Looking into the tiny mirror above the toilet’s washbasin, Liam Kelly’s bloodshot eyes welled up with tears. A moment ago, he had made himself sick in the bathroom, now there was excruciating pain in his throat, his face was puffy and his body exhausted, while his mind screamed: “I need help.”
The Irish teacher, 42, who lives in Abu Dhabi, says he still vividly recalls several such agonising moments spent in his bathroom while he was battling bulimia, secretly, for more than 25 years.
“I would eat as much as I wanted to and then vomit it all out in the bathroom. I knew it was wrong, but I was ashamed of telling others,” says Kelly, who finally overcame his eating disorder in 2016, at the age of 38.
Long stereotyped as a syndrome suffered by skinny, white, affluent girls, eating disorders are equally prevalent among men, many of whom feel ashamed to seek help, for what is supposed to be a “woman's disorder”.
“When I came out of the bathroom after purging, I would pretend I was sneezing, to hide how my face was looking,” Kelly says. “The line that boys don't cry used to destroy me. I never went to a doctor. I was too scared of people finding out about my bulimia.”
Notions of masculinity
Tellingly, not too many studies have been conducted on male eating disorders. However, the statistics that do exist support Kelly’s statement, that in reality, even though men suffer as much as women, there is a lot more stigma and little awareness about the eating challenges they face.
In the US alone, as per the National Eating Disorders Association, eating disorders will affect 10 million males at some point in their lives, and they are less likely to seek help, owing to cultural bias. A 2015 report, funded by the UK Medical Research Council, also found that 25 per cent of those with eating disorders are male and less than 10 per cent of them sought professional treatment.
As traditional societal notions of masculinity expect men to be strong and stoic, it prevents them from revealing their vulnerabilities.
Carine el Khazen, vice president of the Middle East Eating Disorders Association and a clinical psychologist at American Centre for Psychiatry and Neurology, Dubai, says: “A strong man is not expected to display any emotions or show any sign of weakness. They are supposed to always be well and not struggle. I believe these stereotypes surrounding eating disorders are still very prominent in the Middle East, because of which men come later for treatment.”
Types of eating disorders
Globally affecting 70 million people, an eating disorder is a serious mental health condition related to eating behaviours, emotions and thoughts. The most common among these are: anorexia nervosa, characterised by food restrictions and an intense fear of gaining weight; bulimia nervosa, in which a person has episodes of binging and self-induced vomiting; and overeating and binge-eating disorders, where a person has a loss of control over eating and consumes large quantities of food in a short period of time.
For as long as he can remember, Joe Smith, 52 (name changed upon request), a legal professional, admits that he has been a compulsive eater. “There are some food items that I cannot eat in small portions; once I take a bite, my mind reacts and I need to devour as much as I can in the shortest possible time,” he explains.
The food loses its taste and texture and, in the end, after a binge episode, Smith admits he is left with copious remorse and extra weight.
“But the next day itself my mind starts obsessing about yet another binge.”
Physical and mental impact of eating disorders
Abnormal eating habits naturally have an impact a person's health, emotions and daily life. People with eating disorders can harm their digestive system, teeth, bones and heart. They also often have low self-esteem, anxiety and depression. Most alarming of all is, the condition can be fatal.
Reem Shaheen, counselling psychologist and managing director at BE Psychology Centre for Emotional Wellbeing, Dubai, says: “Eating disorders are a disturbing mental illness that can directly cause death.
"According to the US National Association of Anorexia Nervosa and Associated Disorders, 5 per cent to 10 per cent of anorexics die within 10 years after contracting the disease, and 18 per cent to 20 per cent of them after 20 years. In fact, anorexia nervosa has the highest death rate of any psychiatric illness.”
Social media and the pandemic a trigger
The increasing focus on outward appearance, gym culture and near-perfect body images circulated on social media have further triggered unhealthy eating habits.
“The importance of body image owing to social media has probably put more pressure on men to conform to certain stereotypes of muscular bodies and their outward appearance,” says Dr Victoria Mountford, consultant clinical psychologist at Maudsley Health, Abu Dhabi.
She says the pandemic and stay-at-home measures have also led to an increase in the number of men coming to her for treatment of an eating disorder.
“For people who have eating disorders, it is important to have a certain degree of control. Unfortunately, the pandemic took that away. We lost structure and routine, which [further] enabled the eating disorder to take over.”
During the restrictions on movement, there were also consistent messages about knocking down extra weight. While some people developed emotional eating, others began over-exercising.
Help is at hand
A silver lining is that with better diagnostic information, general physicians are able to detect eating disorders, which could be responsible for the ascent in eating-disorder detection in men.
Celebrities have also recently opened up about their eating struggles, leading to more discourse about male mental health.
Singer Ed Sheeran recently spoke about his binge-eating episodes and British actor Christopher Eccleston wrote in his memoir I love The Bones of You about his struggles with lifelong anorexia.
Kelly is writing a series of books, under the title Worried William, documenting his struggles with anxiety and bulimia. “I was in a lonely place for many years. I don't want others to suffer like I did; I tell them to treat their bodies with love," he says.
No matter how complicated these eating disorders seem, they can be resolved through specific treatment. Psychological therapy is one of the most important tools to aid recovery.
“The gold standard treatment for eating disorders is cognitive behaviour therapy enhanced for the treatment of eating disorders (CBT-ED), designed specifically to treat the underlying psychopathology of these disorders,” says Khazen, who is training professionals in such evidence-based treatments through MEEDA.
Within weeks of undergoing therapy, Abdul Rehman, 42 (name changed upon request), who works in Dubai, says he was able to experience spells of relief from the bulimia he has had for 20 years.
“In two months of therapy, by addressing my self-esteem and related anxiety issues, I was able to stop the self-induced vomiting that had started in my teens. I see men suffering silently, but they don't have to. There is help available,” he says. CBT-ED typically involves 20 to 40 sessions, following a personalised treatment plan that tackles unhealthy thinking patterns.
At Maudsley Health, Abu Dhabi, family therapy is offered specifically for young people with anorexia nervosa. First developed at Maudsley Hospital in London in 1985, the intensive outpatient treatment involves working with the family of the patient to break their eating or over-exercising cycles.
Support groups and online platforms are equally inspiring dialogue in bringing change around these sticky issues.
Aakanksha Tangri, founder of Re:Set, an online resource on mental well-being, is one such voice. “Re:Set offers a safe space for men to share their lived experiences, to help them hear others’ stories and get access to affordable mental health resources,” says Tangri. “We also need to chip away at the idea of toxic masculinity and normalise men seeking support.”
Overeaters Anonymous is a global community of people who support each other to recover from compulsive eating behaviours. Through 6,500 groups in more than 75 countries, including a UAE chapter, Overeaters Anonymous offers the 12-step method similar to a proven treatment endorsed by Alcoholics Anonymous.
“In OA, if I complete my day by only eating food that I plan to eat, then I declare myself as being ‘abstinent’. says Joe, who has been a member for 18 years. "So, just for today I am gratefully abstinent and the world is a much better place because of it."