Nearly 40 per cent – and ris­ing. We ask ex­perts why nearly as many men as women have an eat­ing dis­or­der.

The num­ber of men with eat­ing dis­or­ders is ris­ing, with an es­ti­mated one in ev­ery four anorexia ner­vosa pa­tients be­ing male, up from one in 10 a decade ago. Anand Raj OK asks...

Friday - - Contents -

Twenty-six year-old Alex* was clearly up­set. Un­able to ‘cope with life and life’s pres­sures’ he had ap­proached Dr Nasser Al Hindy, con­sul­tant psy­chi­a­trist at Amer­i­can Cen­ter for Psy­chi­a­try and Neu­rol­ogy (ACPN), for help. ‘Alex ex­hib­ited symp­toms of mild de­pres­sion and anx­i­ety, and said he’d been ex­pe­ri­enc­ing these feel­ings for the past sev­eral years,’ says the doc­tor.

A Dubai res­i­dent, Alex was obese and Dr Nasser, in the course of his ex­am­i­na­tion, found that his pa­tient was suf­fer­ing from a binge-eat­ing dis­or­der.

‘Alex told me that he used to be bul­lied about his weight – some called him ‘rolling ball’ – while in school and now at work he was be­ing made to feel ashamed about his phys­i­cal size,’ says the doc­tor.

Alex’s fam­ily did en­rol him in a gym and kick-box­ing classes hop­ing that ex­er­cise would help him lose weight. ‘But there too he was made fun of and af­ter just a few classes, he quit,’ says Dr Nasser.

The con­stant jibes and jokes left Alex with low self-es­teem, guilt and as­so­ci­ated con­di­tions fi­nally tak­ing him to ACPN, which re­cently opened an eat­ing dis­or­ders unit in Dubai.

As part of the treat­ment process, the young man was re­ferred to a psy­chol­o­gist, a di­eti­cian and a phys­io­ther­a­pist. ‘We put to­gether a plan for him to bring about a pos­i­tive change in his life. We first worked on im­prov­ing his self-es­teem, how to face and tackle bul­lies, and how to get over his mild de­pres­sion.

‘We also in­cluded his fam­ily and sug­gested how they too needed to be on the same page when it came to help­ing him,’ says Dr Nasser. That was nec­es­sary to pre­vent any re­lapse. To­day, two months later, Alex is ‘a vis­i­bly a changed man. He is mak­ing great progress – he’s much more self-con­fi­dent and op­ti­mistic. He was put on a diet where he lost around one kilo­gram per week – which is the healthy range of weight loss in his case,’ says Dr Nasser.

How­ever, un­for­tu­nately not all such cases have a happy end­ing.

Eat­ing dis­or­ders are con­sid­ered the dead­li­est of all men­tal dis­or­ders, with an es­ti­mated 20 per cent of suf­fer­ers dy­ing from their con­di­tion. But what could be a shock to many is that men make up nearly 40 per cent of pa­tients with the con­di­tion.

Go­ing against the stereo­typ­i­cal no­tion that women are usu­ally the ones tack­ling food-re­lated dis­or­ders, ex­perts say that while 95 per cent of the suf­fer­ers are women in the 15 to 25 age group, the num­ber of men suf­fer­ing from eat­ing dis­or­ders is ris­ing. ‘There is a global in­crease in the num­ber of men with eat­ing dis­or­ders and that is re­flected in the UAE as well. Men en­gage in eat­ing-disor­dered be­hav­iours nearly as of­ten as women,’ says Dr Nasser.

He re­veals more dis­turb­ing facts. ‘The fe­male-to-male ra­tio of anorexia ner­vosa pa­tients has sig­nif­i­cantly changed – from one in 10 about a decade ago to one in four in re­cent times,’ he says. ‘Also, one in three binge-eaters is male and there are as many men as women who want to change their weight and body shape.’

His col­league at ACPN, clin­i­cal psy­chol­o­gist Carine Al Khazen con­curs.

‘To­day, one in five peo­ple suf­fers from some kind of eat­ing dis­or­der,’ she says.

Eat­ing dis­or­ders have a num­ber of se­vere psy­cho­log­i­cal and med­i­cal ef­fects on the suf­fer­ers.

Bulimia ner­vosa – where bouts of ex­treme overeat­ing are fol­lowed by fast­ing or self-in­duced vom­it­ing – has se­ri­ous med­i­cal reper­cus­sions, says Carine. She quotes the case of the late singer Amy Wine­house, who strug­gled with bulimia.

Med­i­cally un­mon­i­tored di­et­ing is a se­ri­ous cause of eat­ing dis­or­ders. ‘A mas­sive 35 per cent of all “nor­mal” di­eters progress to patho­log­i­cal di­et­ing,’ she says.

The re­sults of eat­ing dis­or­ders are truly scary. ‘The con­di­tion can leave suf­fer­ers de­pressed, anx­ious and cog­ni­tively im­paired; their lives are de­stroyed due to this patho­log­i­cal ob­ses­sion with food and their bod­ies,’ says Carine. So what trig­gers eat­ing dis­or­ders among men? ‘The cul­ture of mus­cu­lar­ity and the in­tense pres­sure to diet and ex­er­cise ex­ces­sively,’ says Carine.

‘And we can see a re­cent es­ca­la­tion of these pres­sures.’

She points a fin­ger at the diet and fit­ness in­dus­try, ‘which spends a lot of money to con­vince peo­ple, par­tic­u­larly men, to use spe­cific di­ets and fit­ness reg­i­mens in­clud­ing... sup­ple­ments, pro­tein shakes and steroids’. Those, sadly, are not the only prob­lems. ‘For men just as women,’ says Dr Nasser, ‘be­ing in an en­vi­ron­ment that val­ues thin­ness, per­fec­tion­ism and ob­ses­sional fea­tures [poses] a ma­jor risk re­sult­ing in them hav­ing eat­ing dis­or­ders.

‘Cer­tain sports such as ath­let­ics, wrestling and body build­ing, and some pro­fes­sions such as act­ing and mod­el­ling too can pose a risk to men.’

Anorexia ner­vosa is not the only eat­ing dis­or­der that is wor­ry­ing. ‘The ob­ses­sion to be lean and [ex­tremely mus­cu­lar] can also be clas­si­fied as an eat­ing dis­or­der when as­so­ci­ated with other symp­toms, and could be a sign of anorexia ner­vosa or mus­cle dys­mor­phia or big­orexia,’ says Carine.

In the case of anorexia ner­vosa or or­thorexia ner­vosa – an ob­ses­sion with eat­ing food be­lieved to be healthy – weight loss is rapid and in­volves ob­ses­sive

EAT­ING DIS­OR­DERS are con­sid­ered the DEAD­LI­EST of all men­tal dis­or­ders, with an es­ti­mated 20 PER CENT of suf­fer­ers DY­ING from their con­di­tion… and MEN mak­ing up nearly 40 per cent of pa­tients

be­hav­iours im­pact­ing all ar­eas of the per­son’s life.

On the other hand, binge eat­ing dis­or­der in­volves weight gain. ‘In big­orexia or mus­cle dys­mor­phia there is an ob­ses­sion to bulk up,’ she says.

Dr Nasser agrees. ‘In many ways this is the op­po­site of anorexia ner­vosa. A pa­tient with this dis­or­der is racked by an in­tense fear that he is in­suf­fi­ciently mus­cu­lar, no mat­ter how well-built he re­ally is.’

Such pa­tients re­sort to stren­u­ous work­outs to build mus­cu­lar­ity and re­duce body fat. Body build­ing ex­er­cises would take prece­dence over al­most ev­ery other im­por­tant area of life.

‘[Suf­fer­ers] also over-reg­u­late pro­tein in­take and ob­sess about con­sump­tion of car­bo­hy­drates and fats. The use of sub­stances such as an­abolic an­dro­genic steroids are also com­mon among such peo­ple,’ says Dr Nasser. He cites the

case of a Dubai-based 25-year-old who was ob­sessed with bulk­ing up. ‘Ini­tially he’d visit the gym a cou­ple of days a week. The pe­ri­od­ic­ity soon went up to four days and fi­nally seven days a week.’

The spin-off was that be­cause he was ex­er­cis­ing more, he felt he should be eat­ing more; then be­cause he was eat­ing more, he be­gan to ex­er­cise more and soon he was trapped in a vi­cious diet-ex­er­cise cy­cle.

The ef­fect was dis­as­trous,’ says Dr Nasser. ‘Be­cause he was spend­ing so much time in the gym, his friend cir­cle nar­rowed down, he broke up with his girl­friend. That left him de­pressed. So he be­gan spend­ing more time in the gym. Along the way, he also be­gan tak­ing steroids, which he pur­chased on­line.’

The gym ses­sions were also leav­ing him tired and his ca­reer be­gan to suf­fer be­cause he could not con­cen­trate on his work.

‘The con­di­tion that was now spi­ralling out of con­trol left him iso­lated and de­pressed. For­tu­nately for him, some friends re­alised that he needed help and en­cour­aged him to seek treat­ment,’ says the doc­tor.

At the Cen­tre, he was given a course of anti-de­pres­sants. A di­eti­cian then cre­ated a diet plan for him; he was also treated by a psy­chi­a­trist for anx­i­ety. ‘Now, more than two months later, the young man is slowly limp­ing back to nor­mal,’ says Dr Nasser.


Dubai-based free­lance fit­ness in­struc­tor Peter Sul­li­van ad­mits that he is see­ing a mas­sive in­crease in the num­ber of men

The BODY needs be­tween 10 and 14 ad­di­tional GRAMS per day to build a POUND of MUS­CLE. How­ever, some of the PRO­TEIN pow­ders avail­able in the MAR­KET have around 80g of pro­tein per serv­ing

‘us­ing the gym ex­ces­sively in the UAE’. ‘So­cial me­dia is a ma­jor in­flu­enc­ing fac­tor – a driver for this trend,’ he says. ‘Some of the more pop­u­lar pic­tures on In­sta­gram and Face­book are of guys in very good shape. Men who see these de­sire a sim­i­lar physique. And they want it in­stantly. It’s this mod­ern­day men­tal­ity where peo­ple seek in­stant grat­i­fi­ca­tion; if they want some­thing, they want it now. They are will­ing to pay what­ever it takes to have a sim­i­lar body in the next six weeks, pre­fer­ring to deal with the con­se­quences later.

‘But what many men do not re­alise is that it would have taken sev­eral years and tremen­dous ef­fort for those peo­ple to get into that shape.’ He cites the cases of some men who, af­ter work­outs, get busy up­load­ing their pic­tures, pub­li­cis­ing their physique to the world. ‘[See­ing those pic­tures] mo­ti­vates more men to get that dream body. So it’s a self-fu­elling per­pet­ual mo­tion of peo­ple post­ing images of them­selves, which reaches out to more men,’ he says.

‘If your sole pur­pose is to have a body that is at­trac­tive then the whole men­tal as­pect of the per­son’s per­son­al­ity is lost; you be­come just a beef­cake – a nice body but no real brain to back it up.’

Peter how­ever, stresses the im­por­tance of ex­er­cise to stay healthy. ‘There’s a di­rect strong cor­re­la­tion be­tween be­ing healthy and stay­ing in a mo­ti­vated state.

‘When you go to the gym you feel happy, pos­i­tive and mo­ti­vated in other ar­eas of your life.’ Fit­ness First man­ager Nicky Hol­land agrees that while not ex­er­cis­ing can af­fect health ad­versely, ‘so can ex­er­cis­ing too much’.

‘The body can be pushed but you must give your­self rest days. Get­ting up early in the morn­ing, train­ing twice a day, go­ing to the gym seven days a week, can be good but it is not sus­tain­able. Ex­ces­sive gym us­age can lead to burnout and can have an im­pact on you phys­i­cally and men­tally.’

Ex­er­cis­ing needs to be­come part of your life­style as a habit rather than a chore. Nicky also touches upon the other bug­bear of the fit­ness world – pro­tein shakes.

‘Pro­tein shakes are very pop­u­lar in the fit­ness in­dus­try with more and more peo­ple tak­ing them,’ says Nicky. She

in­sists that pro­tein shakes ‘need to be used as a sup­ple­ment and not a re­place­ment, un­less pre­scribed by a doc­tor. Get­ting your pro­tein from food and nat­u­ral sources is best.’

Peter agrees. He sug­gests hav­ing a healthy ap­proach to the pro­tein shakes of­ten re­lied upon to beef up the body. ‘They can be healthy – pro­vided they are taken the right way. The dan­ger is when peo­ple move away from nat­u­ral foods and con­sume only pro­tein shakes.’

Dubai-based nu­tri­tion­ist Rashi Chowd­hary (a mem­ber of Fri­day’s Ask The Ex­perts panel) con­curs with the fit­ness in­struc­tor. ‘Pro­tein shakes should be seen as sup­ple­ments, not as some­thing that re­places your main meal,’ she says.

‘If you are a non-vege­tar­ian, you don’t re­ally need to con­sume a pro­tein shake un­less you are work­ing out heav­ily in the gym. For veg­e­tar­i­ans, in­clud­ing a pro­tein shake in your diet could be help­ful, but only on the ad­vice of your doc­tor or nu­tri­tion­ist. You should not rely on pro­tein shakes for all your nu­tri­tional needs.’ Dr Nasser too sounds a warn­ing note on the un­reg­u­lated use of pro­tein pow­ders and shakes. No sup­ple­ment is more widely con­sumed than pro­tein pow­ders, he says, adding that peo­ple may be en­cour­aged to con­sume high-pro­tein foods with­out con­sid­er­ing the health con­se­quences.

The only times one needs more pro­tein in the diet is in the teenage years, when start­ing a fit­ness pro­gramme, when in­creas­ing work­outs, when re­cov­er­ing from an in­jury or if you’re go­ing ve­gan, he says.

‘The body needs be­tween 10 and 14 ad­di­tional grams per day to build a pound of mus­cle. How­ever, some of the pro­tein pow­ders avail­able in the mar­ket have around 80g of pro­tein per serv­ing. The max­i­mum amount of pro­tein that most adults can use per day is 0.9g per pound of body weight.’

In­clud­ing too much of pro­tein with­out fat can de­plete cal­cium in the body, lead­ing to bone weak­ness and re­lated com­pli­ca­tions. It can also dam­age the liver and kid­ney.

Dr Nasser also warns those who ex­er­cise of­ten to be ex­tremely care­ful with an­abol­i­can­dro­genic steroids. ‘They can lead to sev­eral com­pli­ca­tions in­clud­ing high blood pres­sure, heart at­tacks, strokes, and liver and kid­ney con­di­tions,’ he says.


Ac­cord­ing to Dr Nasser, an ob­ses­sion for work­ing out is the first step to slip­ping down an eat­ing dis­or­der slide.

Carine lists more: ‘An ob­ses­sion to lose weight, count calo­ries and eat healthy; ex­tremely rigid and un­break­able food rules; an in­tense fear of be­ing fat; food pho­bias; ob­ses­sions with go­ing to the gym and to have a per­fect body, which never ap­pears to sat­isfy the per­son, no mat­ter how thin or mus­cu­lar he is; ob­ses­sions about body im­age and check­ing and com­par­ing be­hav­iours; pe­ri­ods of un­con­trol­lable binges fol­lowed by guilt and re­morse; and an urge to burn off or get rid of the calo­ries ingested – some­times through un­healthy and dan­ger­ous meth­ods – can sug­gest an eat­ing dis­or­der,’ she says.

Al­though there are sev­eral no­tice­able signs of eat­ing dis­or­ders, the de­tec­tion and treat­ment of the con­di­tion in men is rel­a­tively more dif­fi­cult be­cause they of­ten do not seek help in time.

‘Men who binge-eat or com­pul­sively

PRO­TEIN shakes need to be USED as a sup­ple­ment and not a RE­PLACE­MENT, un­less PRE­SCRIBED by a doc­tor. Get­ting pro­tein from NAT­U­RAL sources is BEST

overeat may go un­di­ag­nosed more than women sim­ply be­cause of so­ci­ety’s will­ing­ness to ac­cept an overeat­ing or an over­weight man more than an overeat­ing or over­weight woman,’ says Dr Nasser. ‘In fact around 50 per cent of obese peo­ple have a binge-eat­ing dis­or­der.’

An­other im­por­tant fac­tor for the de­lay in de­tect­ing and treat­ing eat­ing dis­or­ders in men is be­cause they con­sider the con­di­tion shame­ful and em­bar­rass­ing, so do not ap­proach a doc­tor. ‘An eat­ing dis­or­der is per­ceived as be­ing a women’s dis­or­der so men are re­luc­tant to seek psy­cho­log­i­cal help,’ says Carine.

‘Com­pared to men, women cope bet­ter with eat­ing dis­or­ders. For one, they seek help ear­lier than men. This can lead to a bet­ter prog­no­sis and early treat­ment op­tions,’ she adds.

The fact that dis­or­ders in men are de­tected late leads to poorer prog­no­sis.

De­tect­ing and ad­dress­ing diet-re­lated con­cerns early on can go a long way in cor­rect­ing the dan­ger­ous trend, says Dr Carine.

Dr Nasser warns that ob­ses­sive over-ex­er­cis­ing, too, can have sig­nif­i­cant so­cial and phys­i­cal con­se­quences

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