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Published July 15, 2012, 11:30 PM

Men not immune to eating disorders: Quest for physical perfection often fed by macho drive rather than appearance

CHICAGO – Rob hated to run. But he hated to stop even more. That’s when his disparaging inner voice, the one that had belittled him since seventh grade, would emerge. If he didn’t keep going, it said, he was going to get fat. He would never have the shredded abs that taunted him from every fitness magazine.

By: John Keilman, Chicago Tribune , INFORUM

CHICAGO – Rob hated to run. But he hated to stop even more.

That’s when his disparaging inner voice, the one that had belittled him since seventh grade, would emerge. If he didn’t keep going, it said, he was going to get fat. He would never have the shredded abs that taunted him from every fitness magazine. He would be just a regular guy – not the superman he felt driven to become.

So on he ran. And when even six hours a day of exercise weren’t enough to quiet the voice, he started skipping meals too.

While anorexia, bulimia and other eating disorders are potentially lethal – up to 5 percent of those suffering from them die from suicide, substance abuse or medical issues, according to a study published in the American Journal of Psychiatry – they have traditionally been viewed as women’s problems. Researchers say only 10 percent of those who are treated for the conditions are male.

But a growing body of evidence suggests that number is misleading. A study published last year estimated that males actually make up 40 percent of teens who have eating disorders. An earlier Harvard survey found that men account for 25 percent of adults with anorexia and bulimia.

Some therapists say more men and boys are seeking help. Niquie Dworkin, who practices on the North Side, said males have been tormented by the same kind of unattainable body images that have long plagued women and girls.

“Action figures used to look normal,” she said. “Now they’re superhuman with really cut abs and really big shoulders. Even little boys are being exposed to images of men that are not realistic.”

DIFFERENT FOCUS

While eating disorders in men and women appear to have similar roots in genetics, media messages, perfectionism and low self-esteem, the symptoms are often different. Experts say one big contrast is that men usually focus on muscularity, not thinness, and they tend to manage their weight by working out to incredible extremes.

That’s what happened with Rob, 24, a young man from Elgin, Ill., who asked that his last name not be used. Experts said his case was typical of men with eating disorders.

His trouble began at age 14, not long after bullying schoolmates mocked him for supposedly being fat. Vowing to gain the same kind of lean, athletic physique one of his tormentors had, he started doing 100 pushups a night. He then moved to the weight room, and when he entered high school, the cross-country team.

His parents were delighted. The other runners were laid-back, friendly and supportive, and Rob’s grades improved after he joined the team. He cut junk food from his diet and worked out with a vengeance. Not even a downpour could keep him from his training.

“All the way around, it seemed like a really good thing,” Rob’s mother recalled. “We didn’t think anything of it.”

Almost imperceptibly, though, his routines grew longer. A coach at a summer running camp preached maximum effort – When you’re not running, another guy is, and he’s going to beat you – and Rob took it to heart. By the time he was a senior, he made excuses to leave practice early so he could work out even harder alone.

“I wanted to make a name for myself, be something,” he said recently. “Working harder than anyone else in the group made me better. That’s what I thought.”

Strange thing, though: Rob didn’t care that much about winning races or setting records. He didn’t really even like running. Thinking about the hours of exercise that awaited him after school filled him with dread.

But it was far worse to skip a workout or ease up on its intensity, even when he was sprinting at a 4-minute-mile pace on a treadmill set to a 12 percent incline. If he backed down, his inner voice told him, something indefinably bad would happen.

So he absorbed the pain, and after noticing an odd relief in hunger, he began skipping meals too. Mastering his body allowed him to feel as though he could manage a life that had become lonely and socially awkward.

LOSING CONTROL

Daniel Le Grange, director of the eating disorders program at the University of Chicago Medical Center, said it’s common for people who suffer from the disorders to express a desire for control and self-affirmation. But any contentment that emerges from starvation and hellish exercise doesn’t last long, he said.

“We have patients who are bleeding because they’re on the carpet doing a thousand pushups and situps a day,” he said. “It never gives you that feeling that you’re yearning for, that you feel good about yourself.”

Rob’s intense exercise led to stress fractures, and he decided not to join the cross-country team when he went to college in fall 2006. But he didn’t let up on his body.

Instead he rose at 6 a.m. for a quick breakfast before heading to the gym for a four-hour workout, including 90 minutes on an elliptical machine and an hour of weights. In the afternoon, after skipping lunch, he walked for two hours before doing repeats on the library steps. He picked at his dinner before rewarding himself for his suffering with a giant piece of pie.

When Rob healed enough to run, his routines grew ever more punishing, his body ever lighter – sometimes dipping below 100 pounds on his 5-foot-7 frame. A photograph taken of him at a swimming pool in July 2009 shows deep hollows beneath his cheekbones. Striated ropes of muscle press through his skin. His arms and legs appear as thin and brittle as sticks.

Rob’s family, long in denial, knew he was in trouble. He knew it too. But even though he had begun to see a therapist, it was easier to follow his compulsions than resist.

“We would have these breakthrough moments where he would say, ‘I know I have a problem, but I’m not ready to give it up yet,’” his sister said. “I always knew when he stopped calling that he was getting worse. Because then he wasn’t ready to hear it.”

In November 2011, Rob sustained another leg fracture, the result of what doctors said was a lack of calcium in his bones. Though he was ordered to rest for a month, he became so frenzied from inactivity that he grabbed his crutches and did hobbled laps around his parents’ kitchen table.

It turned out to be his moment of clarity. He called the eating disorders recovery center at Alexian Brothers Behavioral Health Hospital in Hoffman Estates, Ill., and had himself admitted.

Therapy and reflection eventually convinced Rob that he needed to change. He yielded to the program and spent a few weeks putting on weight before transferring to Rogers Memorial Hospital near Milwaukee, home to a rare males-only eating disorders program.

His task there was to excavate the psychological turmoil that lay beneath his behavior – the desire for control, the need to feel special, even the fear of becoming an adult – and reset his mind and body to healthy habits.

In his three months at Rogers, Rob said, he learned to take a more realistic view of himself and gain more control over his eating and exercise habits. He put on about 45 pounds in treatment and now follows a diet worked up by a nutritionist, dining at appointed times even if he isn’t hungry (his long periods of starvation scrambled the neural circuitry that governs hunger – a common side effect of an eating disorder).

He works out cautiously, lifting weights with his father lest he get carried away. On a recent Sunday morning he went for a slow walk around the block, the only form of cardiovascular exercise he allows himself.

“Sometimes there’s the urge to hurry up,” he said, strolling past well-watered lawns and vibrant flower beds. “It’s a little battle. I usually win.”

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