Why eating disorders aren’t just a girl thing

The use of simple BMI readings often mean those with eating disorders miss out on early treatment.
The use of simple BMI readings often mean those with eating disorders miss out on early treatment.
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With a rise in the number of teenage boys being diagnosed with anorexia and bulimia, Sarah Freeman reports on how eating disorders crossed the gender divide.ap

When Bev Mattock’s son Ben began upping his normal exercise routine and paying closer attention than usual to what he ate, she assumed that he was just preparing for the start of a new rugby season Always a quiet child, the sport had given her shy teenager the confidence and popularity he craved. In many ways it had been the making of him, but with his GCSEs looming he had decided to play a little less, and didn’t want to pile on any extra weight.

“A lot of parents worry their teenage children are eating too much junk food and not doing enough exercise, so initially we didn’t really think too much of it,” says Bev, from Leeds. “However, quite quickly Ben’s healthy interest in diet and exercise became obsessive.”

Swapping his normal meals for diet versions, Ben began spending hours at the gym often out of duty rather than pleasure and soon the only thing he was reading were magazines dedicated to health and fitness.

“We thought it was a bit odd and then out of nowhere he developed a sudden interest in cookery,” says Bev. “He would take a recipe and do his own version, removing all the fats. It was like a switch had been flicked in his head.”

Compulsive exercising and an obsession with recipes and diet are classic signs of an eating disorder. However, while anorexia and bulimia are often associated with teenage girls, boys displaying the very same symptoms often go beneath the radar.

Guidelines issued by the National Institute of Health and Clinical Excellence (NICE) showed that 1.6m adults and children in the UK were affected by eating disorders in 2004 and 11 per cent of them were men. However, a snapshot survey carried out by the NHS Information Centre concluded that a quarter of over 16s with an eating disorder were men. Recent reports from the Royal College of Practitioners has also indicated a 66 per cent rise in male hospital admissions and it is thought this could still be the tip of the iceberg.

“The relatively low awareness of boys’ body image issues amongst parents and teachers, coupled with a culture of boys not discussing their worries, makes it a tough environment for boys to seek support,” says Karen Fraser, from the advertising think tank Credos, which this week published the results of its own survey of more than 1,000 eight to 18 year old boys.

“One teacher told the researchers bullying about physical appearance was often harder to sort out among boys. With girls, she said, somebody says, ‘You’re fat’. The natural reaction is the girl cries, the other girl feels guilt and it gets sorted out. With boys there’s a lot more banter. You can see they’re often hut, but the expectation is to laugh and shrug it off.”

Noting the influence of social media, the report was published alongside a government supported pack to help parents and teachers talk to children about how advertisements are made and how they can affect self-perception. It is all part of efforts to raise awareness of the condition amongst boys, but Bev is wary of placing too much emphasis on outside influences and says that eating disorders must be treated for what they are - a mental illness.

“Like a lot of families, we really struggled to get help,” she says. “Because Ben had played a lot of rugby he had bulked out, so while he had lost a huge amount of weight his BMI still registered as normal. I knew his behaviour and his attitude to food was far from normal, but we were told that because he wasn’t classed as an emergency, it would be up to six months before we could access treatment. It’s madness. You wouldn’t say to an alcoholic, ‘Well, you’re only drinking one bottle of vodka a day, come back when you’re up to two’.”

The Mattocks are not alone. According to a Freedom of Information Request submitted by the BBC, a third of health trusts said they used BMI along with other indicators to decide who qualifies for outpatient eating disorder services. Of those, four said it was a primary measure.

“Many people tell us that they were turned away from treatment because their weight wasn’t low enough,” said Andrew Radford, chief executive of the Beat, the UK’s eating disorder charity. “Eating disorders are serious, complex mental illnesses and assessments cannot be based on physical signs alone. We appreciate that mental health trusts are under immense pressure. We are not pointing the finger in their direction - mental health across the UK remains underfunded despite recent investment - but we cannot continue to play with the lives of the 725,000 people in the UK who have an eating disorder.

“If a person gets treatment early, they are more likely to make a full recovery and their chance of relapsing is reduced by 50 per cent. But when someone is told they don’t meet the criteria or that they aren’t ill enough yet, it only encourages the eating disorder to take hold, ultimately putting more distance between the individual and the recovery. We can’t continue to wait until an eating disorder is life threatening before treatment is available.”

Ben’s condition quickly spiralled out of control and while on the waiting list for treatment he ended up being admitted to hospital.

“He went downhill fast,” says Bev. “He reduced the amount he was eating to an absolute minimum and there was no way of reasoning with him. He changed from being a popular teenager with lots of friends to someone who couldn’t bear being around other people. At school he kept freaking out and it was so frightening to watch him change.

“It was 2009 that he became ill and while we got through that Christmas by the New Year his pulse rate had plummeted and his heart rate had dropped to 29 beats a minute when the average is between 60 and 100. I know it sounds mad, but I was grateful when he ended up in hospital because at least it meant he could be fast tracked. Even then because his BMI was still ‘normal’ he had to be treated as an out-patient, which probably tells you all you need to know about the dangers of using that as a reliable indicator.”

Ben is now 22. He recently graduated from Sheffield University with a first class degree and while he still has some issues with food he is living proof that there is hope.

“When we finally got Ben on a treatment programme I think we all thought we could breathe a sigh of relief,” says Bev, who has written a number of books to help families in the same situation. “But an eating disorder isn’t a physical illness which can be made better by having an operation or taking some tablets and often it was one step forward, 10 steps back.

“Now I do talks about boys and eating disorders and it has made me realise just how common it is. In fact I did an event in Edinburgh the other day and at the end one woman came up to me and said, ‘My story is a carbon copy of yours, except for one thing, my son didn’t make it.”

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