. Joe was a regular-looking guy.
Today, G.I. Joe’s proportions are freakishly huge. Buffed, well-cut men display their shirtless physiques in movies and on television. Even Charles Atlas Ltd. now sells dietary supplements online.
In 1972, a Psychology Today study found that 75 percent of men felt fine about how they looked. When the study was repeated 25 years later, the number had fallen to 33 percent. Today, some studies report that 97 percent of men are dissatisfied with at least one part of their bodies.
“There seems to be pressure on men now from Madison Avenue and the media to achieve an ideal of bodily perfection which before now seemed to be only focused on women,” said Kevin Thompson, a psychology professor at the University of South Florida.
Some men resort to silicone muscle implants. Others starve to lose weight. Some use steroids and other dangerous substances to build muscles.
In the first national study of eating disorders, published this year after almost 10,000 face-to-face interviews, Harvard researchers discovered that men account for a quarter of anorexia and bulimia cases and almost 40 percent of binge eaters. Because researchers interviewed only adults, no one knows how many teenage boys are affected, even though the debilitating habits are thought to begin in the peer pressure-cooker of adolescence.
Experts blame a number of factors – advertisers’ increasing emphasis on the half-dressed man as a sales tool; high-school athletics that pressure teenagers to add muscle; and media that offer facile explanations for childhood obesity and condemn kids as fat and lazy.
Despite the growing realization that men need help, too, treatment options are scarce, and insurance companies willing to foot the bill are rarer still.
Because the social stigma is so great, all the men and parents interviewed for this story requested anonymity.
He has suffered the indignity of a feeding tube running down his nose into his belly. Osteoporosis weakens his bones. Fragile from self-imposed starvation, he recently needed a wheelchair to get around.
Still, Michael, 27, repeatedly checks his jeans’ waistband for the dreaded snugness and his watchband to be sure it still slides easily along a bony wrist. He knows now how irrational that is, but it’s tough to lose the habit.
On a recent morning, he woke up with a chocolate-chip muffin on his mind.
“I said to myself, Oh, no. I’ve got a fear food coming up.’ All morning, the voice kept telling me that normal people don’t eat chocolate.”
Michael refers to the negative thoughts as the ED (eating disorder) Voice, an evil, undermining foe he must learn to ignore.
He psyched himself up and managed to get half of the muffin down as he sat at a table surrounded by languid teenage girls. He didn’t enjoy it but understood it to be medicine or fuel.
Michael is midway through his five-month-long treatment for anorexia at Fairwinds Treatment Center in Clearwater, Fla. He could find no options in his home state of Georgia. He shares a room with the only other male patient.
Frail, with a mop of brown hair and kind, soulful eyes, Michael started counting calories in high school. His physique mattered less to him in college as he fell in love and pursued a marketing degree. Sometimes his fiance made cracks about his weight, which had steadily crept up to XXX pounds*.
Then, after five years of dating, his girl dumped him just three months before their wedding.
He would show her. He restricted his diet to egg whites, plain fish and steamed broccoli, then hid his weight loss from his parents.
After they went to bed, he exercised to exhaustion, doing 1,500 sit-ups and 1,200 to 1,400 push-ups. He weighed himself at least 10 times a day and panicked if he gained a half-pound.
“It made me feel proud that I was able to do it,” he said. “It made me feel in control.”
Pauline Powers, a professor of psychiatry at the University of South Florida and the medical director of Fairwinds, said that if the brain is deprived of proper nutrition long enough, thoughts become jumbled. By the time his parents helped him get into Fairwinds, Michael weighed XX pounds*, couldn’t stand, had a heartbeat of 31 beats per minute and required hospitalization to stay alive.
“When we speak of the ED Voice, it’s not a hallucination,” said Susan Wachter, Michael’s therapist. “We direct them to think of the messages they tell themselves as an abusive relationship – it’s dishonest, isolating, berating. It knows their vulnerabilities.”
Like Michael, Jon, 21, worries about body fat. At 6 feet 1, he weighs in at a muscular XXX pounds* and is intimidating enough to work as a bouncer at a nightclub. But no matter how lean and muscular he gets, he’s never satisfied.
“It’s kind of mind-boggling and hard to explain,” he said. “I change from minute to minute almost. I know I want to be real big, so I go to the gym. I’m one of the bigger guys there, and people tell me I’m big. Sometimes I feel that way, but then I’m always thinking that I want to be bigger.
“Then you get bigger and you notice you have put on all this body fat…. So you’re like, Man, I need to cut down so I can see my abs again.’ Then you lose the weight and you feel small. It’s a constant battle. “
Jon was born with a cleft palate and was attacked by a dog at age 5. Both required multiple facial surgeries, and although people tell him he looks fine, he doesn’t believe it. Childhood was a torment of taunting and cruelty by other kids.
“I’ve been teased my whole life,” he said. “But middle school was the worst. I was picked on, beat up, stole from – you name it. As far as self-confidence, I have nil, none, zero because of that.
“I figure since I’m so hideously ugly, I might as well have a nice body. It’s the only thing I can control.”
He started playing sports at age 4. He ran track and played football, baseball and basketball in high school. In his senior year, he needed a class to fill a time slot and discovered weight training.
“From that day on, I was in love.”
Kevin Thompson, a professor of psychology at the University of South Florida, says it’s not unusual for men to keep such concerns to themselves for fear of ridicule. Doctors often pat them on the back for their apparent good health.
What’s easy to miss is how their interest in self-improvement can lead to disruptions in their work and social life. Thompson, who edited The Muscular Ideal (American Psychological Association, 2007), said that when bodybuilding is taken too far it becomes muscle dysmorphia, sometimes called reverse anorexia.
“It can be delusional,” he said. “They’re too exacting about their appearance because they genuinely have a misconception about how they look.”
When family physicians see weight loss in a male patient, they often test first for AIDS or other diseases.
But even in a case as obvious and perilous as Michael’s, few options are available.
Treatment is designed for adolescent girls. Even the questionnaires devised to hone in on anorexic behavior ask about the cessation of menstrual cycles and concerns about fat thighs.
Few facilities nationwide accept male patients, and with only a couple of exceptions, the majority of their patients are female. Therapists say that it is difficult for men to open up in group therapy in front of female patients.
Even if a man finds suitable inpatient care, it might be unaffordable. Most insurance companies refuse payment for the treatment, which can take many months to succeed and cost more than $100,000. Parents often use up college savings or take out second mortgages. Some put the cost on credit cards and hope their child is well before their finances collapse.
Powers says insurance companies have been shortsighted.
“It’s cheaper to treat someone early on, as it costs much more in the long run,” she said. “Early intervention and appropriate treatment make a huge difference in outcome.”
Often, eating disorders are accompanied by obsessive compulsive disorder, depression, anxiety and social phobia – although sometimes it’s difficult to determine which came first. Genetics is thought to be involved, as some patients’ families also have a history of eating disorders, substance abuse or mental illness.
Marjie Ruth, who leads ED support groups in Tampa, says that it’s tough for parents to learn to deal with the problem without contributing to it.
“Your instinct as a parent is not always what is needed,” she said. “I believe it is an addiction, and addicts can be manipulative. For example, a young man may say he doesn’t want to eat meat. The parents will agree to that. Eventually, the parents are cooking an entirely separate meal for their child, begging and pleading with him to eat.
Some of the mothers in her groups are afraid their sons might lash out physically in anger as their thinking becomes more confused.
Amy remembers a day she came home from work and found her 15-year-old son distraught and incoherent. She took him to an emergency room. “A couple of his friends came there, and one started telling me that my son was bulimic and was drinking and doing drugs. I am so grateful.”
In August, a Florida man pleaded guilty to giving his young son steroids to enhance his competitiveness – in roller skating.
“Even in sports you wouldn’t think of as needing power and strength, adolescents and even some adults think they need to be more powerful to achieve in those sports,” Thompson says. The availability of steroids and other dangerous drugs makes the quest for muscles harmful and sometimes deadly.
Eating disorders also can take root during adolescence when athletes such as wrestlers stop eating and induce vomiting before matches. After weigh-in, they gorge themselves.
“It gets to be the social norm,” Thompson said.
“There’s nothing wrong with working out,” Thompson said. “The key is doing it in moderation.”