While six-pack abs and bulging biceps are two common goals for many men, what happens when a normal quest for fitness tuns into a potentially deadly obsession?
Body dissatisfaction, eating disorders and other mental health issues are often seen as taboo for men. But recently, celebrities and athletes like Mike Marjama, catcher for the Seattle Mariners, have opened up about their struggles and what they've done to seek help.
In a 2018 documentary published on the YouTube channel Uninterrupted, Marjama talks about battling his demons from an early age and slipping into the frightening world of eating disorders as a teenager. He now fights to break through the stigma that surrounds men and eating disorders.
Men and Eating Disorders
Of all the people with eating disorders, a third of them are men, according to the National Eating Disorder Association. That means 10 million American men will have an eating disorder at some time in their lives, including anorexia nervosa, bulimia nervosa, binge-eating disorder (an equal number of men and women have this one) and OSFED (other specified feeding or eating disorder).
So why the silence? Andrew Walen, founder and CEO of Body Image Therapy Center and the president of the National Association of Males with Eating Disorders, says people don't talk about the connection between men and eating disorders because we've idealized being fit and lean to an unhealthy extreme.
Because of this, he says, men are slipping into dangerous patterns of behavior, such as restricting food, purging food, compulsive exercise and abusing steroids and opiates to reduce pain and keep exercising.
"It's everyday behavior seen in the gym," says Walen. "But it's only when males are driven to the point of physical and mental health crisis that they tend to seek help due to shame, stigma and secrecy."
And because of this stigma, men are far less likely to be diagnosed and referred for treatment, says certified eating disorder specialist Margo Maine, Ph.D. She says that the assessment tools and questions professionals ask in diagnostic interviews are very gender-biased, as many of the core issues men with eating disorders deal with differ from the typical female experience.
Dr. Maine says men are often more concerned with their body shape than their weight, focusing on muscle definition and a hard, strong body that can lift a lot of weight. Because they grow up with a fear of powerlessness, smallness or anything feminine, their goal is to avoid that at all costs.
In his documentary, Marjama talks about this issue, explaining that his perfectionism and obsessive-compulsive drive toward athletics and the perfect physique is what pushed him over the edge. He quickly discovered that his innate desire to be perfect and push himself further than anybody could ever imagine was both his best friend and his worst enemy.
Unfortunately, for many men, this is seen as normal if you want to be fit and at the top of your game in your chosen sport. It wasn't until Marjama had lost 14 pounds in a matter of four days that a life-saving intervention took place. Sitting in his counselor's office, he went from being an active teenager to being carted out on a stretcher and taken to the ER in order to save his life.
Read more: If Jay-Z Used Therapy to Change His Life, So Can You
Signs and Symptoms of Eating Disorders
Knowing what to look for can be difficult because eating disorders present differently in men than in women, says Dr. Maine. For example, guys are likely to purge through exercise rather than by vomiting, and they eat enough to sustain but not enough to compensate for their overexercise.
If you're concerned about yourself or a friend or family member, both Walen and Dr. Maine say there are a few red flags you should look out for:
- Restriction and purging behaviors
- Mood swings
- Low energy
- Abusing pain medications
- Using appearance- and performance-enhancing drugs like steroids
- Low body weight
- Unusually low heart rate
- Becoming very upset when having to miss a workout
- Compulsive exercise despite pain and injuries
- Workouts taking priority over social events and intimate relationships
- Binge-eating episodes due to long periods of restriction
- Fainting and/or dizziness
- Anxiety and/or depression
The main problem with getting help is that men have been societally conditioned to be ashamed of their emotions and shortcomings. Often, families are also ashamed if a male member is diagnosed with an eating disorder, as they see it as a "women's issue." They may not support treatment or support treatment only to get him out of immediate medical danger, but not to treat the underlying issues.
Read more: How to Help Someone You Think Has an Eating Disorder
Where Do We Go From Here?
"Developing a healthy body image requires rethinking how we value ourselves as men," says Walen. He believes we as a society need to expand the definition of masculinity and encourage men to build a strong sense of self that comes from intelligence, kindness, creativity, empathy and ability to express themselves physically through athleticism, the arts and physical touch.
Walen also suggests increasing an overall understanding and awareness of eating disorders and their risks and treatment. Specifically, he sees the need to push for increased research, as almost none of the research on eating disorder treatment focuses on men.
And for Marjama, he hopes that by being visible and sharing his story it will allow others to seek out help if they need it. During National Eating Disorder Awareness Week 2018, Marjama talked with the National Eating Disorder Association (NEDA) about his struggles and what he's doing now to fight the stigma about men and eating disorders.
His goal, according to the NEDA website, is to fight the stigmas around eating disorders by telling his story loudly to anyone who will listen. He's using his platform, interviews with national newspapers and magazines and his documentary with Uninterrupted to encourage other people to know that it's OK to seek out these resources.
Do you or someone you know struggle with an eating disorder? You can always find help and resources on the NEDA website. Or you can call its hotline (1-800-931-2237), chat with someone online or text NEDA to 741741.
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.