Why are we talking about this now?
Last month, ex-England cricketer Freddie Flintoff discussed his experience of living with bulimia in a BBC documentary, describing how his struggle began when his weight was highlighted early on in his international career. Despite the recent headlines around the film, male eating disorders still need more time in the spotlight: stats show a quarter of those living with eating disorders in the UK are male, with less than 10% of those men seeking professional help.
According to Holli Rubin, psychotherapist and head of personal wellbeing at The Soke, Flintoff’s revelations have already helped increase awareness of bulimia, the most common eating disorder among men. “Cases of male eating disorders are likely to be under-reported too, as men believe it’s an illness that predominantly affects women, and are therefore reluctant to seek treatment for stereotypically female conditions.” In fact, there’s one disorder – bigorexia – which tends to affect men more than women. “This is where someone perceives themselves to be smaller than they actually are, leading to compulsive exercise, use of steroids and protein shakes,” explains Holli. “And it is often accompanied by depression and mania.”
What triggers an eating disorder?
“Historically, there has been less cultural pressure on men to be slim, but men, like women, are susceptible to the notion of an ideal body type, which is only reinforced by the media,” says Alexia Dempsey, specialist eating disorder dietitian at the Priory Hospital Roehampton. “On a daily basis we’re exposed to billboards of men using their naked upper bodies to sell everything from designer underwear to perfume. The message seems to be, if you look like this, you’ll be attractive, worthy and in control.” Alexia says other triggers include peer pressure and a desire to avoid bullying or teasing for being overweight in childhood. “Athletes are also at risk of developing eating disorders – runners, gymnasts and swimmers to name a few.”
Holli adds that men who are more focused on their physical appearance – athletes or not – tend to be more susceptible to societal influence and body image, which may ultimately develop into an eating disorder. Research shows eating disorders are most common in individuals between the ages of 16 and 40, and those with family members with eating disorders are more likely to develop one themselves.
What impact is the pandemic having?
Bulimia, and other eating disorders, can also be triggered by life events, a lack of control, or life trauma, says Alexia. “Covid uncertainty and its impact on physical health or work could absolutely be taking its toll too.”
What are the signs of an eating disorder like bulimia?
Alexia says the main signs of bulimia are eating a large amount of food in a short space of time and then quickly getting rid of it by purging, which can include making yourself sick, exercising excessively, or taking laxatives. “Bulimia sufferers can sometimes be diagnosed by dentists because of the exposure to teeth of stomach acid, caused by being sick. However, whereas women who have lost weight may find their appearance commented on, men may seem initially more athletic in build – sometimes as a result of excessive exercise – and the eating disorder can go unnoticed,” she adds. “Other signs to look out for include mood changes such as anxiety, and a person’s fear of gaining weight.”
What are the long-term effects of an eating disorder?
Early intervention is crucial for successful recovery. If left, an eating disorder can have a significant impact on quality of life, taking a toll on social and emotional wellbeing as well as physical health. “The secrecy of these illnesses can leave the sufferer feeling isolated and disconnected; it can strain relationships with friends and family,” advises Alexia. “Conditions like bulimia can also take their toll physically. It can cause heart problems, kidney damage, bowel problems from excessive laxative use, muscle aches, dehydration and digestive and throat problems.” Harley Street nutritionist Rhiannon Lambert adds that the risk of mortality for males with eating disorders is actually higher than it is for females, stressing the importance of early intervention.
If you think you have an eating disorder, at what point should you seek help?
“An eating disorder is a serious mental illness,” Holli says. “There has been confusion around whether one has a diagnosable eating disorder or merely a difficult relationship with food.” However, if you notice yourself becoming obsessed with food, this may be a sign you could do with support. “As a rule, when you become preoccupied with food, eating and exercise – so much so that you aren’t partaking in the regular aspects of your daily life – something may be wrong,” Holli stresses. “If you have a feeling that something is wrong, trust yourself. People often think a problem needs to be severe and they need to be in crisis before seeking help, but with eating disorders, the earlier you can respond and get help, the better. The more entrenched your thinking becomes, the harder it is to break those thought processes.”
How can you manage and cope with the early signs of an eating disorder?
Alexia says understanding and admitting the problem is the first crucial step to conquering an eating disorder. “Accept the behaviours you are engaging in can be dangerous. It’s important for you to understand these behaviours will need to change in order to allow you to recover. Be honest with yourself, as well as your family and friends, and accept their help, recognising that they only want the best from you.”
If you’re worried about a friend, what can you do?
The level of secrecy associated with these diseases means it can be tricky to pinpoint when something is wrong, but be aware that someone living with an eating disorder can show symptoms that don’t relate to weight. “The sensationalisation of eating disorders, especially in the case of anorexia, creates the idea you aren’t ill unless you’re visibly emaciated,” says Rhiannon. “However, those with eating disorders don’t necessarily have to look skinny, in exactly the same way you don’t have to be covered in bandages to be genuinely ill.”
When confronting a friend you are worried about, encourage them to speak, advises Holli, and ask open-ended questions to engage conversation. “Don’t be afraid to let them know you’re worried about them, and that you’ve noticed they aren’t themselves. Showing you care is helpful and encouraging, and may empower them to take the first step.”
Where can you seek help?
“Contact your GP if you are concerned about your health. The eating disorder charity Beat can also help, while the Priory offers a wide range of specialist services for inpatients and outpatients,” says Alexia. Gaining access to treatment isn’t always straightforward, however, and many find they are faced with a wait before getting NHS treatment. In these instances, it’s worth looking to Beat’s online support services, as well as its confidential adult helpline, which is open 365 days a year.”
What does treatment involve?
As Holli explains, eating disorders are complex mental health issues, and treatment will depend on how severe the problem is. “If the problem is manageable within the context of having therapeutic support – i.e. a psychotherapist or psychologist specialising in eating disorders – then that is one course of treatment. If it’s more complex, you may require a multidisciplinary approach or in-patient treatment. Regardless of treatment, the first step is to talk to someone you trust who can help you with the next steps. You are never alone.”
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