JUANA SUMMERS, HOST:
It can be hard to raise awareness for something that's often silent and looks healthy.
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UNIDENTIFIED PERSON: Beginning workout.
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SUMMERS: But for some boys and young men, that intense workout could be a sign of an eating disorder masked behind muscle building. It's hard to quantify how prevalent this is, but here's one data point. A recent study of young men in Minnesota found that more than 50% reported changing their eating habits to increase muscle size or tone. Now, to be clear, not all of these men have an eating disorder. But researchers say some may go on to develop unhealthy behaviors related to diet and exercise. Jason Nagata is one of the authors of the study.
JASON NAGATA: I do think that it is a really fine line because in general, in moderation, physical activity and exercise can be good for your health. But there's a slippery slope where a subset of young men will really take it to the extreme.
SUMMERS: Nagata is a pediatrician at the University of California San Francisco who specializes in eating disorders among adolescents.
NAGATA: We actually know that the idealized masculine body ideal is to become bigger and bulkier, and in order to achieve that, many of them are engaging in muscle-enhancing behaviors.
SUMMERS: Behaviors like strict dieting, compulsive exercise, use of steroids, all aimed at developing a lean, chiseled look like a professional athlete or a movie star.
GEORGE MYCOCK: I used to love the "Rocky" films and, you know, all these kind of ideas of, that's what a man supposed to be.
SUMMERS: George Mycock's experience with eating disorders began in his early teens. He grew up 40 miles south of Manchester, England, and went out for rugby at age 13, hoping to make his sports-loving father proud. But he fractured his spine. He couldn't work out for a year. He gained weight and struggled with a lost sense of identity. And for the next five years, losing weight and putting on muscle became priority No. 1.
MYCOCK: What I found was that the more I lost weight, the faster I lost weight, the more praise I got from people. No one really cared how I was doing it. I was basically starving myself and exercising multiple times a day.
SUMMERS: Mycock now says his diet and exercise regimen was unsustainable, and it took a toll on his mental health. He underwent treatment and is now working toward a Ph.D. focusing on men's physical and mental health. Andrea Vazzana sees patients like George Mycock in her practice. She's a clinical psychologist at New York University who specializes in the treatment of eating disorders. And she says that for many years, eating disorders have been underdiagnosed in men.
ANDREA VAZZANA: We used to think that there was about a 10 to 1 female-to-male ratio. If you do population-based studies, you actually find that the prevalence is much closer, that it's really only about 1 male to every 2 or 3 females.
SUMMERS: I asked her about the challenges she sees when it comes to working with boys and young men.
VAZZANA: You know, one of the things that we're always kind of working against is these stereotypes, these pressures that people, from a sociocultural perspective, are trying to overcome, the fact that people might actually get more positive attention from being muscular and having an athletic physique and that there are certain, you know, rewards that come along with that. But I think that what's oftentimes underestimated and might be neglected altogether are the costs that come along with trying to achieve that ideal and not only achieve it but to maintain it over time.
SUMMERS: If you could, could you give us a couple of examples of the types of short-term and long-range costs that you're talking about?
VAZZANA: Sure. Well, one of the short-term costs is some of the social impairment that ends up happening, right? It becomes too fearful to go out and eat with your friends - that all your friends might be really enjoying each other's company at a restaurant. But for a person with an eating disorder, that would be a very difficult challenge, right? There's likely job ramifications where you are tired and fatigued. You don't have that nutrition, and over time, that's going to take a toll on your work performance. It certainly will take a toll on your family life. If you're a male and you're not just focused on being thin but also trying to be muscularly fit, it means going to the gym all the time, right? It means that you're spending time developing your muscles rather than developing your life.
SUMMERS: I want to ask you a little bit about patient volume. In recent years, are you seeing an increase of patients and particularly boys and young men who are coming in seeking treatment for eating disorders?
VAZZANA: Yes, I actually am. You know, COVID really was such a stressor. And the way that people tried to manage that was sometimes, you know, through these maladaptive behaviors and having more time. I've seen probably more men now than ever before. It's still a smaller number than the number of females that I'm seeing. But I have teenage boys. I have adult men. I definitely have a fair number of men, more than I have ever had before.
SUMMERS: Wow. Why do you think that is that you're seeing more men than ever before? I mean, I find that striking to hear.
VAZZANA: Right. Well, I think that there's a better understanding of eating disorders. We get a fair number of referrals from coaches who are concerned about their players who might be excessively exercising. And they just recognize, oh, this isn't just, like, a female disorder anymore, that actually men are susceptible to this as well.
SUMMERS: As you are treating men and boys with eating disorders, I'm curious. When you think about the population that you're interacting with, do you see disparities among the types of men and boys who are coming into your clinic and seeking help?
VAZZANA: Sure. I mean, that's tricky in that the clinic where I work - we're not in network with any insurance providers, right? So...
SUMMERS: Understood.
VAZZANA: The - automatically the population that I'm seeing is skewed towards upper-income, at least middle-income with good insurance individuals, right? So in some ways, I might not be the best person to speak to. Or maybe I am the best person to speak to about the disparities because, yes, I definitely see disparities in the type of people who I am treating. You know, we know that eating disorders affect all different races, all different ethnicities. We know that high-income, low-income people - all of them are at risk for having eating disorders. It's just who is coming into the clinic.
SUMMERS: I understand that you've worked in this field for more than two decades, so I am just really curious. How has your experience treating patients with eating disorders changed over that span of time?
VAZZANA: Sure. The pressure that we see men under now to try to achieve this ideal has really increased. And I think, you know, social media has certainly played a role in that. I think it would be - it's undeniable to think that the fitness challenges - right? - that are on TikTok or on Instagram that you're seeing and the health challenges, you know, are kind of increasing the importance that people are placing on their appearance, whether that's right or wrong. So really trying to push back against that and help people to not buy into that is a really important part of both prevention work as well as treatment.
SUMMERS: That's Andrea Vazzana, psychologist and clinical co-director of the Eating Disorder Service at New York University.
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