And when he began to talk about his experiences in public, an onlooker—as well as a doctor—stood up to say that Sheldon had been misdiagnosed because he was neither too big nor too thin, he said.
Sheldon, 34, president of the Ambassadors Program at the National Eating Disorders Association, has had body image issues since she was eight years old. When this problem develops into a concrete eating disorder, she has a hard time recognizing it and getting help because of the stereotype that eating disorders only occur in teenage girls.
As the organization kicks off its awareness campaign Monday for National Eating Disorders Week, experts share how eating disorders affect men and boys and why they are often overlooked.
What is an eating disorder like?
When thinking of someone with an eating disorder, many people think of a girl or woman who restricts food, exercises anxiously, or secretly indulges in overeating.
Men can suffer from eating disorders this way, says Dr. Blake Woodside, medical director emeritus of the Eating Disorders Program at Toronto General Hospital and a professor in the University of Toronto Department of Psychiatry.
But Woodside says men also feel pressure to conform to some of the masculine body types that society considers acceptable, such as muscular superheroes and lean computer geeks.
Some of these ideals encourage men to limit calories, Murray says, but others do the opposite and encourage excessive exercise, excessive protein intake, and severely restrict nutrients such as fat and carbohydrates.
When does an interest in maintaining a certain physique become an eating disorder? It happens when your behavior and interactions begin to be judged by the limitations you place on your ideal body, says Murray.
“What should be the standard: does it affect people’s ability to lead normal, active lives?” She says.
Why are they so difficult to treat?
If men are so affected by eating disorders, why don’t we hear about them? Stigma and exclusion.
Although anorexia nervosa was first recognized in boys and girls in the 19th century, Murray said boys were excluded from the study and diagnostic criteria.
Until recently, changes in the breasts and loss of menstruation were central to the diagnosis of eating disorders, Murray said. He added that although criteria have changed, men and boys are still excluded from most studies on eating disorders.
This exclusion can often lead to stigma, as men and boys – as well as those around them – do not acknowledge their behavior or are reluctant to seek help because they believe it threatens their manhood by telling them they may have a woman’s disease.
Worse still, men’s disordered eating behavior is often perpetuated in the world of social media, Murray said.
He adds that celebrities and influencers post their over-exercising, along with screenshots of their bodies and food cheats of the day, meant to trick their bodies out of starvation mode so they don’t burn muscle.
Regardless of the gender context, almost every doctor classifies this type of behavior as bulimia. “In men, we see it as a pro-social way to gain more muscle,” says Murray.
What we can do
Many families and family doctors are still unfamiliar with the signs of an eating disorder in boys and men, Murray says, so the first thing to start with is knowing what to look for.
Woodside says teenage boys are human grasshoppers, often eliminating every bite of food in their path. He says that if you see someone you care about suddenly change how much they eat or how they eat it in public, they deserve attention.
Woodside adds that if the man or boy in your life is making major changes in the activities and relationships in their life, it might be time to take a closer look.
From there, there is good news and bad news.
Bad news? “The field of eating disorders should treat boys and boys based on treatment studies that include only girls. We have to come to the big conclusion that we’re right on target,” Murray said.
The good news, says Woodside, is that men and boys are often successful in treatment for their eating disorders.
At one point, Sheldon lost his job, money, and relationships due to an eating disorder. It took years of specialized care and support group help to get her body and life back on track.
Now, he says the best way to help men and boys like him receive treatment is to share an often hidden truth: They’re not alone.