Melrose Heals: A conversation about eating disorders

Episode 18 - Eating Disorders in Men & Boys

Episode Summary

On today's episode, Dr. Karen Nelson is joined by Ben Meyers, licensed mental health therapist at Melrose Center. Karen and Ben will discuss how eating disorders can show up in men and boys, as well as a larger conversation around supporting them through their eating disorder recovery.

Episode Notes

On today's episode, Dr. Karen Nelson is joined by Ben Meyers, licensed mental health therapist at Melrose Center.  Karen and Ben  will discuss how eating disorders can show up in men and boys, as well as a larger conversation around supporting them through their eating disorder recovery. 

For a transcript of this episode click here. 

Episode Transcription

Dr. Karen Nelson  00:01

Eating Disorders thrive in secrecy and shame. It's when we create a safe space for honest conversation that will find the opportunity for healing. Hi there. I'm Dr. Karen Nelson, licensed clinical psychologist at Melrose center, welcoming you to Melrose Heals, a conversation about eating disorders, a podcast designed to explore, discuss and understand eating disorders and mental health. On today's episode, I'm joined by Ben Meyers, licensed mental health therapist here at Melrose. Ben and I will discuss how eating disorders can show up in men and boys, as well as a larger conversation around supporting them through eating disorder recovery. Eating Disorders don't just affect women, they can have a dramatic impact on men and boys. But as we always say, recovery is possible. Now, before I begin, I invite you to take a deep breath, and join me in this space. Welcome to the podcast. Ben, I'm so happy to have you here with me today. I'm so excited to be here. Well, before we get started, I'd love it if you could introduce yourself and tell us about your role here at Melrose.

Ben Meyers 01:18

My name is Ben Meyers. I'm an outpatient mental health therapist here at the St. Louis Park location in Minnesota. And I do individual in group therapy. And I've been with Melrose for over four years now.

Dr. Karen Nelson  01:32

So our discussion today will be specifically talking about eating disorders in men and boys. And I want to be clear, and give some definition for our listeners today. On today's episode, when we are talking about men and boys, just for the purpose of kind of continuity. And to keep some clarity, we're going to be talking about cis men and boys that at a potential future date, we also do plan on having an episode to address issues that specifically impact men in the LGBTQ community, men and boys in the LGBTQ community. But for today's conversation, we're going to be talking about cis men. Let's talk about as we move into this conversation, how many men or boys are diagnosed with eating disorders.

Ben Meyers 02:26

So one out of every four people with an eating disorder is a male. And that number has been increasing over the years you look back two decades ago, and that figure is around 10% of those with the eating disorder diagnosis was a male. And just in the makeup of diagnoses. 36% of those with binge eating disorder are men. Anorexia is 25%. And Bulimia is 25% as well. So, this, this exists, but there's this stigma that eating disorders are a female issue or a female problem. And I think that really highlights this barrier that men and boys really encounter that gets in the way of them seeking out help seeking treatment. So a lot of times they struggle with this loan.

Dr. Karen Nelson  03:22

I think you bring up a really good point, Ben, in identifying that the sometimes misperception about eating disorders is that it is a disorder that maybe characteristically impacts females or people who identify as female. And sometimes that misperception can get in the way of feeling like I have a valid reason for needing help or support. So with that increase, you know, over the past years the number of men or boys who are impacted by eating disorders. Tell us how an eating disorder might show up in a man or a boy. Yeah, so it

Ben Meyers 04:06

Yeah, so it looks like the onset of an eating disorder is between 18 and 20 years old, it's been theorized that college can be a stressor, but also I think, too, and something that we're definitely going to dive into I'm guessing later on, is this idea of becoming a man and what that means and how that can interact with how they're treating themselves, how they feel about themselves and their relationship with food. But the symptoms that we commonly see with men struggling with eating disorders is compulsive, excessive exercise, restricting laxative abuse, and then binge eating and purging and all those can interact together or stand alone. But we've we've, I think really identified in the research this A really a presence of masculinity, and how men relate to themselves really feeling these body image struggles that we see.

Dr. Karen Nelson  05:09

Absolutely. So part of what I hear you describing is some of the symptom use may be similar in men and boys that they're engaging in that kind of characteristic. And we need to see those characteristic behaviors in order to diagnose someone with an eating disorder. So restriction, binge eating, purge type behaviors, meaning self induced vomiting, those types of things. I want to go back to that idea that you had talked about around, sometimes this misperception that eating disorders only impact women or girls. And do you think that adds, or can it add to the stigma of maybe seeking help for some men or boys?

Ben Meyers 05:52

Absolutely, you know, I think, masculinity, this pressure that society and also men put on themselves and really relates to one's identity really makes it important for a man to be manly, to exhibit what it means to be a man. So then this idea to, you know, omit or be open or just even look at something that feels unmanly or feels feminine, I think makes it that much more scary. So I think it's much easier than to ignore, closed the door on it or deny it if anybody expresses any concern. But I think, you know, that's a stigma that those struggling with an eating disorder hold, but also providers to, which also becomes an additional barrier that exists here. You know, there were, were these trends that were happening before in which health insurance companies were denying eating disorder diagnoses that were given to men. So what that would cause then would be this provider then to fight this, and really, highly encouraged that this patient needs some help, support and treatment, or that would just be a wedge that would get in the way, and this person wouldn't end up getting this treatment. And I can't imagine how invalidating that would be for somebody to have their health insurance say, hey, no, this isn't a problem you're dealing with?

Dr. Karen Nelson  07:22

Absolutely. Well, I think about that idea of seeking out support when we're struggling. And it already is super vulnerable. But then if I get messages that maybe I don't fit there, or that's an issue that only impacts this other group of people, my providers don't even believe that I deserve help or treatment. My insurance company doesn't believe that. No wonder that potentially can be a barrier to seek treatment. 

Ben Meyers 07:54

Yeah, absolutely. Yeah, there's these experiences that I saw, when doing some research about people that were going to a medical provider with some concerns, talking about the struggles, they're going through, let's say excessive compulsive exercise, or restricting their diet and the medical provider, congratulating them and highlighting Oh, wow, I can tell you're working really hard. It's looking really good. And how painful this was for these individuals, and how that then delayed them ever getting support, which just leads to the strengthening and increasing the struggle that comes with the eating disorder.

Dr. Karen Nelson  08:35

Oh, my gosh, my mouth is literally hanging open as you just write, like how confusing and detrimental to you know, I may be going to provider and saying, Hey, I don't think this feels right, that something feels off. And then I'm praised for that behavior. How confusing. Let's maybe talk about that. You had mentioned this idea of maybe some of the stigma, right? We were talking about, that goes around seeking treatment. What do you think about this idea about how seeking therapy can be a really vulnerable experience? And do you think that vulnerability can be a barrier for some men or boys to access treatment, especially around this culture of maybe masculinity and toughness? What are your thoughts on that?

Ben Meyers 09:28

Absolutely. What masculinity, really, I think pressures and guides people to hold on to these characteristics like power and strength and self reliance. It really pushes men to follow these roles of being the fixer, the protector, the autonomous one to be stoic in the time of adversity. So holding on to masculinity and that forming somebody's identity really conflicts with this idea of Being vulnerable saying, Oh wait, I am struggling. Oh, wait times are really tough for me right now. Oh, I really disliked myself right now all that I think then makes it feel like I'm being unmanly. And I'm pushing back against this mold that's been created of being a man.

Dr. Karen Nelson  10:20

I think it's also important for us to name that we do effectively and compassionately treat eating disorders for people who are in all bodies, all genders, and that men and boys have a place here at Melrose. And we're here to surround you and support you, and that you do fit and belong. Oftentimes, I talk with my patients about how the eating disorder often minimizes or makes up reasons why I probably don't need help or treatment. I remember a patient of mine shared with me, a male patient that he told himself when I walk into that lobby, if I don't see any other man, I'm leaving. And right, so like noticing that place of do I fit? Do I belong? Is this the place for me? Any thoughts on that? Or what do you think about that?

Ben Meyers 11:15

Yeah, I mean, in order to, I think, develop a little bit of comfort, with vulnerability, and just being completely open with these people that you're meeting, in accepting them into your life and trying to accept their support, there needs to be a sense of safety there. And when this is viewed as a female problem, automatically that safety is threatened. And then when walking into a treatment facility and seeing primarily women, I think that safety is threatened as well. And those are some of the barriers I think treatment facilities face when trying to include and encourage men to seek out help. There is some recommendations I was seeing about facilities that feel feminine to men. So for instance, like the decor in the artwork, being like flower based, and the colors, all kind of communicating to these men of You don't belong here. And it brings up this really interesting question of how can we increase the sense of safety for men, just through the environments and how we communicate? And I do think Melrose does go above and beyond and in trying to include men, and I hope there's more that we can go and more that we can do for that mission?

Dr. Karen Nelson  12:42

Let's maybe talk about do you have any tips, Ben, on what might be some ways that men may be able to kind of explore that space of vulnerability, or ways to help men or boys feel a little bit more comfortable being vulnerable?

Ben Meyers 12:59

Yeah, well, you know, if I'm thinking about a family member, or a friend who might be seeing, you know, how a person a male is approaching food or how they are interacting with exercise? Gosh, I just think opening up that door and asking and checking in is an incredibly important first step of hey, how are you doing? Yeah, just been noticing you've been going to the gym a lot. Is everything okay? I think even if the person does not respond by divulging what they're going through, it still creates this sense that, hey, I can talk about this with somebody, when I feel like it's important. So I do think addressing it is important. But I do think, you know, this idea of female stigma really affects us all. So family and friends. We aren't a lot of times viewing this behavior through the lens of an eating disorder. We're kind of viewing this as, you know, a guy being a guy or him just doing what he does. So I think really initiating the conversation can be scary then too, especially with the sense that he just might shut me down. He might just say, no, no, this isn't happening. I still think it's important for us to approach it. Even if they do say no, I think it really is beneficial in the long run.

Dr. Karen Nelson  14:27

I love that. You know, we talk a lot about kind of starting a conversation, right? And often, it makes sense that I might avoid things that feel a little bit uncomfortable. But what I'm really hearing you talk about is bringing up maybe that concern out of a space of compassion and curiosity of like, Hey, I'm, I'm noticing this thing. And, you know, getting feedback from a person on that that feels super important. What do you think about how potentially bought The image may play into the evolution of an eating disorder for men or boys.

Ben Meyers 15:07

Yes, well, they have found that the majority of men struggle with body image issues. And, you know, linking this back to that idea of masculinity, I think that is exceptionally vulnerable to admit and talk about is this idea of I'm really disliking or hating my body right now are feeling comfortable with my body, I think that feels much more vulnerable than saying, I'm feeling anxious right now. I'm feeling nervous. So body image struggles are really present in men. And there's been this pretty fascinating trend that has happened in the media and popular culture surrounding how a man should look. And what they've seen is the muscularity of how men are presented have has dramatically changed. And one thing that exemplifies this is toys. And this action figurine of this GI Joe from the 1960s, if you look at this, it looks like this average guy kind of lanky, just a regular guy, you compare that to the GI Joe from the 1990s, I think is 1997. This this toy, this figurine is huge, protruding biceps, huge chest, thigh muscles that are huge, bulging through pants. And, you know, these are intended for boys to be playing with a lot of the times, and what does that communicate about how men should look, it really creates this sense that I should have these huge muscles. And biologically that is not really possible for a lot of us. So then I think that just pushes us down the path of being unsatisfied and judgmental towards our own bodies.

Dr. Karen Nelson  17:02

Once again, my mouth is hanging open, as you describe this to me, like, I am a mom of a boy. And I can honestly say I've never thought of that, that it's these kind of implicit, quiet, subtle messages that our boys are getting, as they're growing up about what my body should look like. And having some stress around that as then I move into, you know, through puberty into adulthood about this is the perception of what a male body is supposed to look like. So as I see this picture, we can start to see some of the evolution I'm being bombarded first with toys as a little boy. And then as I move into, you know, teen years and now early adulthood, all these pictures, potentially a desire to utilize eating disorder behavior in an attempt to shift push or force my body into looking a certain way. Are men and boys diagnosed with any one particular type of eating disorder more than another?

Ben Meyers 18:09

Yes, so 36% of those who have binge eating disorder are men. That is the most common diagnosis given to men. anorexia and bulimia make up 25% of males receiving that diagnosis. So binge eating disorder is the most common we see. But through research, they found that excessive compulsive exercise really is across the board with various eating disorders in this one research study is 50% of male participants were engaging in excessive and compulsive exercise.

Dr. Karen Nelson  18:46

Let's talk about that place of maybe focusing our attention first on binge behavior and binge eating disorder. How might pinch behavior start for a man or a boy?

Ben Meyers 18:59

I think we often hear this commentary in parents I think participate this too. I've heard this so much throughout my life about boys eating a lot. You know, like, oh, I have such a hard time keeping my fridge for such a hard time keeping my pantry full because I have boys at home. And that starts to seep into somebody's identity, that being a boy being a man means I eat a lot. And it also I think, too, can become competitive, I think back to, you know, times at which I'd go to a restaurant with friends and we would see who can eat the most and somebody that wouldn't be able to eat that much. All of a sudden there'd be insults and criticisms leveled at this person. So this idea of eating a lot being manly. I think it's solidified at a young age. And then you know when thinking about emotions that feel unmanly, right? Emotion means I don't want to feel because they make me feel masculine, like sadness, insecure fear. If I start feeling that I might want to gravitate towards something that makes me feel manly. So maybe that is me then turning to food, and maybe then I don't have to experience those emotions. And they have found that men are usually not concerned about binge eating, unless there is a lack of control that really starts to spread within this behavior that's showing up. So this idea of binge eating might not even seem problematic for a male, just because it might be the status quo. And this can also deter others from then expressing concern and worry, you know, this idea of, well, men just eat a lot. All of a sudden the food is going missing, there could be the sort of Oh, yeah, he's just, he's just eating a lot. If we find wrappers or some evidence that eating is being secretive, it could be the sense of oh, that that's okay and fine. And once again, then we're not addressing or talking about this. And we're pushing back the time at which this person can eventually address this and get support.

Dr. Karen Nelson  21:17

Absolutely. Well, I think about to that kind of emotional component of binge behavior, or quite frankly, all eating disorder behavior, you know, we might be engaging in these behaviors to avoid or distract from an uncomfortable emotion. And if it potentially goes unnoticed, because the social norm is that men and boys eat a lot it someone might not be picking up on it. Well, let's actually talk about transition our conversation a little and talk about potential contributing factors for men or boys to develop anorexia. And so anorexia is more descriptive of the restrictive aspect, right? We were talking about binging, kind of that overeating, feeling out of control with food. Anorexia is classically described as just restriction, right? Limiting intake of food. And so what do you think about those potential contributing factors for men or boys to be engaging in anorexic like behavior?

Ben Meyers 22:18

Yeah, and you know, a part of masculinity is this sense of control, being in control, having control and restriction, often, there's this sense of a way of regaining a sense of control, eating feels out of control, so I'm going to push food away, fullness, if I have any sensation of fullness, then I feel more out of control. So I think that idea of masculinity also can play into this idea of, well, food is the enemy, and I'm gonna push this out in order to lose weight.

Dr. Karen Nelson  22:54

Absolutely. Do you think that there is a way for, you know, teen boys or boys or men to potentially maybe unlearn or push against some of these messages that they are getting on social media or just kind of, you know, through our culture? What thoughts about that?

Ben Meyers 23:15

You know, I do think there is a current trend of pushing back and chipping away at masculinity, I do think we're headed into some, you know, areas in which men can seek out therapy, what therapy means now to boys means a lot different things than what it meant 20, 30 years ago, where I think therapy is a lot less intimidating, a lot more accessible. And I think that in and of itself, self is already chipping away at masculinity. But I think it's up to us, I think, as a society, as you know, being friends or family members to boys and men to just continue to be open, continue to model vulnerability to the open up the door in case somebody is struggling. And I think the more we do that, we cultivate then this culture, where men and boys can be human and feel these emotions that they will feel inevitably because they are human.

Dr. Karen Nelson  24:20

Absolutely. I mean, we could even just talk about, you know, you and I were talking Off mic about we're both parents, and we're both parents to little boys. And they happen to be lucky that their parents are therapists, right that you are not therapists, right. But literally just normalizing that boys can have big emotions, they can cry, and they can be sad and, you know, kind of that idea of like, toughen up, or Boys Don't Cry, or you know, if we get hurt, we shake it off, or, I mean, can is that where it can start?

Ben Meyers 24:55

Oh, absolutely. This idea of man up I think can really come into play early on. And I just think about what I compliment my oldest son on who's a toddler right now. And often they'll be like, Oh, wow, you're so strong, you'll be doing something really active. He's very active boy, and I'm often commenting on his strength. And what does that communicate that communicates that strength is really important. And, you know, that's then up to me to look at that, reduce that and really make an effort to compliment and highlight all these other things that he's doing that are amazing. But it just, it feels so automatic. For me, to complement that, or to focus on that, which I think is fascinating, and also makes me feel a bit guilty.

Dr. Karen Nelson  25:54

I think. I mean, first of all, I love this conversation. Because I think, again, these are kind of those embedded messages that we have in our culture about right boys don't cry, you know, they don't show pain. They are stoic and tough and strong. Like you're saying, you know, I remember my little boy, he got off the bus after the first day kindergarten, and his little eyes were so welled up, I could tell he he had had a really hard day. And he came off the bus and I gave him a hug. And I, I said, looks like you got some big feelings. And I said, it's okay to cry. And he said, Boys Don't Cry. Boys Don't Cry on the bus, kindergarten, he already picked it up. And his mom's a therapist, I'm like, Oh, I got some work to do. And so we bought hugs and right, but it's all that pressure that our boys are picking up. You know, it doesn't even have to be overt messages. It's all the subtle messages that they get.

Ben Meyers 26:56

Absolutely thinking about the cartoons and the cartoon characters, that they're seeing the toys that they're playing with, you know, how their teachers are interacting with them or their daycare providers. I mean, their message is that message seeps in and then I think it's really important for us to realize that's happening and, and try to do something about it, try to highlight all these other emotions that are going to be experienced, that could, I think, be neglected and hidden underneath anger, which becomes then this, this manly emotion, that's okay, all these other emotions that can get lost?

Dr. Karen Nelson  27:37

Absolutely. Well, and I think one of the things we work really hard to do here at Melrose is support people in having those uncomfortable conversations. Right? And that, you know, by not talking about it doesn't mean it's gonna go away. Let's transition and talk about what eating disorder treatment looks like. Can you describe briefly what what an experience might be for someone who has been recently diagnosed with an eating disorder? Coming to treatment here at Melrose? What does that look like for men or boys.

Ben Meyers 28:17

In the outpatient setting, a lot of times that's going to be meeting with a team of dietician, medical provider, and mental health therapist. We also have physical therapists on staff too, that can really focus on ways in which exercise can be a part of our life, but not have to interact with the eating disorder, or exercise doesn't have to hurt us. But a lot of times, meeting weekly with the dietician and the mental health therapists, it depends on the frequency and meeting with the medical provider. But really meeting the person where they're at, where they're struggling with, and also their level of openness and their level of comfort in terms of talking about these issues. Sometimes it's a process to make the space feel safe, make it feel comfortable. And I really feel confident that we have a team that is going to be able to play the long game if needed, but also, you know, encourage and challenge when needed, especially when it comes to an eating disorder that might really be impacting somebody's life.

Dr. Karen Nelson  29:33

I love that. Well, we really believe in collaborative care, right? That, you know, we, your treatment team is a team of people, and the patient is actively involved in cultivating that care for them. And so being curious, right, maybe I met I potentially might have an assumption coming into therapy that I can only see a man if I'm a man, I can only see a man and like you're saying explore a little bit and And, you know, work to have those conversations that, you know, our team can be a variety of people. And we're really committed to meeting you where you are, and being curious about how to best get you to that path of recovery. Let's maybe talk also about if I potentially have a friend, a male friend who's moving through eating disorder recovery, or I'm listening to this podcast, and my loved one is going through eating disorder treatment, how might I support them? Well, you know,

Ben Meyers 30:35

I think, opening the door, a common theme that we've been talking about here, but opening up the door to be able to have these conversations, noticing when this person might be following these masculine roles of being the protector and fixer, and only focusing on others, never asking for help with support. You know, that can be maybe that warning sign that there's some self neglect, that's happening, they're noticing, when body image struggles are showing up in terms of maybe hiding or avoiding, oftentimes, with body image struggles with men, it's avoidance base, so avoiding all mirrors, avoiding the scale, avoiding shopping for clothes. A lot of times, that's how men respond to a body image distress, where another way is body checking, where it's excessive, and fixation and always looking. If you notice a man trying to detach from their physical selves, it could be that warning sign of a this could be going on. And, you know, that can be a scary, uncomfortable question to ask, you know, how are you feeling about yourself physically, but just, I think really important for us to lean into if we're seeing those warning signs?

Dr. Karen Nelson  31:57

Absolutely. Well, I often think too, it's probably one of the most frequent questions we usually get right? As a therapist from loved ones, how do I support my loved one who is going through eating disorder treatment, and oftentimes, remembering that our job is their treatment providers, right? They have a therapist, dietician, medical doctor, maybe psychiatrists, physical therapist, right. And so loved ones don't have to do that for them. They have to love them, and support them, right. And sometimes the support is sitting with them at a meal or literally encouraging them to go to appointments, that can often feel really, really important to not minimize the necessity to receive care.

Ben Meyers 32:47

A great way to support somebody that's going through this treatment is to honor their reluctance, honor, the discomfort that's there, continually remind them that this is very courageous that they're seeking out support. And that's, you know, sharing a meal is always incredibly positive form of support that we can give to somebody that's really trying to change their relationship with food or the relationship with themselves.

Dr. Karen Nelson  33:20

Well, thank you so much for sitting with me today and having this conversation, Ben. It's been an absolute joy.

Ben Meyers 33:26

Yeah, thank you so much.

Dr. Karen Nelson  33:30

That's it for today. Thanks for joining me, we've covered a lot. So I encourage you to let it settle and filter in. And as I tell my patients at the end of every session, take notice. Pay attention, and we'll take it as it comes. I'll talk to you next time. Melrose heels a conversation about eating disorders was made possible by generous donations to the Park Nicollet Foundation