Male anorexia common but hidden | Metro

It?s a tight squeeze even now for the tattoo that?s emerging in outline down the length of Jay Walker?s thin but well-muscled arm, video-game-themed artwork on parchment-thin skin.

?People call me lean now,? admits Walker, who at six-foot-one weighs in at 165 pounds.

Three years ago, the fitness and health instructor was 35 pounds lighter, and suffering the hidden malady of male anorexia.

?I had a full-blown eating disorder,? says Walker, now 25.

Long linked to body image anxieties, to the airbrushed photos of impossibly shaped models that bedeck magazine stands the continent over, most have thought of anorexia as almost exclusively a condition of women and girls.

?The situation is different from what most people think,? says Dr. Blake Woodside, medical director of the Toronto General Hospital?s eating disorders program.

?In the community there is about one male case for every three female cases of anorexia,? Woodside says.

He says three recent studies, one in Ontario and two in the U.S., have each shown this surprising community prevalence.

But it?s not a ratio that is even remotely seen in Woodside?s clinic, where only about one in 20 patients are men or boys.

And it?s not seen there, experts say, because the condition is often invisible ? to friends, to family, to physicians, and to the afflicted men themselves.

Anorexia, also called anorexia nervosa, is characterized by dramatic weight loss, preoccupation with weight and food, and often organ damage.

People see the emaciation, the fatigue, the social withdrawal, Woodside says. ?But neither the men themselves nor the people around them think they are at risk.?

Indeed, even physicians are liable to miss a male anorexia diagnosis due to the perception that it?s a female disorder, says Merryl Bear, director of the National Eating Disorder Information Centre.

?Many health-care providers misidentify or don?t even identify eating disorders in females,? Bear says.

?And they are much less likely to even have the thought that the male in front of them might be experiencing one.?

Walker?s condition, which began in his teens, went unrecognized by his physicians.

?I?d go in and get a regular checkup,? he says. ?I?d have very low weight, very low heart rate and they?d ask me if I was abusing some sort of drug.?

With a one-in-1,000 rate of male anorexia nervosa in the country, thousands of Canadian men and boys are suffering and even dying undiagnosed, Woodside says.

For women, the rate is four in every thousand.

But the social, psychological and genetic reasons that men and women slip into the disorder are surprisingly similar, says Woodside, who is also a professor of psychiatry at the University of Toronto.

Certainly, he says, the desired body images differ: men often prefer muscular, V-shaped torsos, while women want a taut and slender shape. But both these ideals demand ridiculously low body mass indexes, Woodside says.

?An emphasis on muscularity (usually) includes an emphasis on leanness.?

Men might begin dieting for different reasons than women, such as to fit into a team sport environment, but the basic psychology of hyper-dieting is shared between the sexes, Woodside says.

?The underlying sequence, which is that something is troubling the person and they have to try and do something about it, is very much the same.?

Woodside says dieting becomes a means of taking control of something, anything, in a life fraught with anxiety.

And for boys and men, that grasp at control often includes a combination of excessive dieting and compulsive exercising, Bear says.

For Walker, swings between binging and extreme dieting and exercise were his chosen means of battling his anxieties.

His feelings of diminished control, always present in his life, were elevated when he came out as gay at age 14, and faced predictable reactions from friends and schoolmates.

?For me it was always a control thing,? says Walker, whose health and fitness schooling had made him a nutrition expert.

By age 19, he had a problem.

?It was extreme amounts of exercise, eating very little and it eventually got to the point where I was binging and purging on a daily basis.?

Woodside says there is no scientific evidence that anorexia in men is linked to their sexual orientation.

There is evidence, however, that dieting is increasingly common among men in general.

?And that will put increasing numbers of men at risk because that dieting is the environmental toxic . . . event that can activate people?s genetic liability to develop these conditions.?

Genetics is what causes people to slide down the scale from dieting and weight loss to anorexia, Woodside says.

?I?m going to link it to another condition that has a similar sequence that people will be more familiar with. Lots of people take a drink, some people develop alcoholism.

?And our best understanding about why some people develop alcoholism is because they are genetically predisposed, genetically loaded, to develop alcoholism.?

Likewise, anorexia and other eating disorders have their triggers in the DNA, Woodside says.

?Lots of people are exposed to casual and chronic dieting,? he says. ?And we think that it?s this pattern of chronic dieting that activates the genetic liability to develop these problems.?

A genetic basis for anorexia would also help explain the different rates of the disorder for men and women.

He says evidence suggests anorexia might be linked to the X chromosome, which helps determine if a child is born a boy or a girl. Girls have two X chromosomes while boys have an X and a Y.

As for the physiological effects of anorexia, both sexes suffer equally, Woodside says.

Mood disorders, osteoporosis, heart arrhythmias, kidney failure and mortality rates around 15 per cent are common to both sexes, Woodside says. The age ranges for the onset of the disorder are also the same, with 50 per cent getting sick before age 18.

?The only difference is that men tend to show up a little bit more sick and tend to do a little bit better in treatment than women do,? Woodside says.

The more successful recovery rates for men may go back to the differing social pressures placed on the sexes to be skinny, Woodside says.

?It might be that fewer men are heavily invested in chronic dieting behaviours than women,? he says, ?and the notion of weight loss being an attractive thing is less common in men,? he says.

?So even for a man who manages to activate his genetic liability . . . once we start to feed him and talk to him, he kind of snaps out of it more easily than women do.?

Walker, who entered an outpatient eating disorder program in his early 20s, says he?s been fully recovered for a year and a half.

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Source: http://metronews.ca/news/canada/659887/male-anorexia-common-but-hidden-in-canada/

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