Ellen describes her fourth-grader, Nick, as a “husky kid.” (Both names have been changed.) She encouraged healthy snacks and asked him to notice if he was eating because he was hungry or because he was bored. One day, Nick started skipping dessert. He asked for smaller lunches. Ellen was pleased to see her son exhibiting what she felt was good food awareness.
When Nick began to lose weight, she attributed it to playing lacrosse or a growth spurt. His weight continued to change, and so did his mood. He grew quiet and, at times, seemed despondent.
“Is this what normal pre-teen stuff looks like?” Ellen wondered. “Or is this something else?”
It’s a question that more and more parents of adolescent and teen boys are asking. American boys and men account for over one-third of diagnosed eating disorders, according to the National Eating Disorders Association, and many experts agree that statistics fall far short of the real number because many boys and men may go untreated for years.
Embarrassed to seek help
“We have to stop seeing eating disorders as a girl illness,” said Rachel Levi, a family therapist and eating disorder specialist, who founded the Shoreline Center for Eating Disorder Treatment in Long Beach. It’s her belief that parents may consider disordered eating a “phase,” and boys don’t seek help because they feel embarrassed.
Both therapists interviewed for this story explained that boys worry about eating disorders being a “girl thing” or a “gay thing” when they’re just a thing.
“In rehab, I was with six other guys and everyone else was straight,” said 21-year-old Noah Ulin, who lives in Los Angeles and has suffered from an eating disorder.
Noah came out as gay in ninth grade. He was a binge eater for most of his life and had struggled with his weight. He never equated his lack of a boyfriend with his body until, at 16, a friend said he’d be “really cute if he were just skinny.” So Noah started to lose weight.
At first, he made healthier food choices and went to the gym twice a week, but eventually, he took more drastic measures. By his senior year, his daily routine was to consume only 1,000 calories each day (2,400 calories is the recommended daily average for an active teenage boy) and to take a 12-mile walk. He was 5-foot-11 and weighed 135 pounds.
EDs and anxiety
The most common eating disorders are anorexia nervosa, characterized by a fear of weight gain, self-starvation and a distortion of body image, and bulimia nervosa, which manifests in food binges followed by purging.
“Bulimia often has a physiological component,” said Nicole M. Bourquin, family therapist and founder of the Eating Disorder Foundation of Orange County. “It’s a relief of tension and stress. For a brief moment, after vomiting, you do feel better.”
A 2004 study by the Price Foundation Collaborative Group, a team of international genetics researchers, found a significant link between eating disorders and anxiety disorders. The study revealed that roughly two-thirds of people with eating disorders will suffer from an anxiety disorder in their lifetimes.
“We’re driving our kids really hard,” Bourquin said. “Not just with sports, but with school. With everything.”
High-achieving kids are more likely to be stressed and, as a result, more apt to manifest symptoms of an eating disorder. She points out that kids who are invested in getting good grades, in doing well in athletics, who seemingly have it all are the most difficult to diagnose. Parents will say, “Not my kid, he’s too smart for this.” But an eating disorder is another measurable way to have self-esteem. “We are taught to value things that are tangible: grades, houses, cars,” Levi said.
Warning signs
Eating disorders commonly begin from ages 12 to 15. For many boys, it’s less about being thin and more about appearing “cut” or developing a “six-pack.” Barraged by media images of burly superheroes, shirtless models and sports figures, Levi explained, teen boys are starting to wonder, “How can I be more loved? How can I be more competitive?”
The drive to compete is especially common in sports, where there is an emphasis on “making weight.” When Bourquin, who often speaks at local schools, mentioned to a gym class that last-minute weight-loss practices such as throwing up food and “sweating it out,” where students drop water weight by engaging in extreme cardio while wearing plastic suits or heavy clothing, were not great strategies, the coach was dismissive. “We’ve been doing this for years,” he told her.
It’s Levi’s opinion that by encouraging our boys to “tough it out,” we may be missing the signs of illness, such as fear of weight gain, compulsive exercise, oversized or undersized clothing and labeling food as “good” or “bad.”
The National Eating Disorder Association website extends the list of warning signs to include disappearing into the bathroom after meals, constant negative body talk and social isolation. Watch, too, for sudden weight loss or gain.
David Ulin, father of Noah Ulin, said his son “always had a complicated relationship with food.” Because Ulin and his wife were worried about Noah’s heart and cholesterol, they viewed his initial weight loss as a sign that he was getting healthy. But they were on guard. “I remember talking to him and saying, I think it’s great that you’re taking care of yourself,” Ulin recalled, “but I’m worried about you losing too much weight. I worry you won’t be able to stop.”
Treatment
If you suspect an eating disorder, both Bourquin and Levi advise checking with your pediatrician to rule out medical issues and seeking the advice of a therapist who specializes in eating disorders. Both therapists emphasized that as you move toward treatment, it’s important to assemble a team that includes the therapist, your pediatrician and a dietitian or nutritionist. Levi says a team helps ensure accountability and flexibility. With so many eyes on the patient, it’s harder to keep secrets, and an eating disorder is all about keeping secrets.
“A team also helps each practitioner see the patient as an individual,” Bourquin said. There is no one way to solve this puzzle. What helps one patient can be anathema to another.
Noah believes that his first attempt at recovery was unsuccessful because he worked with a single therapist. “I B.S.-ed my way through. Nothing changed. I gained 10 pounds and went right back to the same thing.”
According to the National Eating Disorders Association (neda.org), EDs are complex medical and psychiatric illnesses. An important part of treatment is externalizing the disease. Many therapists will give the ED a name or refer to it as a “monster.” This strategy helps separate the decisions made by the disorder from the ones a healthy person might make.
At the height of Noah’s illness, he weighed 125 pounds, was walking eight to 10 miles a day and taking 30 laxatives a day. His body was weak. “I would think that it was better to pass out on a street corner than in the middle of the street and that’s how I kept going,” he recalled. The Monster was making all the decisions.
Find support
Re-nourishment is the first step in any treatment program, be it inpatient, outpatient or home-based, but in every case, boys are helped by talking with other boys and men who are going through a shared experience.
“I can hear my exact story coming out of someone’s mouth, but if they aren’t a guy, I don’t totally connect with it,” Noah explained. He notes how difficult it was to find literature that contained stories about men and how often he and his parents had to change the pronouns from “she” to “he.”
Some male voices on the subject can be found in the memoir “Skinny Boy,” by Gary Grahl, in the writing of Los Angeles writer Patrick O’Neil and in the “personal stories” section of the U.K.-based website mengetedstoo.co.uk.
For parents, the diagnosis of an eating disorder can be painful. “I’m mostly a stay-at-home mom and I felt like, oh my god, I failed. I couldn’t feed my child,” Ellen, Noah’s mother, explaind. “But I didn’t give in to that; instead I got a hold of the situation.”
David Ulin had to accept his son’s anger and the possibility that treatment would destroy their relationship. “He’s my boy and I love him,” he said. “We were in it for the long haul. We knew he might never speak to us again, but we were willing to take that chance to save our son.”
