The Reality For Men With Eating Disorders

Kyle was trying to be honest about when his body image issues started, but he also wanted to be polite. “My mom is in the room, so I don’t want to say anything offensive,” the 16-year-old California high schooler told me in an interview in January. “But I don’t know a single member of my family over 40 who hasn’t been on Weight Watchers.”

Early on — at about 12 years old — Kyle became anxious about his weight. “With this history of diabetes and hereditary obesity, I was pretty certain that I needed to eat healthy,” he said. That’s when he started to jog every morning. For lunch, he had a salad without dressing every day.

By 15, he was cramming hours of physical activity into each day, without eating much. “I would leave the house at about 5:50 a.m., then run to the gym, work out for an hour, go to school for eight hours. Then I would go to dance rehearsals for four hours, and not make it home until about 10 p.m.,” Kyle said. “Not only was I overtaxing my body and mind and everything, but I didn’t eat any carbs. I was vegan. Pretty much tofu and lettuce, that’s all I ate.”

Kyle attributed some of his body insecurity to what he was reading and seeing in culture, notably in Harry Potter. “Teenagers are supposed to ‘shoot straight up,’ especially teenage boys. I mean, in Harry Potter, they talk about how without any work, Harry just shot up. And it made me realize a lot of my friends were that stereotypical teenage boy who had just grown 6 inches over the summer. And that wasn’t happening with me,” Kyle said. “And that was very disappointing when I was getting messages from real life and the media that my body didn't fit into any of those ideal paradigms.”

Kyle’s parents noticed that he had lost a significant amount of weight rapidly, and started researching whether this could be a problem. Meanwhile, the teen thought the weight loss was evidence that he was on the right path. “I thought losing weight was just a sign of a healthy diet and exercise,” he said. So when he sat across from a panel of specialists — a doctor, a dietitian, and a psychotherapist — and was given an atypical anorexia diagnosis, he was taken aback.

He was only half listening when the specialists said he had to go to the hospital. “I was like, ‘OK, that’s cool. I have a couple of tests this week. Can I go to the hospital next week or next month or something?’” No, they told him. “They said, ‘You have about an hour to pack, and we want you at the hospital by dinner.’”

When Kyle checked into the eating disorder ward at a California hospital, his heart rate was in the low 30s. (A normal resting heart rate is somewhere between 60 and 100 beats per minute.) “I was so close to dying. My heart was beating once every two seconds,” he told me. He spent two weeks in the hospital, on strict bed rest — “They wheel you everywhere. You can’t walk. They don’t want you exerting any energy whatsoever,” he said — before starting a therapy program.

Kyle is lucky on multiple fronts. Anorexia can be deadly — the illness has a death rate as high as 10%. Even when it doesn’t kill, the effects on the body are brutal: Your body enters a starvation state and begins to shut down. Essential organs like the liver and the kidneys begin to fail, then eventually, the heart and the brain. Luckier still: Kyle’s mother told me getting her son into the clinic that diagnosed him was not an easy feat; it took months. When Kyle got his diagnosis, he said he felt like his masculinity was “stripped away.”

During the two weeks Kyle spent in the eating disorder ward, he was surprised that he felt relief. “Finally someone was seeing the pain that I was going through, saying this isn’t healthy and I need to stop it. No one was applauding me for cutting out carbs,” he said. Among the dozen patients in the ward, Kyle met two other men. “It was the first time I realized: Hey, other boys go through this. One was a student at an amazing university; the other was looking at colleges. There were really smart, really strong boys who also got eating disorders.”

He is now trying to come to grips with the lifelong consequences of his eating disorder. “This is probably my biggest regret from all of this: If you see my growth chart, the day I started dieting, very soon after, I stopped growing and didn’t realize it,” Kyle said. “Right now I’m 5’8”, and I was expected to be at least 5’10”. Now I’m done growing, and I’ll never get those two or more inches back. And it was all because of a flawed body image and a flawed body perception.”

That it took a hospitalization for Kyle to learn that other men have eating disorders is not a surprise. Studies suggest that men make up roughly 1 in 3 or 1 in 4 cases of eating disorders. But according to Dr. Blake Woodside, a professor of psychiatry at the University of Toronto who is also medical director emeritus of Toronto General Hospital's program for eating disorders, “in treatment settings, men are more like 1 in 20. There’s a lot of guys out there with eating disorders who never end up in treatment centers.” Woodside stressed the importance of seeking help early. “If you’re concerned that you have an eating disorder, you want to treat that like you’re concerned you have prostate cancer. So you wanna get it checked out.”

Kyle’s name and identifying information, and the identifying information for most of the men we spoke to for this piece, have been changed. Nearly all of them expressed reticence being identified because they said they felt shame for being a man who has an eating disorder, a type of illness they once falsely understood was associated with women.

Jason Nagata, a physician and researcher at the University of California, San Francisco, is working on changing how we talk about eating disorders and men. He said that even the field of research is only beginning to address that men get eating disorders. “The clinical guidelines that we have from the medical field are really based mostly on girls and women,” Nagata said. As a result, “a lot of boys and men go unrecognized and they have delays in getting care.”

“It used to be that to get a diagnosis of anorexia nervosa, one of the criteria was that you had to miss periods,” said Nagata, whose interest in researching eating disorders came from wanting to help more men. “There are still guidelines in place today that just don’t apply to men,” he said. He added that the vast majority of eating disorder research has been done on women, and is based on the assumption that the person you’re trying to diagnose is trying to lose weight. So the diagnostic questions end up missing worrying signs of disordered behavior. “Many guys with eating disorders or with body image issues, they’re not trying to lose weight. They’re actually trying to bulk up and be muscular.”

Between the rise of Instagram and TikTok, and the supremacy of the heroes of the Marvel Cinematic Universe, the last two decades have seen an acceleration in media and technological forces that distort men’s body images. Now, young men are inundated with the pressure to have Captain America’s washboard abs and bodies devoid of an ounce of body fat. The V shape — broad shoulders, six-pack abs, smaller waist — has become the male body ideal. Even men who are famous for their ripped physiques aren’t immune from the shaming that comes with those pressures.

But while men navigate these body image issues, there’s a dearth of shared language and stories of the way they impact men. Many men starve themselves, or spend hours at the gym overexercising, or restrict their food intake, but there’s still a stigma around how they talk about their relationships with their bodies.

James, a 29-year-old who lives in the UK, just finished seeing a therapist after getting a bulimia diagnosis back in 2010. He said his therapist saw 20–30 patients a week, “and I was the only man that he was seeing in the entire clinic.” An eating disorder diagnosis is already a lonely and stigmatizing experience, but being the only man receiving therapy “deepened the feeling of isolation and shame.”

But it also made him realize how many men just aren’t getting the help they need. James had always been a swimmer, and when he arrived at an elite UK university in 2009, he started swimming with the school’s team. “Obviously, starting at university, the academic workload increases exponentially,” he said.

As a competitive swimmer, James said he “had a fixation on weight.” With the pressures of maintaining a certain weight to perform at a competitive level, he found himself looking for something to control. “I was focusing on food as a way to say, Oh, if I can control how much I eat, everything’s kind of even-keeled.”

After going home for the holidays at the end of the first semester, “it flipped the other way,” James said. “All the big holidays, surrounded by food, can be difficult, with eating so often. And about a week later was the first time I would make myself sick.”

What followed next is a cycle that would become familiar to James. “I immediately felt much better about what I was stressed about. My feelings about my weight and emotion felt a bit better,” he said. “But that — high is not the right word, but emotional release or whatever — is temporary. It’s pretty much always followed by lots of negative emotions and shame and disgust and disappointment.”

It didn’t take long for James to realize he had a problem. Just five weeks after he started making himself throw up, he remembered having a particularly bad day. “I think I made myself sick like four times that day,” James recalled. “And I knocked on my neighbor’s door and had a chat about it. He encouraged me to email my parents, because I was very emotional at the time.”

Immediately, James’s parents sprang to action, consulting doctors. “We spoke to my GP, and they referred me to the first place I received treatment. So it’s actually a very quick turnaround,” he added. “I’m glad about this, because even with me receiving treatment so quickly, I’m still dealing with the same issues long term. These could be very difficult, deep-rooted issues to work your way out of.”

Ten years after his bulimia diagnosis, James feels that he is just now in a position to start pushing toward recovery. He started working with a therapist in 2015 and recently completed the therapy program. “My therapist and I think we have the tools for me to continue my treatment by myself and recover,” James said.

James is still trying to untangle the lingering effects of weighing yourself constantly and measuring yourself against other high-level athletes. “Compared to the general population, I was exceptional. But in the pool of exceptional, I was at the bottom,” he said. And this had immediate consequences. “Swimming performance would equate the time the coaches would spend on you and your social status within the club hierarchy.”

He expressed his frustration that for elite-level athletes, “there’s no thought of aftercare, for when someone leaves the sport.” There are few resources to help athletes adjust how they eat or organize their life and free time as they transition from competing at a high level to being out of the sport altogether.

On top of that, comparison can exacerbate the impact of eating disorders. James is determined to let others know that “however good a swimmer you are, or if you make that cut, it doesn’t reflect on your worth as a person or your ability to be a good human being or have an impact on people’s lives.” He’s also worried about how social media is affecting the generation of young boys coming up behind him: “If you look at TV shows, the teenagers on them — men and women — are played by 25-, 26-year-olds in an incredible shape that, realistically, a 14-year-old isn’t capable of,” he said.

James said he’s now on the lookout for men who may be struggling. “I’m always hyperaware that just because someone looks fine, looks ‘healthy,’ or average, you don’t necessarily assume there’s not anything difficult going on with them.” On multiple occasions, he has tried to send a general signal to a person he suspects is having a hard time. “I say, ‘You can always talk to me if you want to,’ and try to leave the door open.”

Leaving the door open is key. James said he doesn’t start conversations about his eating disorder with friends, but will happily talk about it if they bring it up.

The ideal male body didn’t always look like Chris Evans as Captain America. Harrison Ford didn’t need abs to electrify audiences, and neither did Bruce Willis. They looked fit, sure, but part of the appeal was that they also looked like regular guys. But in 2021, being a teenage boy means having endured a dozen years of Marvel movie box office dominance, with an array of ripped superheroes serving as the most popular form of entertainment on the planet.

It’s probably not an accident that the Marvel movies’ explosion of popularity coincided with an acute rise in body image anxiety in men. The superhero of the 21st century is bulkier and more buff and has overwhelming muscle definition basically everywhere.

Kyle told me he was taken aback by the news of John Krasinski’s recent transformation. “I know him from The Office as the sort of affable, friendly, not-super-ripped guy. And he went through this huge body transformation, and he’ll possibly play a superhero in a movie” he said. “I remember thinking: If you’re a superhero and you have superpowers, what’s the point of having six-pack abs?”

There is some pushback against this ubiquitous ideal. Robert Pattinson refused to change his body to play Batman. He told GQ, “if you’re working out all the time, you’re a part of the problem.” It’s a break from his ancestral Batmen — Ben Affleck bulked up to play the role, and Christian Bale built up so much muscle, he couldn’t fit into the Batsuit. Pattinson is having none of it. “No one was doing this in the ’70s,” he said. He has a point: Even in the ’90s, Michael Keaton didn’t need the big, muscular look to don the suit.

Within the Marvel universe, the conversation is evolving. The movies will not suddenly withdraw from the unrealistic body image they helped advance, but at least when comedian Kumail Nanjiani revealed his body transformation to star in the upcoming Eternals, he made sure to note that it takes an extraordinary amount of resources to get there. “I would not have been able to do this if I didn’t have a full year with the best trainers and nutritionists paid for by the biggest studio in the world,” he said. “I’m glad I look like this, but I also understand why I never did before. It would have been impossible without these resources and time.”

While the ripped bodies dominate social media and movies, Dr. Nagata said we need new diagnoses to be more gender inclusive — ones that cover the men who are “preoccupied or obsessed” with spending time at the gym, who “may actually be objectively muscular, but they just don’t see themselves that way.” His research encourages rethinking our understanding of eating disorders. “In the title, it implies it’s eating-related, but really, a lot of these guys are just excessively, compulsively exercising,” Nagata said. “We sometimes have people going to the gym, I kid you not, for 10 hours a day.”

That type of overexercising can be dangerous, even if it flies under the radar. “Even if guys are eating ‘normal’ amounts of food, if they’re exercising for 10 hours a day, you’re still going to get into a huge energy deficit,” Nagata said. “Your body can still get into starvation mode, and still have your heart shut down, or liver shut down, and all these dangerous things, even if you’re not restricting food.”

Jamal, in his late thirties, said the gym is a “huge presence in my life.” The business owner based in the Midwest estimates that he spends “a good three hours a day at the gym.” Most of it is spent on cardio. “If I’m not working out a certain amount of time, I don’t eat,” he said.

“I know objectively and intellectually that weight can fluctuate for a lot of reasons that don’t relate to actual weight gain or fat. I know about water retention and salt, all those things,” Jamal told me. “But I really don’t leave the gym until I see a number on the scale that I’m a little happier with. Sometimes that means two or three hours at the gym, sometimes it means a little bit longer, or sometimes it means multiple visits to the gym during the day.”

Jamal recalls growing up “pretty overweight,” but losing a significant amount of weight when he got to college. The weight loss came with an unexpected downside: “People are effusively complimentary when you’re losing weight. And that’s great to hear. It gives you an adrenaline boost, that sort of jolt of positivity. And you start to need it.”

Because of his fixation with people giving positive feedback, Jamal directed his energy toward managing the number on the scale. “If I’m really thirsty at night, I will resist any urge to have a glass of water. Objectively, obviously, I know water is good for you. It’s not a bad thing to be drinking water. But I know that having that glass of water is going to result in my weight being up this many ounces or 1.2 pounds the next day. So I will decline to do it.” He said that based on the number on the scale, he adjusts how many sips of coffee he drinks.

Jamal was seeing a therapist regularly. Though his reasons for going weren’t specifically about his relationship with food, that was a topic that came up a lot. But when the pandemic began and his therapist went virtual, he stopped. “For whatever reason, the efficacy wasn’t there. I wasn’t able to feel the connection. It just got too removed through Zoom,” he said.

Nagata was careful to note that while not all behaviors and diets and practices are “disordered” per se, “the tipping point is when these behaviors to control your weight or appearance really start to become an obsession, or you’re really preoccupied about them, and you’re not getting enjoyment out of food or exercise, and it’s really becoming a compulsion.”

Nagata worries about the ways social media compounds the problem. “A lot of boys and men now more than ever have their bodies on display for social media,” he told me. “You can get lots of followers on Instagram or TikTok, and there’s this whole new phenomenon of shirtless guys who are getting lots of likes through that.”

I pushed back on this — I grew up with Usher’s abs on TV. How is this any different? I asked. Nagata offered that the music videos were something older generations watched, but “it wasn’t really something you participated in.” And therein lies the difference: “10, 20 years ago, it was a little bit harder to produce your own content.”

The way social media creates enormous pressure to adhere to unrealistic body standards is familiar stuff to Sam. The 27-year-old grew up in Connecticut and now lives in Haifa, Israel. By age 17, Sam said he knew he was gay. “The gay world, and society as a whole, has what I would consider to be a damaging portrayal of what the gay stereotypical man should look like — buff and ripped and blonde and super-high cheekbones, just the whole package,” Sam said. Sam was born in Colombia and adopted as a baby by white parents. He added, “I’m shorter, with darker features and thin, and getting that exposure to what the gay world looked like, knowing it wouldn’t be something I could ever obtain, I started to think that maybe there is something I can obtain that is still desirable. And that, to me, was to be thin.”

By the time he got to college, he was running 35–40 miles a week and biking 20–25 miles. He was also restricting food more and more. Sam described to me how this worked: “I didn’t feel pain to say, I can skip the dining hall today, and then, Oh wait, we can just skip lunch altogether. Or you can make excuses, like, Oh, I have class. The dining hall will be closed by the time I finish.” He added, “People with eating disorders are masters at justification. We can justify just about anything.”

The justification extended to Sam hiding evidence that anything was wrong from his parents, even hiding a particularly worrying health development. After a routine physical, some of Sam’s blood results had come back “obscure,” and so his doctor ordered a brain MRI.

“The doctor calls me, and he says, ‘Well, we have good news and some not good news. Because of the results in your blood test, we had concerns that your body was throwing signals of a brain tumor. The good news is you don’t have a brain tumor. The alternative is your body is throwing the signals because it’s starting to shut your organs down because you are so malnourished.’”

Sam remembered figuring out a way not to tell his parents the serious news he’d just heard. “I think all I shared was the fact that I don’t have a brain tumor and left it at that,” he told me. Even by the time Sam started therapy, he wasn’t planning on changing how he was living. “In my head, I had envisioned going for like a month to dot the i’s, and cross the t’s, and say I did it and move on,” he said. But that’s not how it went. “Finally, after so many years of running and depriving and staying away and not touching, the time and space to open up and to understand and fix, or maybe not fix, but reconcile all of the things that got me to the point of on the road to organ failure.”

But even with therapy, Sam said, he was stubborn. “Even though I was getting professional help, I was also hell-bent on retaining the same build and physique that I had maintained at the ‘peak times’ in my eating disorder.” It took time and developing routines and strategies in therapy to begin to release those habits.

It’s not a journey that’s ever finished. But you can have good days. Sam cautions others who suspect that they’re dealing with an eating disorder: “If you think you’re going to be able to dig your way out of it in a little bit of time, you won’t. You just won’t. That’s something I wish someone had told me.” He added, “Just start talking.” ●

If you’re dealing with an eating disorder and need someone to talk to, the National Eating Disorders Association helpline is 1-800-931-2237; for 24/7 crisis support, text “NEDA” to 741741.