To Be a Man with Disordered Eating

For nine months, Jason felt like a god. He was a first-year student-athlete, rowing for a Division I program. As a high schooler, he had dreamt of becoming a Navy SEAL, of seeing just how far he could push himself, what he could make his body do when he took it to the extremes. Now, he was finding out.

In high school, he had competed in the heavyweight weight class but realized he had a better chance of getting into a top program as a lightweight. He lost 30 pounds for his interview and his hunch was proven right—he was accepted into the Ivy League school. Once there, Jason made a reputation for himself with his incredible ability to drop pounds to meet strict weigh-in requirements while still pulling faster scores.

Of course, the ability to drop and put on weight like Christian Bale preparing for a movie role doesn’t come easily, or naturally. Making weight meant eating as little as possible—a feat aided by the fact he was popping Adderall in a bid to expend as many calories as possible while consuming almost none. Some weeks, he’d shed 15 pounds, having only a jar of Tostito’s salsa for dinner for several days, only to put it back again after weighing in. When the inevitable crash came, it hit hard.

“I wanted to kill myself,” says Jason. “Then somebody gave me an oxycodone right at that moment. For the first time, I don’t know what force wanted me to go through hell more than I had, but something did. Right at the moment the crash came, someone handed me a blue pill and said eat this, it will make you feel better.” For a while, the oxy did help—despite the Adderall-fueled insomnia, Jason was able to sleep. It crushed the growing levels of self-loathing and regret that were growing in his mind. And it completely numbed any last appetite he had for food.

It’s not a new revelation that men suffer from eating disorders—the first medical literature on the subject dates back to the late 17th century and featured case studies of both male and female subjects. However, there is still a sense of taboo-ness around the topic—while it’s now more commonly acknowledged, both in science and in the culture at large, that this is a problem that doesn’t just affect women, the men themselves are seen as outliers or freaks. In short, they’re still dudes who have a women’s disease.

Some weeks, he’d shed 15 pounds, having only a jar of Tostito’s salsa for dinner for several days, only to put it back again after weighing in.

“Early conceptualizations of eating disorders really had built into them that it was a female problem, it was something that happened to women and not men. Now, we know it’s not true, but it’s been slow for the field to take in that knowledge and shift our way of thinking,” says Tom Wooldridge, a psychotherapist in Berkeley, California, who specializes in treating eating disorders.

“Men in general, because of the way they’re socialized are probably more reluctant to show vulnerability and seek help for emotional problems. That’s only amplified because they don’t see in the culture around them images of men struggling with concerns about food, weight or shape.” It’s a stigma that keeps many men from recognizing they have an eating disorder, from seeking treatment and, for those who are in recovery, from talking about their experiences openly. (Jason, for instance, has spoken publicly about his experiences before but asked for anonymity for this article out of concern for his future prospects.)

There has been progress since the 1970s, when, for the first time in a century, medical research started to include men in studies of eating disorders. By 2000, The New York Times was running pieces on male anorexia. Pop culture has been catching up, too. Last year Netflix released To The Bone, a drama that included a teenaged boy battling the disease. Some celebrities, ranging from Russell Brand to Billy Bob Thornton have opened up about their experiences, while in 2017, Penn State kicker Joey Julius went public with his struggle with binge eating disorder.

But that lag in understanding has come at a cost, as while it’s now acknowledged that men can have major problems with food, we’re still just beginning to understand how big of an issue it actually is. New numbers show that as many as 40 percent of eating disorder sufferers are male, a huge increase over the previously accepted 10 percent. Researchers are only beginning to understand that disorders can manifest themselves differently in men.

Stuart Murray, an assistant professor at University of California, San Francisco, is also the director for the National Association for Males with Eating Disorders. In his research, he’s found that because men and women have different ideals when it comes to their bodies, men who suffer from eating disorders can show different behavior than the starving associated with anorexia or the purging of bulimia. Because eating disorders have so long been seen as a problem that mostly affects women, they’re often framed through a female-centric lens.

Part of the reason they’ve gone under the radar for men is because we don’t know how to recognize it when they present in ways that are specific to men. And that’s because men and women aren’t socialized to see their bodies in the same terms. The ideal body type for women is thin. But guys want to get ripped. And trying to lift and diet your way to a body like any of the Avenger Chrises, be it Hemsworth, Evans or Pratt, can quickly become a problem.

It’s a thin line between disorder and the highly regimented diets of a professional athlete or bodybuilder.

“If we zoom all the way out, most men, when they’re dissatisfied with their body, don’t want to get thinner,” says Murray. “They want to become more muscular. There’s a derivation between thinness versus leanness. Most men want to be lean and muscular rather than emaciated.”

The ridiculously cut body as an ideal for men is relatively new: One of Murray’s studies consisted of tracking Playgirl centerfolds over the course of the ‘90s. He found that the models got more muscular, with a lower percentage of body fat, over the years. “The images we’re exposed to are changing, we know that,” he says. “Now, there’s been studies even looking at action figures and things like that, and the premium placed on muscularity is extensive. It extends to computer game characters, which now are anatomically impossible for humans.”

Because the types of bodies men and women are conditioned to want are so different, so is the behavior. Murray’s research showed that men suffering from these muscle-oriented eating disorders tended to not engage in the binging and purging of bulimia or the starvation of anorexia. Instead, they had obsessions with hitting their macros.

“A person with anorexia nervosa might say ‘I can only eat once a day,’ and that can be a very rigid rule. Someone with a muscularity-type disorder might say ‘I can’t go longer than three hours without eating,’ because I don’t want my body to go into a catabolic, tissue-wasting state. I want to be anabolic, in this muscle-building state, permanently.” It’s a thin line between disorder and the highly regimented diets of a professional athlete or bodybuilder. Murray says these habits become disordered when they start taking precedence over things like a partner’s birthday, or when one continues the same diet and exercise routine in the face of injury.

These types of unhealthy behaviors around food and fitness were something he saw quite a bit of during a previous life as a soccer player and amateur boxer in his native England. “Generally, a couple of things we would say is that one’s shape and weight is the most important thing in their life,” he says. “We see an issue when this gets in the way of other important things in life. They can’t desist from engaging in these behaviors.”

Brian Cuban knows something about unhealthy exercise and eating. Now a lawyer and outspoken advocate for mental health, he didn’t just suffer from anorexia and bulimia—in college, he would run for hours each day. “Running became a way of both maintaining my weight, losing more weight and also putting myself in a position where no one could see me, and I could just run and feel good about myself,” he says. “Running gave me a high like binging and purging gave me a high.” Cuban didn’t necessarily aspire to shredded abs.

Growing up, he was a pudgy kid who experienced an intense incident of bullying. Losing weight seemed like the surest way to become worthy of love. He started restricting his eating during his freshman year of college in the 1970s and began binging and purging.

“I would say things like ‘It’s so nice to hike 10 miles a day because I’ve earned my food.’ Some staff would hear that and be like ‘You earned your food by breathing.’ “

In many ways, Cuban was typical—most boys who have been diagnosed with eating disorders first began presenting the behavior in their late teens, as opposed to early adolescence in girls. Like Jason, Cuban was also abusing drugs (some studies show as many as 50 percent of those with eating disorders also abuse drugs or alcohol). Unlike Jason, Cuban didn’t seek help in his 20s. His patterns continued until his 40s, hiding his issues with food and exercise from everyone, including his psychiatrist.

Again, it’s typical: while most girls with disorders tend to have a reduction in dissatisfaction with their bodies as they get older, men will stay unhappy into middle age. According to Murray, the reasons why aren’t known, but could be because being a man is so tied into strength. A man who’s scrawny is unmanly at any age.

Part of the reason body dissatisfaction and eating disorders could persist longer is because men simply aren’t getting treatment. Aside from the taboos that keep men from recognizing their problems, there’s a lack of treatment options aimed at them. As Wooldridge points out, many therapists are still conditioned to believe eating disorders are limited to women. There’s a lack of mental health professionals who are trained to help men improve their relationships with food and their bodies. Some inpatient eating disorder clinics are unisex.

“Men that have eating disorders often are uncomfortable being placed in treatment groups populated by women. ‘I don’t want to be the only guy in therapy with 10 other women. Their experience, just because of gender difference, may not match mine,’” says Wooldridge. “Once men make it into treatment, it’s not so much that treatment needs to be altogether different, it’s more that treatment needs to speak to the male experience of having a male body in this culture.”

For Jason, finding treatment proved to be an ordeal unto itself. After his crash, he took a summer to intern in Europe. He went cold turkey on the Adderall and oxy, experiencing withdrawal symptoms, and managed to return to eating somewhat normally. But when he returned to school, even though he quit the rowing team, he was soon replacing a normal diet with pills once again.

“Because I would buy drugs, I wasn’t going to spend money on food,” he says. “I continued to basically eat pills instead of food, in a way. So long as my body still looked like it could perform, then somehow that was a mask I was able to present to the world, and I could convince myself I wasn’t as fucked up as I was.”

He ended up withdrawing from school, and detoxing at home under the supervision of a doctor hired by his parents. While the doctor looked after his physical symptoms, Jason received no help for his mental health. After several relapses, he tried a mental hospital in Texas, but the environment there was a bad fit. Finally, he ended up at a nature-based retreat for his addiction issues. While he never sought treatment for his eating disorder specifically, it was a place that helped him heal on that front, too.

“It did come up. I would say things like ‘It’s so nice to hike 10 miles a day because I’ve earned my food,’ Jason recalls. “Some staff would hear that and be like ‘You earned your food by breathing.’ That sort of resolved over time, naturally.”

While Jason asked that his real name not be used in this article, he has slowly begun talking about his experiences in the past few years. He’s gotten involved in Project HEAL, a non-profit dedicated to raising money for eating disorder sufferers who can’t afford to get help. Looking back on his experience now, he says he realizes he was privileged to have a financial support system that was able to pay for the help he needed.

But for thousands of other men who know they need help, but find themselves unable to express why or how, getting better can seem impossible. Jason hopes there can come a time when the stigma is gone. “We need to destigmatize mental health, first and foremost, people standing up and saying ‘This is what happened to me,’” he says. “Then everyone else gets permission to do the same. They feel like less of a prisoner.”