Pretzels and Cheese

By Francis Iacobucci

The Sunday after Thanksgiving I received a text from a trainer at my gym: don’t forget to sign up for a session this week to burn off all those calories! As someone who has struggled with body acceptance for essentially my entire existence, I was filled with emotions and racing thoughts.

In the immediate aftermath of the text, old eating disordered thoughts emerged: It’s not like I ate that much. Or did I? I’m pathetic. I should have purged. I wonder how much weight I gained. I’m so ashamed. 

And then justifications: Well, I had this much protein and this many carbs – that seems about right. I’m a man, so I’m supposed to be big and strong; and it helps me lift weights, of course. I need to eat a lot! Stop being a wimp – be a man! Just make sure it’s the right amount of calories and macro nutrients.

And then, as a bit of reason and years of therapy began to set it, I became frustrated: What gives this person the right to dictate to me what foods are good and what foods are bad? I’m never going back to that gym!

And finally, after my emotions regulated a bit (it’s amazing how one text can get someone so fired up!) I asked myself some questions, and I answered them: did I enjoy the food I ate? Yes. Did I eat to the point of feeling full? A little. Is that okay? Yes. Why is that okay? Because I’m allowed to eat food that tastes good.

 I’m so thankful – after years of therapy and support from so many – that I’m able to process thought and emotion to ensure my safety and health. For so many, the constant barrage of diet and wellness culture rules and regulations lead to constant uncertainty and shame about their bodies. For those with eating disorders, it can be exponentially more damaging.

I was once asked to write down a list of all the “rules and regulations” that wellness culture had influenced me over my lifespan – the list was five pages single-spaced. Eat this to look like that. Stretch that to feel like this. Don’t eat this to date a girl like that. At one point I had written down all the rules that stated why it was bad to eat certain foods, and it got to the point that the only foods that was “safe” from wellness rules and regulations were basically fruits and veggies – organically and locally grown, of course – that had fallen off the tree. Everything else was off limits if you wanted to be happy and healthy.

The list was tangible evidence that the way I thought about food and body dissatisfaction were intertwined and tangled to a point that seemed impossible to unravel. Going from saying no food is bad to engaging in that practice while eating took years, and is still very much a work and progress. I’ll always remember, though, eating pretzels and cheese (two things I would have never eaten in the past because they were on the list) and feeling satisfied and satiated, rather than guilty and ashamed. I had successfully snacked. I had put down the notions of food morality so ingrained within me briefly enough to feel what eating can be: a fulfilling and pleasurable experience. It was a blissful moment in my recovery process. I smirked as I crunched the pretzel and chewed the cheese, scoffing at the notion that what I was eating was going to change my ability to be a “good” person.

While I’m sure that trainer has good intentions, no one has the right to dictate to anyone the morality of food. Save biological reasons and personal preferences, restricting or eliminating foods from diet because they have been labeled “bad” by a multi-billion dollar industry is not healthy. I have – and at times – remain a victim of the wellness culture’s campaign to profit off of individual’s fear of imperfection; and I thank all the therapists, family members, friends, pets, colleagues, and humans that have helped me develop coping strategies for when I’m told to be ashamed of the food I eat, and the food I enjoy.

Every person’s eating disorder and body image story is unique, and I hope those who are struggling have the support they need and deserve. You are beautiful and worthy – not just of food – but of life.

Powerless Over Food

By Tommy Barnett

Which is worse, the fear of eating food or the shame you experience after you eat something? The pain of hunger and the necessity to live always led me to eat. I can remember being so afraid of taking a single bite because I feared that I would gain weight. When I would eat, the shame would penetrate my core and force me to engage in eating disorder behaviors.

I can remember a time when I was in a treatment center. During snack time, I was called upon to go and see my primary counselor. Before I could leave the group, I was told I had to eat the yogurt that was given to me. I tried to sneak out of group because I didn’t want to eat the yogurt but the therapist caught me. As I stood in the middle of a group, I ate every bite of yogurt. The fear I was facing didn’t come from eating the yogurt but more from the shame I felt that everyone was watching me.  I felt naked and embarrassed being in my own skin.

Someone once stated that the difference between guilt and shame is that guilt is when you do something wrong and shame is when you feel you are wrong. Having an eating disorder is fighting a double battle. It takes so much effort to face the fear of eating and an even greater effort to be okay with ourselves after we eat. Every time I would eat food, I can remember using self-hatred as a motivator to engage in eating disorder behaviors. I felt like I couldn’t live with myself after I would eat something. The trick is, that in order to live you must eat. This was the cycle I lived in for too many years.

As we approach the holidays, being around food of any sort is almost inevitable. Today, I am neither afraid nor am I ashamed. I value my mind, body and soul and to do that is by practicing both a kind relationship with myself and with food. My hope is for you to find freedom from your pain and realize the true nature of yourself. A kind and loving soul, no matter how far down in the darkness you have gone. Beneath your fear, guilt, hurt and shame is a light waiting to shine through. Be strong my friends for you are never alone.

 

Considering Gut Health in Treating Eating Disorders

by Jason Arnold, PhD, ND

Currently there are approximately around 30 million people in the United States struggling with some form of eating disorder whether it be Anorexia Nervosa, Bulimia Nervosa, or Bing Eating Disorder (National Eating Disorder Association, 2018). According to the American Psychiatric Association, eating disorders have the highest mortality rate of any mental illness described in the Diagnostic and Statistical Manual (DSM; 2013). Clinicians and providers are still searching for new and innovative ways to treat these serious illnesses. We have seen the use of psychopharmacology, therapy, group therapy, family-based treatment, and functional approaches to clinical nutrition – all of which have been met with measured success. One of the areas that has been recently explored is your own body system and how this can influence not only your physical health, but your mental health as well.

There has been a huge amount of attention on the gut microbiome, or the community of microorganisms living in our digestive tracts. It appears that, in the past couple years, many physicians and providers have been looking at gut health as being a link to physical and mental health. For a Cliffs Notes idea of what this means is that your gut has trillions of microbes – “gut bugs”, so to speak – that are used in digestion and other physical processes that enable a person to live.

There is evidence that the health of your gut can impact your mental health. Based on research from the Journal of Psychosomatic Medicine (Kleiman, Watson, & Bulik-Sullivan, 2015) there appears to be a direct link between your gut and your brain. A majority of Serotonin – the neurotransmitter that regulates mood and anxiety states – is actually made in your digestive tract. The link between gut health and eating disorders is even more so. According to Dr. Loren Cordain, a scientist who specializes in nutrition and exercise physiology,  people who are struggling with eating disorders have different types of microbes, or gut bugs, than those who do not have ED. Each individual has close to a trillion bacteria in their gut that aids in digestion and processing of nutrients.  In addition, those who have eating disorders also typically have fewer microbes than those without eating disorders, which may be a result of altered digestive processes or eating disorder behaviors (Kleiman et al., 2015). Research suggests that a change in your gut microbiome can also help a change in your mood and aid in your recovery as well (Thaler, 2015; Deans, 2015).

So here are a couple of helpful hints that could  build back up your gut microbes, which in turn, may potentially help improve your mood, decrease your anxiety, and also help regulate how your body digests food and stores nutrients as you progress through the recovery of an eating disorder:

  1. First things first. The best rubric: Lack of nutrition and a lack of a balanced diet lead to poorer health, symptoms of depression, anxiety, and ultimately can influence the microbiome in your gut. A balanced diet according to Dr. SC Kleiman, a researcher on gut health and eating disorders, leads to more positive outcomes. Meet with your dietician regularly and make sure you ask questions and address any concerns you have about what you are eating and how that may influence your recovery.
  2. Consider the types of foods that you do eat. To strengthen your internal body system and your gut microbes, eating a variety of foods in textures, colors, etc. Research (Heiman & Greenway, 2016) suggests that variety helps to challenge gut microbes, encourages reproduction and diversity in your gut microbes, and strengthens the microbiome. The road to good gut health and an improvement in mood and anxiety, and ultimately a reduction in symptoms of an eating disorder is to allow for variation in your diet. This is a great way to also work on challenge foods as well!
  3. If you have been struggling with an eating disorder for quite some time consider probiotics. As a society, we’ve been using probiotics for years to support good gut health and digestion. These are foods, such as yogurt, that contain good, friendly bacteria that can help restore gut health. According to Dr. Karen Ross, MD, MPH, a physician and columnist from Psychology today, probiotics are associated with positive physical and mental outcomes. Probiotics also come as supplements including products like Culturelle. These can be taken under the direction of a physician.

If this is something you feel is worth exploring, speak to your doctor, dietician, or treatment team. During your recovery, it is important to have the maximum amount of support you can during a time that may be intimidating and sometimes very scary. Your providers can best help direct your treatment in a way that is right for you that will not only keep you healthy, but keep you safe. Everyone has the right to recovery regardless as to where they are in that process. If you need help, please do not hesitate and reach out.

Be well.

 

Bibliography

Deans, E. (2015). Junk food, gut, and brain. Evolutionary Psychiatry. Retrieved from https://www.psychologytoday.com/us/blog/evolutionary-psychiatry/201505/junk-food-gut-and-brain on September 15, 2018.

Heiman, ML & Greenway, FL (2016). A healthy gastrointestinal microbiome is dependent on dietary diversity. Molecular Metabolism, 5(5) 317-320.

Kleiman SC, Watson HJ, Bulik-Sullivan EC (2015). The intestinal microbiota in acute Anorexia Nervosa and during renourishment: Relationship to depression, anxiety, and eating disorder psychopathology. Psychosomatic Medicine. 2015.

Thaler, C. (2015). Eating disorders, mental health, and the gut microbiome. The Paleo Diet. Retrieved from https://thepaleodiet.com/eating-disorders-mental-health-and-the-gut-microbiome on September 12, 2018.

The Futility of Comparisons

By Justin Mazza

All my life my I have been involved in some sort of organized physical activity and developed a competitive nature; from baseball and basketball to soccer and martial arts- I have constantly been involved in a structured sport activity. Growing up and being one of the heavier kids on these teams, I learned to use my size and strength to my advantage, especially in martial arts where I dominated my competition year after year. I won 4 national fighting championships and felt on top of the world. I embraced my size because it helped me rise to the top of my competition.

Then at 19 it all shifted when I made the decision to step away from martial arts and focus on college. I remained somewhat active but nothing as compared to my previous activities. I gained some weight in a few months of starting college and felt my size wasn’t doing anything for me anymore. It no longer provided me with a competitive advantage considering I wasn’t fighting anymore. At that time, I decided to lose weight and started to develop an eating disorder. It started with trying one change to my diet, then another, and another until it spun out of control and I was doing 5 different diets at once. In addition to that, I decided to join a gym and long cardio sessions 6 days a week.

I started comparing myself to the other men at the gym- some were “bigger” than me and others were “smaller” than me. I wanted to be smaller than what I was and ended up dropping a significant amount of weight. I was finally looking like the skinner men at the gym but being that way didn’t make me happy. It didn’t give me any sense of accomplishment where I thought it would. Now that I was “smaller”, I looked at the more muscular men who were much bigger than me and now wanted that! I went from wanting to be small to now wanted to be large- how could this be?

Now in my third year of outpatient recovery and 25 years old, my entire mentality has started to change. Since I lost all that weight so quickly at a muscular developing age, my bone structure is wide especially around my hips and shoulders. I used to think of this as I look “big” but now I embrace it as part of my journey. I now look at other men- some who are “smaller” than me and others who are “bigger” than me and no longer compare myself to them. I no longer say I want to look like that. I am focused on my own health and what my body needs to be happy, not what others look like as compared to myself. I even have men and women compliment my “big” shoulders that I used to be self-conscience about. Its amazing looking back at my recovery journey from where I was to where I am now. I am so excited to see the future of my recovery and hope to help others in their own recovery journey.

It’s Time to Talk About ARFID

By Anne Bouchard

Our family has a son with an eating disorder. He’s had it since the age of three, and his condition has not really changed. We found out by accident that he had a food allergy to peanuts (and tree nuts), which happened even earlier than the eating disorder. Certainly, having a food allergy makes the cautiousness around foods – especially “new foods” – even more present.

Though the years have not brought big changes to our son’s eating disorder (he is almost 15, and is still allergic and highly selective with foods), we know that eating disorders are not caused by individuals or circumstances: No one is to blame. 

Aversion to trying new foods was something we noticed in our boy as early as the feeding years. People still ask us how long his condition has existed and we still answer, “Since we can recall.” It’s been a long time.

We’d share our experiences and concerns with family, friends, and medical experts, though our explanations and observations were often dismissed. Most reassured us the “picky eating” was just a phase. We felt dismissed and alone in our quest for answers about the definite feeding limitations. It was clear to us that something was not being acknowledged.

Over time, we’ve learned to listen to our “gut feeling” and to advocate for what we are experiencing and for what we need. We never received an actual diagnosis for our son. We accept this, though we hope other families may be heard and believed to get the needed help early on.

Our son is almost 15 now, and he still has the eating disorder. Luckily, there’s a diagnosis that’s finally made it into the DSM-5, and that means a lot. The condition used to be called Selective Eating Disorder (SED) and is now officially Avoidant Restrictive Food Intake Disorder (ARFID).  It’s a longer name, but it seems more accurate in describing the often early onset of the disorder (during the feeding years).

We still continue to explain the disorder and refer professionals and anyone else to look up the name and condition, accept it as an actual disorder, and gain awareness about its existence.  This is key for families like mine who were dismissed for too long. Recognize and diagnose; accept it and treat it. We accept that a disorder is not a choice and so a big part of our efforts is to make that known to more people. Let’s inform and inspire. It’s Time to Talk About It!  

Like all disorders, an eating disorder is not a choice. Our son did not choose to have a disorder, yet he accepts and manages it one day at a time. We’re impressed by his wit, his positive attitude on life, his supportive friends, and his performance at school and on the soccer field.  He’s developing well despite the limited selection of foods. He’s physically and mentally fit and has the endurance needed to excel at competitive “travel” soccer. In fact, he plays overseas as part of international tournaments. What to eat and what to bring to those trips can be challenging, but the boy with ARFID is undeterred!

After all these years, his diet is still limited and consists mostly of dried and packaged snacks.  Favorite foods remain the crunchy, dried type like potato chips, pretzels, bread sticks, fries, and mostly brand name snacks. Preferred foods are classic finger foods.

As for treatment, we’ve seen allergists, specialists at nationally-renowned centers for eating disorders (teams of occupational therapists, researchers and psychotherapists). Maybe anxiety experts can help. We’ve also explored hypnotherapists, though we have yet to work out a match with someone in our area (Maryland). We’re basically not giving up, though “new food adventures,” eating together as a family, and seeing improved eating are not yet regular happenings in our life.

We don’t push and we don’t give up.  We are here to listen, encourage, and withhold judgment regarding a disorder that is real yet still not well-understood. What’s hopeful is to see that our son is thriving in so many ways and is not showing major concerns about how he will manage ARFID in the future.  Gotta love that!

Anne Bouchard is a proud advocate for the National Eating Disorders Association (NEDA), and an active fundraiser for programs and services specific to eating disorders (especially ARFID).  She’s a parent, spouse, former media advertising professional, and current substitute teacher in Maryland.  She lives with her husband, son, and teen daughter in Maryland. Anne continues to advocate for ARFID awareness and treatments. Her fundraising page for ARFID is here.

SOURCES:

Society for Adolescent Health and Medicine. Published by Elsevier Inc., copyr. 2014.

Google Alerts- Anyone can subscribe to getting these.  I get alerts for anything coming up on Selective Eating Disorder (SED) since that is the earlier name for ARFID.

Diagnostic and Statistical Manual 5th edition (DSM-5)

Learn more about the symptoms, warning signs, and health consequences of ARFID here.

 

This piece originally appeared on the National Eating Disorders Association’s blog.

Male Eating Disorders in the LGBT Community

by Anne Hall

The increasing prevalence of eating disorders amongst men is something that more and more people are becoming aware of: In the United States alone, 10 million men will suffer from a clinically significant eating disorder at some time in their life (Wade, Keski-Rahkonen, & Hudson, 2011). Parents are increasingly aware that they must watch their sons, as well as their daughters, when looking for signs of a developing eating disorder and this increased awareness is something that should be appreciated.

What some people are less aware of, however, is that eating disorder rates are increased amongst the sexual minority male community compared to their ‘straight’ counterparts. According to the National Eating Disorders Association, 42% of men who seek treatment for eating disorders identify as gay (Carlat, Camargo, & Herzog, 1991). What’s more, outside of the formal diagnosis of a full blown eating disorder, gay men are an incredible 12 times more likely to binge and purge than heterosexual men (Austin, 2004). This leads us to the question of why are gay men more vulnerable to developing eating disorders than heterosexual men, and how can we use this knowledge to provide help and support?

Controlling an Uncertain World

If being a teenager is difficult, then imagine how much more difficult it is to be a gay teen. Whilst many teens struggle with boundaries, with control, and with finding a place in the world that they feel that they fit in, gay teens must also deal with the added complication of coming out to their family, of living in a world that can still be very homophobic, and dealing with a wealth of feelings of shame and confusion surrounding their sexual orientation. Alissa Petee, child and adolescent primary therapist at Washington’s Eating Recovery Center, states in the article “Eating disorders are far more common in LGBTQ communities — here’s why,” that this can make the path to adulthood even more complicated for gay teens, and controlling their food intake by developing an eating disorder can help those teens to feel they have regained some control of their life in a world that all around them seems so uncertain. In males particularly, eating disorders can also develop as a reaction to feeling weak or unmuscular in comparison to their peers, and wishing to ‘bulk up’ in order or meet a perceived societal norm, match the appearance of those they admire, or fit into the perceived stereotype they feel they should be conforming to. What’s more, eating disorders often develop as a result of an interaction between biology and stress, and there are many stressors that result from being a gay teen: harassment at school and work, and the negative reactions of friends and family are sadly still very common.

An Attempt to Change The Body

For men and women that identify as being transgendered, an eating disorder can develop in conjunction with body dysmorphia, as a way of changing the way their body looks, because they have so many negative associations with it in its existing form. There is still a lot of social stigma associated with identifying as transgender, and this can be difficult to come to terms with: many transgendered teens who have not yet accepted they are transgendered (or don’t even have a clear understanding of what being transgendered means) are typically unable to even vocalize what they are feeling or truly understand why changing their body makes them feel better about the way they self-identify. It can be a very difficult and scary time for teenagers without a strong support network, and regaining control through controlling eating can sometimes become the next step if those teens are not presented with other more healthy ways of managing their emotions and dealing with the negative energy that may surround them.

The way in which LGBT individuals receive treatment for their eating disorders may differ slightly from that for heterosexual teens. This is because the eating disorder may be tied up with their LGBT identity, and therefore positive affirmation and coming to terms with their identity may be helpful to overcoming their eating disorder. However each teen is an individual and, regardless of their sexual orientation, there are a myriad of different reasons that teen may develop an eating disorder: it could well be that the eating disorder is not related to their sexual orientation, or that they have accepted their identity but cannot cope with the criticism and judgment of others. Regardless of their sexual orientation, there is no easy path back from an eating disorder. But with the right help and support, determination, and an understanding of who they are, a those teens can soon find themselves walking the road towards mental and physical health.

A Comment on “Eating disorder symptoms in middle-aged and older men” (Mangweth-Matzek, Kummer, & Pope2016)

by Brian Pollack

Key Points from the Article:
– Males aged 40-75 years of age participated.
– 6.8% of males reported having eating disorder symptoms
– Only 9% of those men were identified on the EDE-Q
– Male ED questionnaires are needed

In a recent research study published by Mangweth-Matzek, Kummer, and Pope (2016) in the International Journal of Eating Disorders (http://onlinelibrary.wiley.com/doi/10.1002/eat.22550/abstract), 6.8% of 470 males aged 40-75 who participated in the study report having current eating disorder symptoms including: (1) a low BMI, (2) binge eating, (3) binge eating and purging, or (4) purging without binge eating. This is in line with current estimates that more females than males struggle with symptomatology (Hudson, Hiripi, Pope, Kessler, 2007).

But there’s a caveat…

What is astonishing about the numbers is that there is an obvious misrepresentation taking place in terms of testing and reporting of ED symptoms in middle aged males. We don’t hear about these cases but, as a male therapist, I get these calls more than ever.  In the past few months I have spoken with an increasing number of middle aged men and their families, who call in desperate and unsure where to turn because no one knows what to say or how to handle the problem.

These are families that are at their wits end. In one particular case the father figure was creating an atmosphere of neglect because his obsessive thinking was run by eating disorder actions. When I began working with this gentleman, the initial questions were not about how he felt – you see he felt his gym habits and over exercising were normal. He wanted to know how he could continue and find more happiness in his life. He struggled to see his day to day behaviors were causing problems. Emotions were avoided and actions were the focus of discussion. Being a man from an older generation, finding the proper language and approach was a challenge. Concrete in nature he was unaware of the effects within his psychosocial sphere. It wasn’t until trust and a mutual language was built over multiple sessions that discussion about feelings, shame, guilt, and impairment of social and relational functioning came to light.  It can be challenging for men to speak about this stuff.  In a world where common themes in our national dialogue surround women fighting for influence, this man had it.  He was afraid of losing it.

As professionals, we have come to understand that the EDE-Q and similar diagnostic assessments don’t do male sufferers justice, and yet not everyone knows this.  Although the frequency of middle-aged male eating disorders is close to the norms reported in the professional advocacy groups across our country, is there something we are missing?

The middle-aged male experience is being overlooked.

So, what are we missing?  The current metrics and questionnaires are based on a long history and misunderstanding that eating disorders are a “woman’s disease.”  This is placing men at risk as cultural norms, clinical education, and poor awareness are creating a vacuum that overlooks male sufferers.

The most poignant observation in the piece is that only 3/32 (9%) of the men who reported current eating disorder symptoms were captured using the cutoff on the EDE-Q, a common “gold standard” measure of eating pathology within the field. This is striking and signifies that current measures of eating pathology lack sensitivity in men. This is likely a result of the EDE-Q and other measures being largely based off of white females; as a result, the extreme behaviors that men experience have become overlooked.

Of particular interest is how much middle aged men utilize exercise as a compensatory behavior. This is acceptable by a large majority of the population and an easy way that many men hide their behaviors. You’d be surprised that not only young males and females are intensely controlling their diet and physicality.  Having worked closely with men who struggle, they often feel as though their “body is getting away from them” and will start to excessively exercise to achieve leanness.  They aren’t obsessed with loss of weight – they want muscle – they want the body they had when they were younger and that is where dangerous territory can take hold – the use of anabolic steroids.  Imagine how many athletes, how many gym goers, how many men are trying to use steroids to maintain an ideal which can cause such harm. There is a growing amount of data about adolescent males and young adults, but I struggle to find studies about this issue focusing on middle-aged males.

So what does this mean for all of us?

We need to pay more attention. We need to do something. We need to come together and build prevention systems and measured approaches.

We are at an interesting crossroads in which history is repeating itself.  What once happened to women in our mass marketed media is now happening to men. This study demonstrates that middle-aged men struggle with eating disorders just as women do.  Yet, there is very little representation for men who are older; when I get a call from a male in his 40’s+ I often find they are disappointed in the inability to get help. They call multiple institutions, residential and day programs, even hospitals – yet they are often told that because of their age they aren’t appropriate for the program. I recently worked with an older male who felt as though no matter how hard he tried, no matter how much he obsessed over getting treatment, there was no one to help.  He ultimately sought treatment at a program with a much younger, less relatable crowd of mostly young women. It was his only option to find safety from the disorder that has run his life for 20+ years.

What do we do?

We have an opportunity to build awareness with more socially accepted consumerism and advocate for better interventions, awareness and most importantly, prevention to make sure that no one has to live with an eating disorder. Middle-aged men are one of the unknown faces of eating disorders and maybe there’s a way to help within our own healthcare system.

In my opinion, if we want to make the most impact, going after consumerism is not going to be where a community of professionals is going to get the most “bang for their buck.”  The system is too large and the players are likely short sighted with opposing intentions.

But where the real progress can be made is with awareness and prevention.  My suggestion is that we begin reaching out and educating the substance abuse rehabilitation community about the hidden dangers of anabolic steroids and the quest to be lean. This is a focus professionals in the field inherently understand and hold as a concern.  A strong partnership for a more well-rounded preventative system would create a dialogue between two very large communities.   Perhaps starting at the local agency or detoxification unit may be a great place to plant the seed and being a conversation.  We need to figure out how both communities can work together to help improve care for middle-aged men with eating disorders.

Are use of dietary supplements and performance enhancing drugs also disordered eating behaviors?

by Jerel P. Calzo, PhD, MPH

You might have looked at the title of this blog post and asked yourself why there would be a post about dietary supplements (e.g., protein powders, creatine) and performance enhancing drugs (e.g., anabolic steroids) on a website about eating disorders. Shouldn’t this be on a website about sports or substance use instead?

The first reason for this post is that the topic is timely. Dietary supplements and discussions about performance enhancing drugs have received considerable media attention over the past two months. Media coverage ramped up during the Olympics, as public concerns increased regarding corporate sponsorships and athlete endorsements of dietary supplements during the games. With high school and college football season starting up this fall, parents, coaches, and health professional raised concerns about athletes turning to dietary supplements to build muscle and increase athletic performance. Supplements, doping, and athletic performance are back in the news again with coverage of the cyber attacks on the medical records of Olympic athletes. Stories like these, while often noting the potential dangers of performance enhancing supplements and drugs, still reinforce the harmful message that exceptional feats of athleticism can’t be achieved without the aid of supplements and drugs.

The second reason for this post is that as clinicians, researchers, and supporters of males affected by eating disorders, we need to recognize that performance concerns may be a neglected area of eating disorders work. Thus far, much of the research on eating disorders has tended to focus on the appearance components of body image. For boys and men, body dissatisfaction may not be limited just to how their bodies look, but may also include what their bodies can and cannot do. Turning to dietary supplements with the goal of lifting more and running faster may seem like a quick solution to resolve these performance concerns. The fact that dietary supplements are easily purchased at many grocery and health food stores may lead consumers to think that these products are safe.

Unfortunately, dietary supplements are under-regulated, and run the risk of containing contaminants, dangerous amounts of pharmaceutical ingredients, banned substances, or analogues of banned substances1. In fact, due to the Dietary Supplement Health and Education Act of 1994, which prohibits safety and efficacy prescreening of dietary supplements, the Food and Drug Administration can’t remove unsafe supplements from the market until a healthcare professional files a report with the government that someone has been harmed by a supplement. As a result, serious adverse events occur, including death.

Although there is general agreement on the dangers of performance enhancing drugs, such as steroids, dietary supplements are far from innocuous. As research and clinical work on male eating disorders grows, more attention is warranted on the appearance and performance concerns underlying supplement use, which may also be detrimental to mental health and wellbeing.

References:

1. Cohen PA, Maller G, DeSouza R, Neal-Kababick J. Presence of banned drugs in dietary supplements following FDA recalls. JAMA. 2014;312(16):1691–3.

What Inspires me Towards Working with Males with Eating Disorders?

By Stuart B. Murray, DClinPsych, Ph.D.

Why do I focus my work on eating disorders in males? Shouldn’t I focus my work on something more worthwhile? Something more prevalent? Something less obscure? If you’re planning to study eating disorders in males, won’t it take you 10 years to finish any meaningful study because of how few of these guys there actually are? Why haven’t I decided to step into ‘mainstream’ eating disorder research, because surely no funding body will throw their money away and fund eating disorder research in males, which by default will only apply to so very few people?

Sadly, these are questions I’ve fielded all too many times from colleagues working within the field of eating disorders, at conferences, meetings, and even in casual hallway conversations. Our field is pervasively biased against eating disorders in males. This is reflected in our diagnostic system, which is set up to measure concerns more predominantly reported in female eating disorders. This is reflected in the measurement tools we use to track eating disorder symptom severity, which are often geared towards questions which don’t apply to males, like satisfaction with one’s hips or bust. This is reflected at a clinical institutional level, where many eating disorder residential treatment facilities don’t accept male patients, or when family doctors tell male eating disorder patient to toughen up, forcing them to live unassisted with a horrendous disease burden. This is reflected at an academic institutional level during casual conversations with mentors when junior colleagues are dissuaded away from a career in research relating to male eating disorders. As a result of this longstanding bias, far too many boys and men with an eating disorder are falling through the cracks into an abyss of stigma and marginalization. It is time for our field to change the goalposts.

When I made the decision to study to become a clinical psychologist, knowing it would be an arduous road of many years’ of study and sacrifice, I did so with the primary motivation of wanting to help people. Before I entered into the world of clinical psychology, I had envisioned it to be a panacea of warmth, nourishment and encyclopedic expertise, where all comers are welcomed with compassion and assisted in equal measure. However, as I ventured further into the world of clinical psychology, I realized that this was an illusion. It soon occurred to me that there were distinct subgroups of patients who were deeply marginalized, within an already marginalized population of those suffering from a mental illness.

Few illnesses carry the same stigma as eating disorders, where sufferers are often conceived of as narcissistic, controlling, or even attention seeking. These stigma are profoundly damaging, and can delay treatment seeking and cause far greater suffering. It was with deep sadness that I realized that mental health professionals, my own kind, the world I had conceived of as a panacea, contributed to and propagated this stigma. It was then and there that I decided to devote my therapeutic and research efforts to the male experience of disordered eating. I hoped, and still hope, to help as many males as possible who are struggling with an eating disorder. This takes me back to the origin of my decision to become a clinical psychologist; to help people.

In my journey in working with male eating disorders, I very quickly learned that these disorders do not discriminate along gender lines. Moreover, I learned of the incredible strength many male eating disorder patients carry within them, in navigating a brutally difficult illness, and the disabling stigma attached to it, while stepping forward to seek treatment. Further still, many recovered patients I worked with have gone even further, and have volunteered their own time to help overturn the stigma attached to eating disorders in males, or share their story in helping to connect other males to treatment.

If we can’t stand as a field, together, and advocate for the inclusion of males in eating disorder services, how can we defend the values that drove us all towards the profession of caring for people marginalized by mental illness? Surely we can all see the incredible strength of man who has taken the step to come forward and seek treatment for a life threatening eating disorder, despite society, and even health professionals, telling him that he has a female disease? Then why can we not match our patients’ strength in making our own voice heard in the Ivory Towers, or in treatment centers?

The National Association for Males with Eating Disorders serves as an important platform to share our collective voice in supporting males with eating disorders. One must recognize the paradox of needing to establish a male association for a disorder which profoundly impacts all gender orientations, and it is our hope that all eating disorder organizations and institutions will one day be as inclusive of male patients as they are to female patients. Until that day, we will continue to work towards greater recognition of male eating disorders, and improved treatment options, and reduced stigma.

If Only You Had Known

By Daniel O’Kelly

Dear 15-year old Daniel,

There you were, passed out and gasping for breath, 100 meters from the finish line. You felt fine at the beginning of the cross country race – calm, cool, collected. Victory was in sight. Too bad you had restricted and over-exercised the day before.

You had failed even before you began.

And for what?

According to your logic, the lighter you were, the faster you were. It worked for Kenyans, right? Kenyans have less mass for their height, longer legs, and shorter torsos.1 Those aren’t your genes.

Was it to be the best on the team? Was it to impress your French class crush?

At 15, you had the same testosterone levels as a 5-yr old boy. Your body was literally eating the muscles surrounding your organs because you weren’t feeding it enough. Some people suggested you see a doctor as you exhibited “anorexic-like behavior.” Me? Anorexic?  I’m a male. Anorexia is a women’s issue, right?

Wrong. Anorexia is as much a male issue as it is a female one. Toned, male bodies are as detrimental to the male psyche as slim female bodies are to the female psyche. However, there is a social stigma associated with men acknowledging their vulnerability and seeking help. It could be your brother, your father, the guy in the next cubicle over, or a passerby who needs help but doesn’t seek it because eating disorders are perceived as a “women’s issue.” That thought process can be fatal. Anorexia is the most life-threatening physiological disease out there – twice the death risk of schizophrenia and three times the death risk of bipolar disorder in some cases.2

So, how did you recover?

Truth be told, you are still in the process of recovery. In my experience, anorexia is like a scar – it fades, but never disappears. I have learned to ignore troubling thoughts about food restriction, just like any other uncomfortable thought. Perhaps it came with maturity. Perhaps I began recovering after spending a year in Paris, where people actively socialize over a meal and don’t obsess over gym culture and the nutrition facts. You were a victim of our culture’s unhealthy and distorted perception of what it means to be attractive and “sexy” as a male.

Had you known all this at 15, would you have changed your ways? Would you have eaten appropriately and rested the day before the race? It’s hard to say. Anorexia is a complex, biologically and socially-influenced psychological disorder. However, you can take steps to recover. First, understand what’s triggering. Next, implement a plan to take care of yourself, body and mind, if you ever feel like relapsing. And finally, above all else, seek help – don’t face this beast alone. When family and friends reach out their hand, take it.

References

1. Fisher, M. (2012, April 17). Why Kenyans make such great runners: A story of genes and culture. Retrieved from http://www.theatlantic.com/international/archive/2012/04/why-kenyans-make-such-great-runners-a-story-of-genes-and-cultures/256015/

2. Arcelus, J., Mitchell, A. J., Wales, J., and Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. Archives of general psychiatry68(7), 724-731.