A BELATED AFFIRMATION

There are days when I wake up in my hospital bed and I still wonder if I belong here. For the past five weeks I’ve been in treatment for an eating disorder, an affliction I’ve struggled to acknowledge within myself and I’ve struggled even more to get others to understand.

Each and every time I’ve dared to disclose to someone, the response is quick, a snap judgment. “You don’t have an eating disorder.” 

I don’t feel like having to prove my point.

It’s true that I don’t look the part. I’m male, I’m in my fifties and I’m not rail thin. I even sport some pesky love handles. 

Twenty-four years ago, I dared raise the possibility of an eating disorder with my family doctor, a compassionate gay man whom I assumed would have many patients with low self-image issues, disordered eating and excessive exercise regimens. I had a great deal of angst in the build up to telling him what I thought I might have. He dismissed it as if to reassure me. It only made me feel more alienated. If I didn’t have an eating disorder, then how could I get help? I was starving myself for huge chunks of the day, obsessing over fat content in foods and exercising through injuries, feeling trapped by my workout routines. If I missed a day, the belly would never be tamed.

There were ebbs and flows to my disorder. In relationships, I’d sometimes let up. I’d eat ice cream and pizza with my boyfriend, feeling like a sinner but happy to have a partner in crime. Whenever I wasn’t with my boyfriend, the food restricting would kick back into high gear. Aside from my non-skinny appearance, a big reason so many people haven’t thought I had an eating disorder is because the key behaviors happen when alone. It’s a clandestine disease. When my eating disorder ruled me, I didn’t want to be caught. I didn’t want anyone telling me to change. My eating disorder brought a twisted sense of comfort. It represented control and self-discipline when I felt powerless in many areas of my life. 

You don’t have an eating disorder.

I heard it so many times, I felt I couldn’t get help. I was embarrassed to bring it up. I didn’t want to be invalidated again.

Even when I was hospitalized for depression five years ago, refused food and obsessively exercised in my hospital gown on an elliptical, professional staff failed to recognize my ED behaviors. It took a second psychiatric hospitalization for a psychiatrist and dieticians to piece things together after the nurses complained about my resistant behaviors to eating meals and to eating with the other patients. I finally got a referral to an eating disorder program. 

There are no elliptical machines during my current hospital stay.

I’ve since been assessed by doctors several times. Each time, I hear a common refrain in my head: You don’t have an eating disorder. Each time, I am both disheartened and relieved to hear the doctors confirm the diagnosis. Yes, I have an eating disorder.

As I sit in groups with other patients with eating disorders, I nod with them. They say the same things I think. They nod when I speak. By golly, I belong. 

When I awaken at 5 a.m., I can’t help but wonder if much of my life would be different if I’d gotten help twenty-four years ago. With earlier intervention, maybe I would have overcome the insecurities about my body and chipped away at all the self-hate. 

In my hospital room, I tell myself it’s not too late. I want to believe this old dog can learn a new way of living and can be more forgiving of all the imperfections I obsess over. This cycle of treatment ends, however, in nine days and I know I’m nowhere near real change. Many of my co-patients have had multiple hospital admissions. Is it the program that’s unsuccessful or is the eating disorder just too strong? Maybe it’s both.

I’m lucky to have more counseling and another treatment program on the horizon. Another team of professionals is recommending I stay three months in a group home for people with eating disorders. 

Me? I may not look the part but suddenly the professionals won’t let me slip through the cracks. My behaviors still feel entrenched but I have some hope for change. I want this hospital stay to be the start of a different way of living.

  

THE FIGURE THAT EATS AWAY AT ME

It's Eating Disorders Awareness Week and I gave this speech last night at an Open Mic Night event last night in Vancouver. If you know someone you think may have an eating disorder, read up on the facts, have a heart-to-heart conversation and let them know you care.

1 in 10.

That’s the number equation I grew up with.

I out of 10 people was purported to be gay or lesbian. (We didn’t have the term LGBTQ or any of its incarnations back then.)

I’d sit in my high school government class and look around. So who are the other two?

Sadly, I couldn’t even count on another one, much less two.

I was alone. 1 in 10 be damned.

And this is how I grew up. Alone. Lonely. A lost lamb in search of his flock.

That was back in East Texas. I had to move to Malibu to finally feel some camaraderie. Two hundred fifty in my year at law school. Twenty-four others then? No. Two. But two more than what I was used to.

Now I deal with another fraction: 1 in 4.

Not my math. It comes from Miami, Florida, from an organization with the acronym, NAMED: National Association for Males with Eating Disorders.

1 in 4 persons with an ED is male.

I cited my source because I figured people would doubt the prevalence. Back when I first struggled with obsessive dieting and it evolved into an eating disorder, back in the time when Karen Carpenter was the only person I’d heard of having an eating disorder, the figure I read—somewhere--was 5%. 1 in 20 people with an eating disorder was male.

Even that seemed like a stretch. Back then, I didn’t know of any places where I’d find a room full of persons with eating disorders so I couldn’t check if 1 in 20 had any basis in reality. It seemed high. After all, as I began to read articles about eating disorders—the topic has long been of personal interest for obvious reasons—every “client”, “patient” or person with an eating disorder was given a pseudonym like Amy or Mary. Never Bob.

Really, how could it be 1 in 20?

But let me repeat the current figure: 1 in 4.

In fact, on the home page of the NAMED website, a study is cited and a range is given—25-40% of people with Eating Disorders are male.

Still, now that I am involved in eating disorder groups with Vancouver Coastal Health and with St. Paul’s Hospital, I look around and the figures don’t mesh with what I see.

I take tonight’s theme, I Wish You Knew, and rework it to what suits me and my journey: “I Wish I’d Known”. If it’s really 40%, or even 1 in 4, I wish I’d known someone else, another male struggling with an eating disorder.

The first case study involving eating disorders was in 1690 when Robert Morton considered one man and one woman with symptomatic behavior. 50/50. A nice start.

But over time, eating disorders became known as something women struggled with. It became gender stigmatized. Even as recently as a year ago, when I went through a Coastal Health orientation regarding the eating disorder program, I fought back tears—and some anger—when a PowerPoint slide showed the physical harm to the body that can occur due to an eating disorder. I couldn’t even take my usual stance of denying the facts. The body on the screen was that of a woman. Much of the harm mentioned was female-specific. My first exposure to eating disorders in a room of newbies—myself the only male—was a sense once again of being alone. Something was wrong with me for having an eating disorder. But something even greater was wrong with me for being the only guy. Last month, I completed a questionnaire for a University of British Columbia study about eating disorders. There were questions about how much I worried about my thighs. Nothing about any obsession with muscle mass. When the questionnaires and presentations slant toward one gender, it’s no wonder male cases are under reported.

I speak tonight to provide a male voice. I’m on a bit of a mission, you see. It’s often said that men are taught that they are supposed to handle things themselves. Be tough. Deal with it. It’s why many men resist going to the doctor for a physical ailment. The resistance—and denial—is even greater for mental health issues. Admitting that one needs help and actually seeking it out is even more challenging for a man when it involves a struggle associated with women or, when there’s also the perception that, if it’s a man, it’s a gay man (yes, like myself). (I can only debunk so much as I speak.)

I don’t think I’m saying anything earth-shattering. And I know there are many more poignant, more emotional speeches, recitations and performances tonight. But I ask you, if anyone should wonder how tonight went, that you include mention that there was a guy with an eating disorder who got up and spoke. It’s not about anything I said. It’s just getting the word out there. A guy with an eating disorder. Other guys need to know it’s not some freak occurrence. Because, if it really is 1 in 4—or, just imagine,...40%--then it should be clear to everyone here that there are a lot of guys out there who aren’t getting the help they need. And just knowing that is what got this extreme introvert of a guy itching to speak tonight. 1 in 4.

Where are they?

BODY TALK

If you’ve got a gut, enjoy it. Appreciate all the food that got you there. You may cringe when you look in the mirror or maybe you don’t. Maybe you are perfectly comfortable with the "imperfection." Bravo! If you long for a better body, one like those buff “avi is me” pics on Twitter, know that the price can be too high for a slimmer you.

I have never before posted a shirtless photo of myself. Not my thing. Wouldn’t even send it privately to a boyfriend. My body and I have a longstanding hate-hate relationship. Still, I included this photo of me from this week because, while I can savagely pick it apart, this is as good as it gets. Maybe if I document it, I can stop the madness. Been there, done that, movin’ on. Objectively, I know it’s not bad for forty-nine. I am acutely familiar with the natural belly inflation that occurs at this stage. I’ve fought it off, but it’s nothing to be proud about.

I’ve written about eating disorders before. (If you're so inclined, you might want to read this or this.) I have struggled with food and weight issues for most of my life—at least since I was eleven or twelve. Male or female, there is pressure to look perfect. I knew that in the ‘70s as a kid who sipped Tab while friends guzzled root beer to show off their belching prowess. They had their priorities right.

Women talk about the constant media exaltation of The Body Perfect. While they can’t fully ignore the pressure, they can sit together over skim lattés and talk about it. Men, not so much. Most guys would just laugh it off. What’s your problem, man? Have another beer. This leaves guys who are, for whatever reason, more susceptible to this body pressure to internalize their feelings of inadequacy.

I’d be envious of these other guys—if I had any fondness for beer. (I say I don’t like the taste. Subconsciously, I probably formed a strong resistance to the beverage because it spawned the term beer belly.) Pizza, ice cream, cheesecake, these are indulgence possibilities. I talk about them a lot. But it’s rare to catch me ingesting anything beyond nonfat cottage cheese, Melba toast and plain fruits and vegetables. I have maintained a strict diet for decades, typically with the same dull staples.

The only blip was a couple of years when my ex and I were together. I indulged and the relationship went sour. The sex stopped. He became terse, then abusive. Logically, I can say that the ten extra pounds around my waist—and that’s as extreme as it ever got—had nothing to do with the demise of a doomed relationship. But my nagging interior/inferior voice says, “Porking out couldn’t have helped.”

Oh, what a piece of work I am.

Things become most dire whenever I hit a time in life where things are out of control. I drastically reduce, I deprive and the weight drops. Fortunately, the last severe bout was about twenty years ago when I first moved to Vancouver, was underemployed and questioned whether the spontaneous move had been an act of pure stupidity. Friends intervened and insisted I see a doctor. He turned out to be clueless about eating disorders in men--no diagnosis, no resources or support--but somehow my friends shook me up enough to get me to change course...a little bit. I returned to never-ending dieting and wisely didn’t talk about calories or fat.

Last fall, as feelings of isolation escalated, I became especially critical of what I perceived as my bloating gut. Despite the regular workouts and the dieting, the Pillsbury Doughboy always greeted me in the mirror. Next up: Little Buddha. “This is 50,” I told myself. Single, fat, lonely, hopeless.

When my dog, Hoover, died in April, I went into full deprivation mode. The grief was so intense and the guilt so great that food deprivation constituted both control and punishment. Whenever the grief lapsed, a general apathy stepped in. Why bother? With food or anything.

It took five days before I acknowledged I needed to be admitted to hospital, for severe depression, not for an eating disorder. In the short term, it was the right thing, but I am still dealing with the aftermath. Nobody raves about hospital food. Especially not vegan hospital food. Plain bread, vegetable broth, half a canned pear. It made deprivation even easier. In the psych ward, everything was highly scheduled—all controlled by someone other than myself. Meals at 8, 12 and 5. Snacks at 2 and 8. I’m sure the intent is to help stabilize some people, but for me, it only intensified my desperation to exert control over the only thing I could: my body.

My food restriction does not get too drastic when I can exercise. I am fanatical about it. I over-exercise. I exercise when injured. In the hospital, confined to my ward, there was no jogging, no swimming, no cycling, no weightlifting. There was a Stairmaster that I would ride in my flimsy hospital bottoms and gown, but I worried too much about body odor. (We weren’t given soap for the showers; only tiny gel packets that failed to do much of anything.)

No one monitored my intake at meals. The food trays went largely untouched. I hoarded soda crackers, instant decaf coffee packets and apples from snack time. When I felt dizzy, I’d slowly chew a Saltine or lie down and try (unsuccessfully) to sleep.

I lost twelve pounds in the first six days. They didn’t bother to weigh me after that. More troubling was where the loss occurred. In the mirror, my body was unrecognizable. After all those years of building muscle mass, all was lost.

 

Biceps gone. Pecs gone. Quads gone. Welcome to a new kind of hideous.

The transformation only made me care even less about living.

In the three months since being released, I’ve increased the intensity of my workouts. I’ve lost a few more pounds but I’ve regained strength. I don’t have near the bulk from before, especially in the chest. My tight t-shirts are now roomy. Still, my body gets noticed. Gay guys are openly complimentary. It’s foreign territory.

But I am an example of how unrealistic body images are in our society. Yes, I am forty-nine and I appear fit. But my food intake continues to be tightly controlled even more so than before I entered hospital. No more breakfasts. I’ve cut lunches in half, dinners by a third. I look healthy. It’s an utter deception.

GODS AND (MY) MONSTERS

Divers.  Gymnasts.  Swimmers.  Many of us have to wear a bib when watching the Summer Olympics.  These athletes are drool-worthy.  I know I am not alone.  I see the tweets.  Entertainment Weekly’s coverage includes a Stud of the Day.  These men are Greek gods.

And, yes, there is a sharp contrast between those deserving of a place on Mount Olympus and the rest of us.  This is a good time for a reality check.  Doing ten cannonballs in the local pool isn’t going to make you look like Matthew Mitcham.  Five minutes—heck, five hours—on the monkey bars at a school playground won’t get you the biceps of Arthur Zanetti.  And signing up for Aquafit classes at the Y won’t lead to folks mistaking you for Nathan Adrian.  Harsh as it may seem, we are mere mortals with bodies that can only reach modest gains (or losses) on account of food and exercise regimens. 

It’s a reality I wish I grasped when I was a twelve-year-old.  Or twenty-two.  Or thirty-two.  But even in non-Olympic years, there was always something in the media to tell us we can look better.  Oh, how I wished one of the gimmicks would do the trick!  Doing the ab crunch exercises in a men’s magazine might get me the physique of the male model demonstrating the routine.  If I bought a Boflex machine, I’d have one of those bodies in the infomercial.  

The trigger that I recall for becoming overly body conscious was back-to-school shopping when I was ten or eleven.  My mother and the saleslady decided I needed Lee “husky” jeans, instead of the regular fit.  Husky.   The dictionary definition includes the phrase “big and strong,” but also “burly.”  Yep, I needed fat jeans.  My mother mentioned this episode while my grandmother or a neighbor visited later that day.  That part is foggy.  What I do recall is being mortified.  It was as though someone had grabbed a megaphone and toured North America, telling everyone I was a fatty, fatty, two by four. 

I don’t think I had ever thought about my body before that day.  I had other concerns—worst player on the team (any team), strong suspicions that I had to be an adopted child, an Eeyore complex (woe is me).  I don’t know why but all my angst channeled into my body image.

I only had one pair of husky jeans.  Sometime over the next year, I had a growth spurt and that jelly belly went away.  But I always saw it.  I’ve seen it every day of my life since then.

The majority of people, especially guys, will be able to shrug off a fat reference.  They can ogle the Olympic gods, chug a beer and chow down on a bag of Cheetos at the same time.  In a sense, I envy them more than the jocks with the buff bods.  What is it like to eat guilt-free?  How does a guy grocery shop without looking at the fat content for every item? 

I think about fat and calories before, during and after every meal, every snack.  Essentially, I have been watching my weight for thirty-five years.  Not some high profile diet like The Atkins or The Grapefruit or The South Beach or Weight Watchers or Jenny Craig.  That gives the control to someone else.  I monitor my intake and, whenever I feel I’ve committed an eating infraction, I pay for it.  More exercise, no cheese, whatever it takes.

Since I have an aversion to seeing doctors, the closest anyone ever came to a diagnosis was “borderline anorexic.”  But that was after I’d put back on twenty pounds of the fifty I’d shed during my most critical point in university. 

My obsession with body weight evolved when I came out of the closet after graduating from university.  Being fat wasn’t the only thing to avoid.  Being thin wasn’t acceptable either.  Muscles mattered.  I continued to monitor my food while getting fanatical about exercise, but my body would not cooperate.  In the mirror, I always saw those little love handles, chicken legs, dainty wrists and arms devoid of definition. 

I do not take my shirt off in the locker room at the gym.  I always change at home.  I am an avid swimmer so that means I do have to expose some skin.  I even wear a Speedo.  But I only swim when I feel my fittest.  When winter comes and I gain five pounds, laps would be the easiest way to battle the bulge, but I cannot be seen in the swimsuit.  Even when I decide I can go to a pool, I select a more distant venue where I will not run into anyone I know.

I only go to the doctor when I feel I am trim enough.  Otherwise, there is too much shame—I haven’t taken care of myself.  I like to buy baggy clothes, but then I feel the baggy parts look like fat, too.  Boyfriends have encouraged me to purchase form fitting clothing but I feel my fleshy parts are bubbling over.

In darker times, I have limited my eating to once a day, I have fought off hunger by going to bed ridiculously early—before the pangs surface.  Other times, sleep has been difficult.  I prefer sleeping on my stomach, but that has been uncomfortable when my ribs have been too exposed.    Just as others eat through stress, I tend to starve myself when I feel the rest of life is out of whack.  My body is the one thing I can control.

I can logically explain the bodies of Ryan Lochte, Usain Bolt and Ashton Eaton.  They train for eight hours a day and have a team of advisors to monitor body fat and prescribe meals.  It’s an extreme life.  But I also see the guys with better bodies in the local gym and the guys who never make an appearance but walk through town on hot summer days, shirts off, abs defined, perfect torso “V”.  I see the Twitter avatars of guys with ripped bods.  Even if the pics aren’t of them, they are of someone.  Somebody has that body.  Genetics, I remind myself.  But logic doesn’t last.

Believe it or not, I am better than I have ever been, but I have never broken free from my eating disorder.  I simply cope.  I never step on a set of scales.  I work out intensely when I can—that is, when my day isn’t eaten up by work and my commute.  Currently, I am exercising six days a week (2 ½ hour gym routines, 15 km jogs, 25-45 km bike rides).  It is a tough battle.  My tummy still jiggles.  The middle-aged gut is not responding to what has worked in past summers.  I have also found the point where I ease up on the weight loss.  It’s pretty much the ribs-keeping-me-from-sleeping test.  (Don’t think I can achieve that point again.)  I could go on and on about all the ways my body image rules my life.

Almost every article I’ve read or feature I’ve seen on TV about eating disorders has focused on females.  I know, however, I cannot be the only one and I worry about an unexpected legacy from the Olympics.  According to the National Eating Disorders Association, one million males have an eating disorder.  My gut reaction:  so I am not the only freak. 

Just as it has always felt affirming when a celebrity or political figure acknowledges he is gay, I would love for men to publicly state that they struggle or have struggled with an eating disorder.  In the past thirty-five years, I have only met one other guy who talked of an eating disorder.  He had gone through bulimia, something that I could never do.  Too squeamish.  We went on a couple of dates, but it is probably a good thing we didn’t connect.  Who knows what we would have learned from each other!

If you are able to eat a slice of cheesecake, a muffin or half a bag of regular (not baked) chips, celebrate this simple pleasure.  If you can get out of the gym in less than an hour, hurrah!  You may not have the body of Bolt, but when will you need to run 100 meters in less than 10 seconds anyway?  You are indeed a lucky one.