Fat is NOT JUST a Feminist Issue Anymore
by Leigh Cohn, M.A.T.
Co-Author of
Making Weight: Men's Conflicts with Food, Weight, Shape and Appearance

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 (Gurze 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 and the numerous 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.

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During the height of the Roman Empire...

from The Daily Bulletin
Ontario, Canada
by Susan McCormak
Published Tuesday, August 22, 2000

During the height of the Roman Empire, wealthy men ate until their stomachs bulged, then visited a vomitorium to make room for another course. Heavy men represented power and money. Today, trim, muscular men grace underwear advertisements and TV shows, and society looks with disgust upon the figures of the Roman elite. This change in ideals has resulted in alarming numbers of men suffering from eating disorders, according to the authors of a new book being touted as the first to address men's concerns with body image.

In "Making Weight: Men's Conflicts with Food, Weight, Shape and Appearance" (Gurze Books, 2000), Dr. Arnold Andersen, Dr. Thomas Holbrook and publisher Leigh Cohn write that society is putting increasing pressure on men to look like Adonis. "Men everywhere are talking about getting back to their high-school weights, workout plans and approach-avoidance toward chocolate. They are worried about having flabby stomachs and losing more hair. The average male is as hung up about his looks as is the average female," the authors write.

According to the book, therapists are seeing 50 percent more men with eating disorders than they did 10 years ago, and about 40 percent of American men want to be thinner, while an additional 40 percent want to bulk up. Men are spending more money on plastic surgery than in the past, the authors continue. Between 1992 and 1997, the number of men undergoing liposuction, especially to reduce "love handles," tripled, and men also are having silicone implants inserted in their calves and chests to simulate large muscles. Just as women's magazines featuring underweight cover girls and stories on staying slim have set the standards for women's body shapes since the 1960s, images in popular media during the last 10 years are making men more sensitive about their physiques.

Adding to the problem, the authors write, is that science and society have viewed fat primarily as a women's issue, which has led to men being misdiagnosed and excluded from treatment for eating disorders. "In many ways, men are being discriminated against," said Cohn, who has published books on eating disorders from his San Diego County-based company Gurze Books since 1980. "People think something must be wrong with a man if he has an eating disorder. We wanted to set the record straight and help men get out of the closet."

Paul Mueller, spokesman for Rogers Memorial Hospital in Wisconsin, which started the nation's first residential eating disorder program for men two years ago, said the most common disorder in men harks back to Roman times - bulimia nervosa, overeating, then getting rid of food by vomiting, using laxatives or compulsive exercise. This disorder is 10 times more prevalent, in men and women, than anorexia, he said. "Men used to be easily identified as compulsive overeaters," Mueller said. "But there was always a persistence of anorexia and bulimia. It's just now being more widely recognized."

According to "Making Weight," one disorder seen almost exclusively in men is reverse anorexia nervosa or body dysmorphia, when a person feels he can never be muscular enough. Jim Macdonald, a personal trainer and owner of Iron Works Gym in Claremont, said he believes men have always been more body-conscious than women. "It's a macho thing," he said. "Men always want a six-pack. The first thing they want is for their abdominals to show. Then it would be their chest and shoulders, then arms. Their legs are at the bottom of the list." Macdonald suggested that men interested in losing weight or firming up first consult with a nutritionist and personal trainer to get off to a healthy start and not overdo their diet and exercise regimen.

Men also suffer from the opposite disorder, anorexia, which involves self-starvation. Holbrook, who also is the clinical director of Roger Memorial Hospital's male eating disorder program, writes about his experiences with anorexia in "Making Weight." For years, Holbrook survived on rice cakes for lunch and exercised up to eight hours daily. "Making Weight" offers a number of suggestions for men suffering from eating disorders. When exercise or eating begins to interfere with daily life, men should consider seeking therapy with someone who specializes in eating disorders.

Men should not get advice from popular diet books or commercial weight loss programs, the authors write, nor use diet pills or steroids. Staying healthy is a matter of determining why the disorder exists and then developing new habits.

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A number of resources are available for men suffering from eating disorders, including:

* American Anorexia/Bulimia Association, information on support groups, referral speakers, educational programs, professional training, (212) 575-6200, or www.aabainc.org

* Eating Disorders Awareness and Prevention, sponsors Eating Disorders Awareness Week each February, (206) 382-3587, or www.edap.org

* Eating Disorder Referral and Information Center, information specifically for men, symptoms, family support, therapist referral, www.edreferral.com

* Gurze Books, publishers of books and more on eating disorders, (760) 434-7533, or www.bulimia.com

* National Association of Anorexia Nervosa and Associated Disorders, distributes list of therapists, hospitals, support groups, conducts research and has crisis hotline, (847) 831-3438, or www.anad.org

* Rogers Memorial Hospital, nation's only residential eating disorder program for men, (800) 767-4411, or www.rogershospital.org

* Something Fishy, information on symptoms, dangers, treatment options and more at www.something-fishy.org

* Yahoo Club-Male Eating Disorders, chat room and bulletin board for men at http://clubs.yahoo.com/clubs/maleeatingdisorders

Source: "Making Weight: Men's Conflicts with Food, Weight, Shape and Appearance" (Gurze Books, 2000).

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Common eating disorders

* Anorexia nervosa - Mostly seen in people in their teens or 20s; characterized by self-starvation and compulsive exercising because of fear of becoming fat

* Compulsive overeating or binge eating - Found in about 25 percent of obese men, usually men in their 30s and 40s; characterized by impulsive eating beyond the point of feeling full, then feeling shameful afterwards but not purging

* Body dysmorphia or reverse anorexia nervosa - Primarily seen in men; when a person feels he can never have large enough muscles. More about this...

* Bulimia nervosa - Most common eating disorder that is often driven by psychological needs to numb pain or depression; characterized by eating large amounts of food in a short time, then getting rid of the food by vomiting, using laxatives or over-exercising

Alendronate for the Treatment of Osteoporosis in Men

The New England Journal of Medicine
-- August 31, 2000 --
Vol. 343, No. 9 [ORIGINAL ARTICLE]

By Eric Orwoll, Mark Ettinger, Stuart Weiss, Paul Miller, David Kendler, John Graham, Silvano Adami, Kurt Weber, Roman Lorenc, Peter Pietschmann, Kristel Vandormael, Antonio Lombardi

Abstract

Background. Despite its association with disability, death, and increased medical costs, osteoporosis in men has been relatively neglected as a subject of study. There have been no large, controlled trials of treatment in men.

Methods. In a two-year double-blind trial, we studied the effect of 10 mg of alendronate or placebo, given daily, on bone mineral density in 241 men (age, 31 to 87 years; mean, 63) with osteoporosis. Approximately one third had low serum free testosterone concentrations at base line; the rest had normal concentrations. Men with other secondary causes of osteoporosis were excluded. All the men received calcium and vitamin D supplements. The main outcome measures were the percent changes in lumbar-spine, hip, and total-body bone mineral density.

Results. The men who received alendronate had a mean (±SE) increase in bone mineral density of 7.1±0.3 percent at the lumbar spine, 2.5±0.4 percent at the femoral neck, and 2.0±0.2 percent for the total body (P<0.001 for all comparisons with base line). In contrast, men who received placebo had an increase in lumbar-spine bone mineral density of 1.8±0.5 percent (P<0.001 for the comparison with base line) and no significant changes in femoral-neck or total-body bone mineral density. The increase in bone mineral density in the alendronate group was greater than that in the placebo group at all measurement sites (P<0.001). The incidence of vertebral fractures was lower in the alendronate group than in the placebo group (0.8 percent vs. 7.1 percent, P=0.02). Men in the placebo group had a 2.4-mm decrease in height, as compared with a decrease of 0.6 mm in the alendronate group (P=0.02). Alendronate was generally well tolerated.

Conclusions. In men with osteoporosis, alendronate significantly increases spine, hip, and total-body bone mineral density and helps prevent vertebral fractures and decreases in height. (N Engl J Med 2000;343:604-10.)

Source Information From Oregon Health Sciences University, Portland (E.O.); the Clinical Research Center of South Florida, Stuart (M.E.); San Diego Endocrine and Medical Clinic, San Diego, Calif.

For further information about men and eating disorders read Making Weight: Men's Conflicts with Food, Weight, Shape and Appearance

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