Making Weight

Healing Men's Conflict with Good, Weight, Shape & Appearance

by Arnold Andersen, M.D., Leigh Cohn, MAT, CEDS,& Thomas Holbrook, M.D.

Fat Is NOT JUST a Feminist Issue, Anymore!

In recent years, there has been an explosion in the numbers of men with eating disorders, body image conflicts, compulsive exercise, and obesity. Long thought to be "women's issues," these are now actually hidden problems for millions of men. Therapists are seeing 50% more men for evaluation and treatment for eating disorders than ten years ago, and experts believe this number may be the tip of the iceberg.

"Men feel stigmatized about having these ‘women's diseases’ and have been reluctant to seek help," explains Arnold Andersen, M.D., co-author of Making Weight (Gürze Books, ©2000), the first book on the subject of men's problems with food, weight, shape, and appearance. Men have been ignored because clinicians have not thought of them as having these kinds of problems, and men have been too embarrassed to seek treatment. It's a double-edged sword, but the situation is beginning to change. "Ultimately, we will recognize that men have just as many challenges as women, they are just different," Andersen believes. "But, all men will be better off once they get over the shame associated with keeping their problems secret."

Ten years ago, men accounted for only 10% of eating disorder cases, but recent studies show that 16% of patients are men, and that figure appears to be rising. Traditionally, men have been virtually ignored in eating disorders research, and even the American Psychiatric Association's diagnostic criteria for anorexia nervosa includes "the absence of three consecutive menstrual periods"—a condition impossible for males. " It's ridiculous. How are men supposed to feel when they're asked if they've missed a period?" said Andersen, who is the director of the eating disorders program and a professor of psychiatry at the University of Iowa. "No wonder so few have been willing to seek professional help."

Today's "everyman" feels social pressures to be lean and muscular. Male skin is definitely in, as evidence on billboards, magazine covers, and shows like NYPD Blue andthenumerous Baywatch clones. Even mainstream magazines like TIME and Men's Journal have recently featured bare-chested hunks on their covers. Men want "six-pack" abdominals, yet most are overweight, eat poorly, and do not get enough exercise. Similar to women, 80% of whom want to lose weight, an equal number of men feel bad about how they look, too. Although, interestingly, as many men want to gain weight—particularly pounds of muscle—as lose it. The 95% of dieters who fail to achieve long-term weight loss and the vast majority of men, who are unable to match the bulk of male models, experience poor body image, may develop feelings of sexual inadequacy, have low self esteem, and may acquire eating disorders. Some men turn to cosmetic surgery for a solution. In 1997, men spent $130 million dollars on liposuction, anti-wrinkle injections, pectoral implants, and penile enhancements.

Also, there are some disorders that primarily occur in males, such as "body dysmorphia" a condition which is often referred to as "reverse anorexia" and occurs when an individual thinks he cannot get big or muscular enough. Like an emaciated anorexic who looks in the mirror and sees fat, many overly brawny bodybuilders see parts of their body as being too scrawny. Binge eating disorder is another illness which is as common for men as women, and men who compulsively exercise share many of the same traits as anorexics.

Thomas Holbrook, M.D., a coauthor of Making Weight, suffered from compulsive exercise and an eating disorder. "I was running 15 miles a day and eating little more than rice cakes," explains Holbrook, who is recovered and the Clinical Director of Rogers Memorial Hospital in Wisconsin, the only residential treatment facility in the US that specializes in men. "When I was anorexic," he remembers, "No one ever diagnosed it. I even went to the Mayo Clinic, and not one specialist questioned if I had an eating disorder. Of course, I was in complete denial anyway, after all, I was a psychiatrist who treated eating disorders."

Clinicians are starting to learn more about gender-specific treatment and how eating disorders and body image issues effect the sexes differently.  Segregated programs for men can address male sexual and biological concerns, and their needs can be more adequately served—for example, through exercise and strength training classes and nutritional education. Male support groups allow men to express their emotions more openly and with a common language.

Public awareness about men's dissatisfaction with their bodies is on the rise. Inside Edition recently ran a piece on actor Billy Bob Thornton, who talked about his brush with anorexia nervosa, and HBO aired a segment about a male student athlete, who died from that disease. Men and plastic surgery, which is also discussed in Making Weight, has been covered on the evening news, and a trend seems to be occurring much like when women started talking about bulimia 20 years ago.

"Bulimia" became a household word within two years of the first publication on that subject in 1980, which was co-written by Leigh Cohn, the third author of Making Weight. "I see the same thing happening again with men's eating disorders," said Cohn. Prior to the early-80's, practically every woman who binged and vomited thought they were alone in their behavior. They were afraid to tell anyone about their secret, and most therapists were unfamiliar with this newly-described eating disorder. As Cohn points out, "All of a sudden there were books coming out, magazine articles, women on talk shows, and made for TV movies. For a short time, it became almost fashionable for women to say they had bulimia." Now, there are about 500 books which discuss bulimia, but for the past ten years there has only been one clinical text, written by Andersen, about men and eating disorders.

Andersen believes that as many as 25% of individuals with eating disorders are men. "We're going to see more men coming out, and soon everyone will be talking about how guys have problems, too." Once it becomes commonly accepted that these concerns cross gender lines, men will have greater access to support and treatment.