Lanie Submissions

This is a section of articles found and submitted by Lanie.

A personal Battle With Anorexia


Kari Hanson's life seemed perfect when she was a senior at Mandan High School.

In the fall of 2000, Hanson won one of the most coveted sports awards in North Dakota when she was named Miss Basketball. She also led Mandan to its second straight Class A high school basketball state title.

In addition to being named Miss Basketball, Hanson made plenty of other headlines on the basketball court as a junior and a senior. Head coach Greg Amundson said he received 20 letters from NCAA Division I schools inquiring about Hanson. The University of Connecticut - the top women's basketball program in the nation - at one time showed some interest in Hanson. She might not have been on the school's "A" list, but UConn was aware of her.

Hanson chose Kansas State University in Manhattan, Kan., to continue her career. KSU was a heralded program in Division I and Hanson fit into the school's plans. She almost immediately worked her way into the team's starting lineup. She was living her dream ­ on the court

But Hanson was living a much different life off the court. Off the court, she was barely living at all.

Toward the end of Hanson's freshman year of college, she was diagnosed with anorexia nervosa, a state of starvation accomplished by severe dieting or purging and in some cases extreme exercise

Because of her battle with the disorder, Hanson is no longer playing basketball for the KSU women's team.

Hanson's life on the college basketball court may be over, but her life off the court is geting better. Hanson is ready to talk about her disorder. She's ready to let basketball fans in North Dakota know where she's been the past few years. Maybe if she talks about her ordeal, she says, her story could help save somebody's life.

Kari's story

Hanson says she slipped into her problem after graduating from high school. The coaching staff at KSU asked her to lose about 10 pounds. Hanson, who then weighed about 160 pounds, lost the weight, but lost it rapidly and not in a healthy manner.

A normal day for Hanson went something like this: Eat half of a granola bar, run on the track and work out in the gym, eat a sandwich, lift weights and do a cardio workout, eat a small salad and go to bed.

"They asked me to lose weight and I was trying to make people happy," said Hanson, a 5-foot-8 point guard. "It wasn't so much because of my looks. I can understand the coach's point of view ­ they don't want a guard with a lot of extra weight.

"I learned how to count calories. I just ate as least as I could to get through the day. I trained myself and thought it was good to be hungry. It made me feel like I was accomplishing something. I was a slave as far as the things I did. It is like an addiction"

Some of Hanson's personality traits that contributed to her eating disorder were evident earlier.

Amundson recalled Hanson's first game in a Braves' uniform. She was disgusted with the decisions she made on the floor and she was angry with the way her team played.

She grabbed her backpack and told her parents to meet her at her car. On the way to the game she ran out of gas and left her car stranded on the highway. Instead of accepting a ride with her parents, she jogged about a mile to reach her car. Things didn't go her way that night and she needed time alone.

Her sense of perfection would also explain why she graduated high school with a 4.0 grade point average.

"I'm a very, very strong perfectionist," Hanson said. "If somebody tells me to do something, I do it 100 percent, there's no ifs ands or buts about it."

Hanson's mom, Phyllis, said that characteristic has always been evident.

"If the coaches told her to practice 10 hours a day, she would push herself to do that and push herself to do one more," Phyllis said. "She's always had the urge to excel. Grade-wise, she tried to get straight A's. She always kept her room organized. She likes things in order."

As expected, Hanson made her coaches at KSU happy by losing the weight. She drifted back into her normal routine. Hanson also impressed her KSU coaches with her talent on the floor. She found herself in KSU's starting lineup and her team was ranked in the top 20 in the nation KSU upset Iowa State University around Christmas time and gained even more national recognition.

Hanson's obsession with basketball paid off. She was in the main five on a nationally-ranked team - something she strived for.

But after the ISU upset, Hanson hit a roadblock.

She tore 80 percent of the cartilege in her knee and it floated around in her knee joint. Every two weeks Hanson needed her knee drained. The pain was excruciating. She hoped to return to her team in mid-season, but the surgery wasn't a success. She went through another surgery around Easter time.

Hanson slipped into a depression. Basketball was her life, and she couldn't play.

"I lost my idenity," Hanson said. "I was very obsessive. I was willing to do anything to play or to be the best. My life was off balance."

Rock bottom

From being immobilized after her surgery, Hanson gained a little weight. That's when trouble set in.The KSU coaching staff told her the weight would need to come off when she returned to the court. She also didn't want her knee to support extra weight.

So Hanson basically quit eating.

She consumed only 600 calories a day and burned off about 2,500. Before college, her body fat tested at 22 percent. At one point it got down to seven percent. She eventually shed several pounds from her frame and once weighed in at 113 pounds. She also began to take laxatives.

Hanson began distancing herself from her boyfriend, friends, teammates and family. At meal time, she brought her food back to her room and ate alone, despite being invited to sit with her teammates.

For Hanson, it was the worst case scenario. Her career on the court was suffering, and her life off the court began to change, too.

"My relationship with my best friend suffered," Hanson said. "The friendship drifted. She didn't know what to do or say. I cut everybody out of my life. I told my boyfriend the only way he could see me was if he came to the gym. He got the brunt of everything and he stayed by my side. I tried so hard to push him out. He blames himself that he didn't get help for me earlier. I don't blame him. I lied a lot to make it sound like I was eating more."

Like most people who suffer from anorexia nervosa, insomnia set in. Hanson eventually was prescribed medicine to help her sleep. She still sometimes struggles sleeping. Her skin turned yellow from taking laxatives.

"I had big bags under my eyes," she said. "I was sick, tired all of the time. I would just lay and snooze on and off all day long. My sleep was just off the wall. I would read before I went to bed, wake up and clean house. I tossed and turned and laid there."

Hanson, a kinesology major, saw her grades began to slip, although not as much as they could have. Hanson maintains a 3.6 grade point average as she works to complete a doctorate degree in physical therapy.

"I couldn't concentrate," Hanson said. "I didn't have enough fat around my brain to process anything. My memory went away and I was going through mood swings. My hormones were imbalanced. It was like I was bipolar. A lot of things were comfort issues. If I felt like I was losing control of the situation, I would flip out."

Hanson recalled spending several hours preparing for an important exam. Because of starvation, she couldn't concentrate during the exam and she couldn't remember what she had studied.

"I had an anxiety attack during it and I failed," Hanson said. "I couldn't process what I was reading. It was really scary."

Hanson also battled a slow heart rate, which slowed the flow of blood to her brain. Exercise was out of the question for fear of the stress it could put on her heart, which could've resulted in a heart attack.

"I was sleeping and I was dreaming," Hanson said. "The side effect is not being able to wake up. I jumped head first on the floor and cut my chin open The doctor said it had to do with my heart rate being slow.

"I did lose bone mass, but I had very dense bones to start off with. I have been plugging with the calcium. I did lose some bone mass, but it's not below average."

Getting help

Hanson was confronted by several friends at KSU and the coaching staff, but she continued to deny she needed help. She flew home to Mandan in August. Her parents knew immediately she had a problem. Once of Hanson's close friends saw her and cried.

"Her coloring wasn't good," Phyllis Hanson said. "I recognized some of her eating habits. She was real careful not to eat too much and not to eat certain foods. She did all of the good things most of us should be doing, like dabbing fat off pizza. She read everything about how to lose weight and she combined that with intense exercise. She was in excellent shape, but she took that to an extreme, too."

Hanson was taken to a hospital in Kansas City, where she received treatment. She saw a doctor twice a week, a therapist twice a week and a nutritionist once a week. She was not allowed to exercise because she was too weak, something that lasted for about a year.

"I could hear my mom and dad whispering some things," Hanson said. " I was oblivious to the whole thing. I was really mad and I felt nobody was listening to me."

Hanson was presented with three choices in her treatment - she could go back to her parents' home and rehab, she could be admitted into a hospital or her parents could live with her in Manhattan until she was stable. For five months, Hanson's parents rotated living with her in Manhattan. Hanson's dad is a scientist for the United States Department of Agriculture and her mom is the school nurse at the elementary schools in Mandan. Her dad worked out of an office in Manhattan and her mom was granted time off from work when she needed it.

"I had more arguments with my mom than my dad," Hanson said. "It was hard for me because I hadn't eaten with people I always ate alone.

"My parents have been incredible," she said. "I realized how much they loved me. They were willing to drive 13 hours one way and that isn't easy. Our relationship has improved. I would leave in the summers and play on national teams. We traveled all around the nation. I never got to see my parents."

When Hanson began her sophomore year at KSU, she was transferred out of the dorms where athletes lived. She won't be cleared to play basketball again until her weight reaches 135 pounds. As far as competing at the college level, Hanson said her career is finished.

"I pulled away from the team," Hanson said. "It was hard for them to see me going through this. I was always really hyper and had energy. I was always a jokester, laughing and happy. They saw me when I was sad and depressed and I had no energy."

Putting pieces back together

Hanson has played intramural and pickup games. She once smoothly used a wide selection of moves on the court, but her body now is physically unable to perform those moves. She used to be automatic from the 3-point and free-throw line, but she has lost the strength to be a sharp shooter.

While Hanson struggles with losing her basketball identity, she deals with it on a day-by-day basis. She still focuses on her school work and she plans to travel to China this winter for a missions trip through a church.

"What I had gone through made me realize I was living my life for the wrong thing," Hanson said. "I was sacrificing my life for basketball and my happiness for basketball. I let my coaches have a say in what my life was like. I was obsessed with basketball and I put it first."

Now Hanson puts her own life and her own happiness first. If she were still involved with basketball, she wouldn't be able to complete her missions trip in China.

"I know for a fact I wouldn't be where I'm at without God," Hanson said. "The counselor said I'm in the process of recovering really fast. It's hard because I'm addicted to exercise. I don't like to fail. I want to be the best, no regrets."

Phyllis Hanson and her husband do miss watching their daughter play competitively on the court, but they are thankful that she became interested in playing intramural ball. They are also pleased that she has developed other interests, such as playing recreation volleyball and softball and focusing on school and a relationship with God.

"There's a time for every athlete to say it's the end," Phyllis said. "Her's came a little sooner. She's starting to play again and the love of the game is coming back again. That's what scared me, seeing her having no feeling toward playing initially. She's realizing the importance of having other activities and school and faith. If she was playing ball she wouldn't have those opportunities."
Back To Top

Self Injury

Whether cutting, burning, head banging, scratching, and even scab picking, growing numbers of adolescents are hurting themselves. In fact, the latest statistics show that as many as 3 million people -- mainly adolescents -- practice self-harm.

And "the rates certainly seem to be increasing," says David S. Rosen, MD, MPH, chief of the section of teenage and young adult health in the department of pediatrics at the University of Michigan Health Systems in Ann Arbor .

"We live in a more stressful world; people's behaviors are more infectious because of the Internet and instantaneous communication, and we recognize [self-harm] much more than we have in the past."

While doctors are getting better at recognizing it, treatment is still evolving, experts tell WebMD.

Why Do Young People Harm Themselves?

Actress Angelina Jolie has talked openly about how she once cut herself to express pain. The movie Thirteen , which was written by a 13-year-old girl, highlighted cutting. In it a 13-year-old girl is transformed from a well-behaved honor student into a rebellious member of her school's popular crowd.

According to many experts, self-harm is not necessarily attention-seeking behavior. Most agree that self-harm is a way of coping with feelings that the individual has difficulty controlling or expressing.

"If you think about youth suicide, which 15 years ago was heavily portrayed in the media, it did seem as though media representations increased rates of that behavior, so if that is a model, then a lot of media attention to [self-harm] could, in fact, increase the likelihood that someone might try this if she is feeling bad," he says.

What Is Self-Harm?

Cutting is overwhelmingly the most common type of self-harm, but some people bang their head, some people stick themselves with pins and needles, and some people scratch or rub until they abrade their skin, he says.

"Picking scabs can also be a [type of] self-harm," says Karen Conterio, author of Bodily Harm and founder of SAFE (Self Abuse Finally Ends) Alternatives at Linden Oak Hospital in Naperville , Ill.

"Everyone has picked off a scab, and that doesn't mean they should be running to the nearest psychologist," she says. But "if you pick a scab because you are anxious and can't get the words out or think 'I am fat' or 'I am ugly' and then pick a scab, or if you created a wound on your face and then picked the scab, it could be self-harm," she says.

Cutting Is Not a Suicide Attempt

"Many people are viewed as suicidal, but [self-harm] is much more of a self-preservation act," she says.

Steven Levenkron wrote the book(s) on cutting -- literally. Levenkron took a fictional look at the behavior in The Luckiest Girl in the World and examined it further in Cutting: Understanding and Overcoming Self-Mutilation. The USA network made a movie on his fiction called Secret Cutting .

"The first cut is a result of a large insult or catastrophe, and the second cut takes less provocation. The third cut takes even less, and the next thing you know you are cutting because you anticipate having a bad day, and after that they cut because they are at a low point in [their] mood cycle, and then finally they cut because its been too long since the last cut," Levenkron tells WebMD.

Who Cuts?

Self-harm can occur with other disorders such as depression, obsessive-compulsive disorder, addictions, and eating disorders. It usually starts around puberty and can get worse if not treated.

And "anybody could be doing it," Rosen says. "It's more girls than boys, and more people start when they are 13 or 14, and self-harm is associated with depression, low self-esteem, anxiety, and a history of trauma or abuse," Rosen says.

Women who are abused physically or verbally by their partner are 75 times more likely to harm themselves, according to a study in the Emergency Medical Journal . And men who harm themselves were more than twice as likely to report partner abuse than their non-self-harming counterparts, report researchers from Addenbrooke's Hospital in Cambridge , England .

However, they are not sure if it's the chicken or the egg. Either domestic abuse could lead to self-harm, or self-harm could be associated with personality traits that make a person more likely to choose to be or stay in an abusive relationship.

"There seems to be a high percentage of people who report physical, sexual, or emotional abuse, but that doesn't have to always be the red flag," SAFE's Conterio says. "Divorce can be a trigger, or sometimes there is an ill child in the family where the healthy child is neglected and may feel guilty, as in 'why I am I healthy? Why is my sibling sick?' So they self-harm," she says.

You can tell by "unexplained injuries or injuries such as 'my cat scratched me' or hiding of arms or legs in warmer weather. I think if a parent does suspect their child is self-harming, they should ask, 'Are you hurting yourself?" she says. If they say yes, then get some evaluation to see how serious it is, she recommends.

"Noticing a cutter in summer is easy as pie if they are wearing short sleeves -- its 'gotcha,'" says Levenkron.

Parents and peers need to recognize the signs of distress linked to cutting such as being increasingly anxious, depressed, unable to handle feelings or emotions, and panicky.

"We try to help people understand why they do this and develop strategies to manage the anxiety, [and] there is some sense that medication can be helpful," Rosen says.

Cutting is often associated with other psychiatric illness, so addressing other disorders can help stop the self-harm, he says.

SAFE offers a 30-day inpatient program for adolescents, and for adults there is an inpatient/outpatient program.

With a combination of medications and therapy, Levenkron says that 90% of self-mutilators in his practice give up the self-harming behaviors within one year of treatment. This is followed by much longer period of time in therapy to heal the underlying causes of these behaviors.

For more information, call SAFE at (800) DONT CUT or visit www.selfinjury.com.
Back To Top

Pro Anorexia

Aug. 2, 2001 -- The visitors, almost all of them young women in their teens and 20s, visit the Web sites by the thousands each day. All are struggling with body image issues and many have full-blown eating disorders. They come, incredibly enough, not to find help, but to find allies in their battle against their perceived fatness.

Pro-anorexia Web sites have proliferated on the Internet within the last two years, and there are now hundreds of them with names like Dying to be Thin and Pro Ana (for anorexic) Sanctuary. Most warn people who are trying to recover from eating disorders to stay away, but experts say the message is lost on those who are desperate to have their weight-loss obsessions validated, such as this visitor:

"My parents have been making me talk to this counselor once a week, but I continue to lose weight. I tried to hide that but my family and friends notice. Now they say if I don't gain two pounds in the next week, the doctor is putting me in an eating disorder clinic. What do I do?? I can't gain the weight. I am so close to where I want to be. And I don't want to be in some clinic. Do any of you have any advice that could help me?"

At 5'6" tall and 101 pounds, the young girl posting this message in mid July at the Yahoo! chat room My Friend Ana is between 20 and 40 pounds underweight, according to standard weight tables. But the "advice" she received included drinking huge amounts of water prior to her weigh-in and hiding rolls of pennies in her underwear.

"I am appalled when I see these sites, which present eating disorders as normal," Vivian Hanson Meehan, RN, president of the National Association of Anorexia Nervosa and Associated Disorders, or ANAD, tells WebMD. "Young people struggling with this issue want to believe family and friends are wrong when they tell them they are too thin or they should eat. Anorexia is a deadly disease, but these sites treat it as a choice."

According to ANAD figures, 7 million women and 1 million men in the U.S. suffer from eating disorders. More than 80% have developed the illness by age 20, and 6% of serious sufferers -- those who are repeatedly hospitalized -- die from it.

While many of the sites claim to promote healthy weight loss, most of the sites visited for this story contained tips to help anorexics and bulimics hone their skills. For example, one site found through Yahoo!, called The Perfect Body, proclaims anorexia to be "a lifestyle, not a disease" and offers readers "tricks" to help other food-averse visitors hide their disease. Here are some examples:

When you are watched while eating, or in my case w/ your parents, put the food in your mouth and spit it out in your cup while u pretend u r drinking, so they won't know, they'll just think u r drinking. -- Steph

When you go to restaurants or a party or something and you are served, play with your food a lot, if you have to eat. Eat only when someone is looking, and put some food in a napkin. That is exactly what I did on my birthday with the cake. ... But you really have to be careful, cause there really aren't any good explanations on why you put your food in a napkin.

WebMD contacted Yahoo! for the company's view about these sites. A company spokeswoman read this prepared statement:

"The Internet is a rapidly growing medium and, as is true elsewhere in our society, we and our users are struggling with society's most challenging issues," she read. "When content with the sole purpose of promoting harm is brought to our attention, we will evaluate it and in extreme cases remove it. Although this issue affects an extremely small portion of our overall user base, it is something we take very seriously."

Judy Sargent, 33, tells WebMD that these pro-anorexia Web sites "give people ideas about how to best starve themselves or purge, and they make it seem like a game. ... People don't realize how dangerous anorexia is and how much it will take from their life."

Sargent should know. She struggled with anorexia for a decade and was hospitalized 26 times. Three of those times, she wound up in intensive care, and she watched three close friends die from eating disorders. Now a registered nurse, she has written a book about her illness titled The Long Road Back: A Survivor's Guide to Anorexia.

"I ended up with no friends and no life, locked behind closed doors in a psychiatric ward," she says. "All my friends had gone on to college or had married, and I had none of those things. Eventually eating disorders consume your whole life. They don't lead to happiness. They take everything away."
Back To Top

Older Women and EDs

Dec. 11, 2002 -- Some women who struggle with eating disorders like bulimia and anorexia nervosa may have immune systems that have been thrown out of whack and are now interfering with their bodies' own ability to control food intake and body weight.

A new study suggests that eating disorders may stem from some of type of immune system abnormality that causes other difficult-to-treat diseases like rheumatoid arthritis, multiple sclerosis, and lupus.

Anorexia and bulimia affect up to 3% of women at some point during their lifetime. Both conditions tend to develop at a young age and can cause serious mental and physical problems.

Anorexics tend to develop a distorted body image that causes them to limit food intake severely and become dangerously underweight, while bulimics go through cycles of "binging and purging" -- eating excessive amounts of food followed by induced vomiting.

Although the exact causes of the eating disorders are unknown, recent research has suggested that an abnormality in the nerves of the area of the brain that controls hunger may be to blame. And the researchers of the current study thought the problem might be that antibodies in the body cause damage to these nerves.

In the current study, Swedish investigators found that 74% of women with anorexia or bulimia had developed these antibodies that may make it harder for them to regulate food intake and body weight.

Their findings appear in the early edition of the December issue of the Proceedings of the National Academy of Sciences.

This may mean that the cause behind eating disorders may lie within the immune system. In conditions where the immune system goes awry, the body -- for an unknown reason -- forms antibodies that attack other areas of the body, as if they are foreign objects. This group of conditions is called autoimmune disorders and includes rheumatoid arthritis, lupus, and multiple sclerosis.

Researcher Serguei Fetissov of the Karolinska Institutet in Uppsala , Sweden , and colleagues say it's unclear whether the antibodies directly affect the brains of women with eating disorders. But laboratory tests in rats showed the antibodies could indirectly interfere with brain signals involved in metabolism and weight control.

However, a small number of healthy women also carried similar antibodies, and researchers say merely having these antibodies in the blood may not guarantee development of an eating disorder.
Back To Top

Body's Food Cycle Amiss in Night Eaters

Night eating syndrome is commonly seen in overweight people. And new research shows that the cause may be an abnormal food cycle in the body.

Researchers say that people with night eating syndrome appear to have disturbed circadian rhythms of food intake. Circadian rhythms are the cycle that your body operates on -- your body's 24-hour clock.

Night eating syndrome is seen in about 6% of people who seek treatment for obesity, according to Albert Stunkard, MD, emeritus director of the Weight and Eating Disorders Program at the University of Pennsylvania School of Medicine. Night eating syndrome may also run in families.

First described by Stunkard in 1955, night eating syndrome may be stress related and is often accompanied by depression. Individuals with the disorder eat one - third or more of their daily calories after their evening meal, sometimes rising from their beds once or twice a night to snack.

Speaking at the North American Association for the Study of Obesity (NAASO) annual meeting this week, Stunkard presented some of his latest findings.

In his new study, Stunkard and colleagues monitored sleep/wake activity over one week in 55 obese adults with night eating syndrome. Participants were compared with 60 people of similar weight who did not have night eating syndrome.

The researchers found that night eating syndrome involves a disturbed circadian rhythm of food intake while circadian sleep rhythm remains normal.

"The circadian rhythm of food intake is extremely disturbed and the timing is delayed by 4 or 5 hours compared to that in normal people," Stunkard tells WebMD.

According to the researchers, night eating syndrome "is the first clinical disorder to manifest different circadian rhythms of two biological systems."

Stunkard also found that 36% of those with night eating syndrome had at least one first-degree relative with the disorder, compared with 22% of those who were not night eaters.

The researchers also report that night eating syndrome may respond to treatment with the antidepressant Zoloft.

In a separate study of 17 night eaters, 29% of patients taking Zoloft experienced total remission of the disorder, and 18% improved significantly. This study was funded by the National Institutes of Health and Pfizer Pharmaceuticals, the manufacturers of Zoloft.

On average, nighttime awakenings fell by 60%, nighttime eating by 70%, and number of calories eaten after supper by 40%, they report.

A paper describing these research findings will be published in the January issue of the International Journal of Eating Disorders .

Stunkard says that their ongoing research is looking at the effect of certain hormones, such as insulin and leptin, on circadian rhythms.
Back To Top

Chromium May Cut Carb Craving in Depression

A popular nutritional supplement may reduce serious carb cravings in people with depression.

The supplement is chromium picolinate. The new finding comes from a small clinical trial sponsored by Nutrition 21, which years ago purchased the patent rights to chromium picolinate from the U.S. Department of Agriculture.

John P. Docherty, MD, president of Comprehensive Neuroscience Inc., White Plains , N.Y. , and adjunct professor of psychiatry at Cornell University , penned the report. Docherty presented the findings at the National Institute of Mental Health's annual New Clinical Drug Evaluation Unit Conference, held this week in Phoenix .

"It is an exciting finding," Docherty tells WebMD. "The real benefit of this is the high rate of response in this subgroup of depressed patients. If this finding holds up, it is a very important finding for depression. And there was a very, very favorable side effect profile."

Chromium Picolinate's Effects on Metabolism

Chromium picolinate is a nutritional supplement. The "picolinate" part of the compound is thought to enhance the body's ability to absorb chromium. Chromium is a necessary mineral. The typical Western diet barely contains an adequate amount of chromium -- so chromium supplements are quite popular. It's the second most popular mineral supplement in the U.S.

All kinds of claims have been made about chromium picolinate. Few of them are proven. One known effect is the supplement's ability to increase the body's sensitivity to insulin, helping it work better to control blood sugars. It's not clear whether the supplement provides significant help to people with diabetes. A recent analysis of well-designed studies showed that it does not significantly affect blood sugar or insulin levels in people who do not have diabetes.

Depression, Diabetes, and Carb Craving

Docherty notes that there is a connection between diabetes and depression. People with depression, he says, are twice as likely to get diabetes. What's the link?

The most common form of depression, ironically, is called atypical depression. Instead of losing their appetite, people with atypical depression often overeat. Many of these people report an almost irresistible craving for carbs.

Docherty's study enrolled 113 people with atypical depression. Two-thirds took chromium picolinate supplements for eight weeks, and one-third got a placebo.

When the researchers looked at all the patients -- those with and without carb cravings -- they found no overall depression benefit from the chromium supplement compared to placebo. It did, however, cut carb craving.

But chromium did improve depression in certain patients. Researchers found that atypical depression patients who also had carb cravings improved with chromium compared to placebo.

"In that group with high carb craving -- a third of the patients -- we had a very significant benefit from chromium picolinate," Docherty says. "Compared with placebo, it had a 2-to-1 advantage in reducing depression overall."

Maybe, Docherty speculates, this small study has found the missing link between depression and diabetes.

"This could turn out to be a very big benefit if the relationship between depression and diabetes is mediated by carb craving," he says. "It might be that if you eat more carbs, you tax your insulin system more and are at greater risk for diabetes. This treatment chromium picolinate may lower high risk of diabetes in people with depression. That would be terrific."

Chromium Picolinate for Carb Craving?

It is not clear that chromium picolinate -- or anything else -- can help normal people eat fewer carbs, says Leslie Bonci, MPH, RD, director of sports nutrition at the University of Pittsburgh Medical Center. She is also a nutritional consultant for several sports teams and the Pittsburgh Ballet Theatre.

"What is carb craving? It would be really difficult to define that," Bonci tells WebMD. "Yes, there are some people who are going to gear more toward the pasta and potatoes than steak and tofu, but that doesn't have a clinical definition. ... It would be a stretch to say that across the board, carb cravers should go with chromium. Bodies aren't that smart. Psychological and environmental factors do a lot more to determine the cravings we have."

On the other hand, Bonci says, the findings regarding insulin sensitivity and chromium picolinate are "exciting." Moreover, she explains, many people do get too little chromium in their diets.

Huge exposures to chromium can be dangerous. But Bonci notes that people who take chromium supplements don't get harmful side effects.
Back To Top

The Color of hunger

Is the face of eating disorders only white and middle class?

Not even close, according to Becky Thompson, a professor of African-American studies and sociology who studies eating problems from a multiracial perspective. Thompson is the author of "A Hunger So Wide and So Deep: A Multiracial View of Women's Eating Problems" (University of Minnesota Press, 1997). The book culminates her unique research, based on eighteen multiracial women's struggles with anorexia, bulimia, dieting and compulsive eating.

Thompson's subjects are African American, White, biracial, Latina and Jewish; their classes and sexual orientations vary. The link? They've grown up with a variety of stresses--racism, homophobia, sexism and abuse--which Thompson pinpoints as the true catalysts of many body problems.

So why the shroud of silence? Shame makes it especially difficult for women who don't fit the "profile" to speak up and seek help. For many ethnic women, healing from body problems goes hand-in-hand with finding a solid racial, sexual, or personal identity.

Why do you use the term "eating problems" instead of "eating disorders?"

BT: Racism, poverty, homophobia or the stress of acculturation from immigration-those are the disorders. Anorexia, bulimia and compulsive eating are very orderly, sane responses to those disorders. So that's why I don't even use the word "disorder." I'm shifting the focus away from the notion of eating problems as pathology, and instead labeling forms of discrimination as pathological. I even thought for a while that I should say "eating issues." But I ended up using the term because eating problems do become problems for women.

What about perceptions that eating problems are linked to vanity and appearance, rather than to trauma?

BT: It's perfectly acceptable for a woman at a lunch table to say something like, "God, I really want to lose five pounds," or "My dress doesn't fit right," or "I want to go to the gym so I can look better." It's not nearly as acceptable for that same woman to sit at a table and say, "I got beat up last night," or "I'm really worried about my son on the street." We need to figure out a way to have the real conversations with each other, and to make those as acceptable as ones about bodies and dieting.

One thing I found really interesting was that you used the term "body consciousness" rather than "body image."

BT: I would never have known to be critical of the concept of body image until I was talking to an African-American woman named Jocelyn, and she described her body image as "just ashes up in the air...." It hit me that I had to start way back and not assume that women are "in their bodies" to begin with. For women who've been traumatized, issues of embodiment aren't anything to take for granted. I had to look at whether they felt comfortable residing in their bodies, or just in part of their bodies; whether they considered their bodies a friend or an enemy; whether their bodies felt like safe places to be. These are things people who haven't been traumatized don't consider: If you're used to your home being in one place, it won't dawn on you what it's like to be homeless.

You would picture body issues as kind of a "homelessness" that goes on until a woman becomes comfortable, or has a sense of her body as a safe place?

BT: I was talking to some people once who couldn't get their hands on what it meant to not live in your body. It's very hard to understand unless you've been through it. One of the images I use is, you're driving down the street to go to your house, and you turn into what you thought was your driveway, and the house has just completely disappeared. You're gonna spend time going from one neighborhood to the next going, "Did you see? Do you know what happened?" You're gonna try to get a story of how it happened. Your life will never be the same without that home, with all your things in it. Women who have had to leave their bodies because of trauma try to recreate a sense of home in their bodies.

How strong is the link between trauma and eating problems?

BT: In my study, I sought a community sample—everyday women who were working three jobs, holding half the world up. It's not like I interviewed women who'd been hospitalized. The women I talked to were community leaders, professionals, mothers, artists. They were knock-down-drag-out, amazing women—and the level of trauma in their lives was shocking. That left me to wonder what level of trauma so many marginalized women are living through in a day-to-day way that's just become like the air they breathe. I find that really troubling. I had no idea I'd find that depth of violence in the lives of the women I interviewed. And at the same time, they were very inspiring in their ingenious and methodical ways of healing. Really creative! The negative thing is that none of them got professional help from people who had background in eating problems.

Right. They went to Overeaters Anonymous, and that sort of thing, but they weren't hospitalized.

BT: They weren't treated, but they also avoided some of the stigmatizing aspects of a medical solution to eating problems. They didn't get caught up with being restrained in an eating disorders clinic, or an inpatient clinic. They didn't get pushed with drugs.

I like that you expand the definition of body consciousness beyond weight.

BT: The whole body image category came out of the fashion industry. I tried to think of body consciousness as something that had to do with weight, height, skin color, hair texture, facial structure. All of these things go into how we perceive ourselves, how others perceive us, and the kind of power we're granted in the world. A lot of body literature is problematic because it ranks gender oppression as more severe than other kinds of oppression. That's totally missing the mark. There's a simultaneity of oppression-we don't need to rank them, but we can recognize them all. Jocelyn felt like she couldn't change her skin color or her hair texture, but she could change her body size. That was part of her thinking process, and the way she chose to protect herself while growing up. So it's not possible to talk about body consciousness outside of colorism, or plain old racism.

Why did you pick a multiracial focus on body image?

BT: In the 1980s, I did workshops called Women's Hunger and Feeding Ourselves, in university and community settings. I also worked at The Multicultural Project, which is a community-based, anti-racist, anti-oppression training center. Many of the people who came to these workshops fit the standard portrait-White, middle-class, heterosexual women. But a lot of the people who came didn't fit that portrait-women of color, lesbians, and working-class women. A lot of people lump White women into one homogeneous group. You can't do that. The White Christian women I talked to never would have addressed the issues of anti-Semitism and feeling like they didn't fit in to mainstream American culture. Many Jewish women felt like they were getting hit with one thing after the next-if it wasn't the shape of their bodies it was their noses. If it wasn't their noses, it was their curly hair.

Why do you think there's such a silence for women of color, lesbians and working-class women around this issue?

BT: In my situation, as a lesbian, when I first started to seek treatment for my own eating problems after ten years, I snuck to the support meetings. I thought that it would kind of sully my lesbian credentials. The notion of it being a heterosexual phenomenon made it harder in the '80s for some lesbians to come forward, for fear that they would be seen as having internalized all those patriarchal standards, or weren't "real lesbians." I'm part of that same invisibility.

So it's more of a taboo--as though you crumbled to the patriarchy?

BT: There's a long history of scrutiny that Black women have needed to have because of racism within the health profession. Black women are regularly mistreated by the medical system and misunderstood by psychologists. There are also problems for African-American women who come from families where being big was considered positive in previous generations, and eating was a sign of celebration. To dare develop anorexia or bulimia is in a way to feel like you're betraying your ancestors.

There's a belief that Black women don't develop anorexia and bulimia in the same proportions as White women. Is that a myth?

BT: There's no reliable statistical analysis. We need a quantitative study that's race- and class-sensitive. I don't think it's possible at this point to even say with any clarity whether anorexia and bulimia is more common among White women than among Black women. The level of secrecy would make that hard to measure.

Does that play into people's feelings, that they have to protect the public image of their communities?

BT: In 1994, Essence surveyed its readers about overuse of laxatives, chronic use of diet pills, dieting and starvation. Then they compared the results with statistics from a 1984 Glamour survey of White readers. In every single category, Black women scored higher in terms of difficulties than White women did. Those statistics are very revealing. Eating problems often reflect trauma, and Black women face so many different kinds of trauma.

What were some of the biggest myths these women shattered?

BT: There's a continued tendency in American culture to view healing as an individual process. The women in this book talk about healing as part of the body politic: If eating problems are a consequence of racism, sexism and homophobia, nothing less than revolution will do. The women in the book talk about healing through activism-through working at a battered women's shelter, or a rape crisis hotline. Some of the Jewish women in the group put together a body image awareness group that met every three weeks for two years. They didn't feel comfortable going to Overeaters Anonymous, because it's so Christian-based. They wanted a self-help group that was "leaderful"-meaning everyone in the group led, instead of following one facilitator. That kind of creativity speaks to the collective process of justice work.

How can we begin making change?

BT: We're living in an incredibly regressive, conservative time, so talking about issues of revolution can feel fraudulent. We need very specific and concrete coping strategies. One of the most valuable models is the National Black Women's Health Project. They do self-help groups that are both about self-transformation and community-based politics. They've done these for over ten years, and go all over the country educating women on nutrition and issues of embodiment.

Would you say the answer is a combination of education and activism?

BT: It's consciousness-raising that takes into account race and class. People also need to get uppity. We need to demand that treatment centers have multiracial sessions. One conference after the next has sessions on eating problems where everyone on the panel is White, and there's a real taboo against being a professional who's also had eating problems. It's like if you've had eating problems, you somehow can't speak to the issues as a professional. We need to get rid of those dichotomies. Healing is a profoundly communal affair.

Thin Not 'In' for Everyone (I have major issues with this article because it doesnt add up to me after reading the article above "The color of hunger" - Choose whether or not you want to place this article on your site. I am giving it to you because I found it but I do not agree with the idea that minorities have less eating disorders. In fact, maybe in the past that was the case but now that our entire world has become fashion and body conscious, there is no way we can say that minorities have less eating disorders. I mean, I heard that a woman from an african nation won a miss universe or miss something or another pageant. It was the first time they had won b.c it was the first time that the person chosen was as thin as the western women. Well a lot of the women in the country started to go on diets and started fasts b.c they too wanted to look like the person from their country who won. I also know for a fact that eating disorders are on the rise in countries like china. And as far as minorities in the US. I think maybe they are afraid to speak up or people dismiss the possibility of them having EDs because of their race. Either way, I dont agree with this article at all.
Back To Top

Minorities and EDs

Not all American women are obsessed with thinness. In fact, unless they feel extreme pressure to conform to mainstream society, blacks and Hispanics are much less likely than their white counterparts to develop bulimia, a new study shows.

"For some minority women, while they may be unhappy with their bodies, being thin is just not that high on their list of values; in the dominant mainstream culture, the ideal body is high on the value list," says study leader Thomas Joiner Jr., PhD, the Bright-Burton Professor of Psychology at Florida State University in Tallahassee, in a news release. "It just shows how powerful the protective quality associated with many minority groups -- strong families and connections to a community -- can be."

The team looked at the effects of body dissatisfaction and acculturative stress -- the pressure to adapt to a society's dominant cultural norms while rejecting the standards of one's own ethnic or racial group. They surveyed 118 white, black, and Hispanic female college students.

Overall, white and Hispanic students were more likely to report having bulimia and body dissatisfaction than were the black students, although blacks also reported being unhappy with their bodies. Bulimia was notably more prevalent in those black students who also reported particularly strong acculturative pressure.

Obsession with body image and the cyclic bingeing and purging of bulimia affects people of all races and ethnicities, and our society's strong emphasis on physical perfection leads to eating disorders in both men and women. But in this study, the researchers identified "a subgroup of women whose body dissatisfaction is not associated with bulimia," says Joiner. "Minority women may be protected as long as they are not actively acculturating."
Back To Top

Male Athletes Have Poor Body Image, Too

Having poor body image is often associated with women but a new study shows that male athletes have their share of problems with it, too.
A survey of elite college athletes showed that 20% of male athletes believed they weren't muscular enough. Jennifer Cater, a psychologist at Ohio State University Sports Medicine Center, recently presented the research at the meeting of the American Psychological Association.
It appears, however, that male and female athletes view body image problems differently. Women in the study wanted to lose weight (an average 6.8 pounds), while men wanted to gain (an average 3.2 pounds).
Men Struggle With Magazine Images
"Some male athletes see pictures in men's fitness magazines of big, extremely muscular men and feel that they don't measure up," Carter says in a news release. Researchers also found the following about male athletes:
22% believed that parts of their body were too fat.
20% believe they are not sufficiently lean and muscular.
9% use and/or spend a lot of money on performance-enhancing drugs or substances.
5% avoid situations exposing their bodies.
Carter's study specifically looked at athletes in "lean" sports -- gymnastics, swimming, diving, cross country running, and track. There is an added pressure in these sports to be lean for aesthetic or performance reasons she says.
The findings for athletes in lean sports showed that 17.5% of them showed symptoms of eating disorders compared with only 9% of athletes in non-lean sports -- basketball, football, and hockey.
Overall the study shows that men make up an estimated 10% of the American eating disorder population.
Carter says the problem needs more attention, especially because there is little research on it and poor body image can be disguised in men. "I don't have male athletes approaching me to say they have an eating disorder, but I do see athletes who say they are concerned about their body and want to be bigger and more muscular. Sometimes their desire to be more muscular has little to do with improving their athletic performance," she says.
Back To Top

Chris Godsey gets real about mens growing body obsession

Brad Pitt is a beautiful man. I'm a male, I'm straight, and I don't mind admitting that Brad's body, especially in "Fight Club , " is an impressive sight. Same with D'Angelo, in that powerful, sexual "Untitled" video; he's a put-together dude, and there's no reason to deny it.

But while I'm cool with thinking those guys are fine, I'm bothered by my occasional inability to see them, Men's Health magazine, or any Soloflex commercial, without honestly believing that unless I have three percent body fat, a hairless torso and washboard abs, I'm a sorry human being.

I spent the week after watching "Fight Club" counting calories like Sarah Ferguson; if I catch "Untitled" on MTV Jams before heading to work in the morning, I usually skip breakfast and double that day's workout.

After a long time believing I run, lift, bike, hike and try to "eat right" in the interest of being fit, I've realized my motivations are more superficial than healthy. Instead of seeking true mental and physical fitness, I worry about appearances—about what I'm convinced I should look like, based on magazines, movies and MTV.

I go through streaks of avoiding certain foods not because they taste bad or otherwise disagree with me, but because I'll feel guilty after eating them...like getting freaky with Little Debbie or Sara Lee is something I should be ashamed of.

The thing is, I'm actually in pretty decent shape—about 6' 2", 200 pounds, and relatively solid. I don't lift much, but I do a lot of pushups, pullups and crunches, and I run and bike about 80 miles a week. Most of the time, I usually eat whatever I want, and while I'm working some back fat and a little extra around the middle, I'm not doing too bad. I'm not ripped, but I'm not flabby, and I'm healthy enough to feel lucky.

Still, since high school, I haven't been content. On an intellectual level, I understand that every human body is different, and that there are no "right" and "wrong" ways to look, and that I don't have to live up to anyone's standards by my own.

But what are my standards? A few years ago, I lived with a bodybuilder who was my height, plus 40 pounds, and about four percent body fat. I felt skinny and soft and sub-par that whole year. Now, I live with a competitive runner who weighs about 140, and if I'm not careful, I start feeling like an oaf, all big and clumsy and excessive.

My head just about explodes trying to find a balance between what women want to see, what constitutes fitness, and how much (and why) I actually care. It's tough to observe my own standards when they never stay the same, and when they're manipulated by forces I don't always comprehend.

So what the hell is going on? Why do I spend so much time in the mirror, flexing and twisting and prodding and scrutinizing every part of my body that I deem less-than perfect? Why can a Polo Sport ad inspire me to denounce all fat and commit every waking moment to some sort of muscle-building or cardiovascular activity? Why, after my girlfriend tells and shows me in 50 different ways that she considers my physical presence a religious experience, do I ask her if she's attracted to me? It's like I'm a...

I don't want to say it, but it's true. It's like I'm a woman. My sense self-esteem too often depends on how I see my body, and my body image is increasingly affected (infected?) by a continuous, arbitrary onslaught of images and messages that dictate the rights and wrongs of physical appearance. And I'm not the only guy going through it...

I've got buddies who are manly men—who would punch me for saying what I did about Brad Pitt—but who get real touchy about what their asses look like in a pair of jeans. I know dudes who won't eat anything that's not low-fat, non-fat or otherwise tasteless because they "need to lose a couple pounds." Just the existence of magazines like FLEX and Men's Fitness proves that men provide a viable market for folks looking to make money by exploiting bullshit ideas of perfection.

I used to wonder why every woman in Glamour and Shape is impossibly gorgeous and half-dressed—I couldn't figure out why women (straight women, at least) wanted to gawk at sexy pictures of other women. Then I realized something: they don't want to see those models, they want to be them .

Somebody way smarter than me figured that out a long time ago and started making serious cash selling women images and ideas that breed dissatisfaction and self-doubt.

Men are also consumers, and we're just as receptive to the suggestive sell. Now, somebody's making money off our insecurity, too. Karma's for real, baby, and it's coming to get us.

This is complicated stuff, man. Why do so many people obsess about body image? Do we want to look good for other people, or for ourselves? Are we trying to attract a mate, or prove our dominance over the competition?

Do conflicting messages breed insecurity and self-abuse? Or are magazines and movies just mirroring a culture that values style over substance, looking good over feeling good, and what sells over what's right?

One thing I do know: Body image is no longer an exclusively female problem. In fact, men now have 10% of all eating disorders. Body image isn't limited by race, culture, religion, social or financial status, education or geography either. It's a human problem, and it runs remarkably deep. And since we caused it, I'd like to believe we have the ability to fix it.

Where do we start?
Back To Top

Not For Females Only

It is generally assumed that the problem of eating disorders is a female issue because, after all, appearance, weight, and dieting are predominately female preoccupations. Magazine articles, television shows, movies, books, and even treatment literature dealing with eating disorders focus almost exclusively on females.

Binge eating is seen somewhat differently than the classic eating disorders anorexia and bulimia. Males have always been included in the literature and in treatment programs for compulsive overeating. Compulsive overeating, however, has only recently been recognized as its own eating disorder—binge eating disorder—and it still is not accepted as an official diagnosis. Because anorexia and bulimia are official diagnoses, the term eating disorder usually refers to one of these two disorders.

Males do develop anorexia and bulimia, and, rather than being a new phenomenon, this was observed over three hundred years ago. Among the first well-documented accounts of anorexia nervosa, reported in the 1600s by Dr. Richard Morton and in the 1800s by the British physician William Gull, are cases of males suffering from the disorder. Since these early times, eating disorders in males have been overlooked, understudied, and underreported. Worse still, eating disordered males seeking treatment are turned down when requesting admission to most of the programs in the country because these programs treat females only.

The number of females suffering from eating disorders far exceeds that of males, but in the last few years reported cases of males with anorexia nervosa and bulimia nervosa have been steadily increasing. Media and professional attention have followed suit. A 1995 article in the Los Angeles Times on this subject entitled "Silence and Guilt" stated that roughly one million males in the United States suffer from eating disorders.

A 1996 article in the San Jose Mercury News shocked readers by reporting that Dennis Brown, a twenty-seven-year-old Super Bowl defensive end, revealed that he used laxatives, diuretics, and self-induced vomiting to control his weight and even underwent surgery to repair bleeding ulcers made worse by his years of bingeing and purging. "It's always been the weight thing," said Brown. "They used to get on me for being too big." In the article, Brown reported that after making such statements in an NFL-sponsored interview session, he was pulled aside and reprimanded by coaches and team officials for ". . . embarrassing the organization."

The following research summaries, provided by Tom Shiltz, M.S., C.A.D.C., from Rogers Memorial Hospital's Eating Disorder Center in Oconomowoc, Wisconsin, are included here to provide insight into the various biological, psychological, and social factors influencing male eating disorders.

Approximately 10 percent of eating disordered individuals coming to the attention of mental health professionals are male. There is a broad consensus, however, that eating disorders in males are clinically similar to, if not indistinguishable from, eating disorders in females.
Kearney-Cooke and Steichen-Asch found that men with eating disorders tend to have dependent, avoidant, and passive-aggressive personality styles and to have experienced negative reactions to their bodies from their peers while growing up. They tend to be closer to their mothers than to their fathers. The authors concluded that "in our culture, muscular build, overt physical aggression, competence at athletics, competitiveness, and independence generally are regarded as desirable for boys, whereas dependency, passivity, inhibition of physical aggression, smallness, and neatness are seen as more appropriate for females. Boys who later develop eating disorders do not conform to the cultural expectations for masculinity; they tend to be more dependent, passive, and non-athletic, traits which may lead to feelings of isolation and disparagement of body."
A national survey of 11,467 high school students and 60,861 adults revealed the following gender differences:
Among the adults, 38 percent of the women and 24 percent of the men were trying to lose weight.
Among high-school students, 44 percent of the females and 15 percent of the males were attempting to lose weight.
Based on a questionnaire administered to 226 college students (98 males and 128 females) concerning weight, body shape, dieting, and exercise history, the authors found that 26 percent of the men and 48 percent of the women described themselves as overweight. Women dieted to lose weight whereas men usually exercised.
A sample of 1,373 high-school students revealed that girls (63 percent) were four times more likely than boys (16 per-cent) to be attempting to reduce weight through exercise and caloric intake reduction. Boys were three times more likely than girls to be trying to gain weight (28 percent versus 9 per-cent). The cultural ideal for body shape for women versus men continues to favor slender women and athletic, V-shaped, muscular men.
In general, men appear to be more comfortable with their weight and perceive less pressure to be thin than women. A national survey indicated that only 41 percent of men are dissatisfied with their weight as compared with 55 percent of women; moreover, 77 percent of underweight men liked their appearance as opposed to 83 percent of underweight women. Males were more likely than females to claim that if they were fit and exercised regularly, they felt good about their bodies. Women were more concerned with aspects of their appearance, particularly weight.
DiDomenico and Andersen found that magazines targeted primarily to women included a greater number of articles and advertisements aimed at weight reduction (e.g., diet, calories) and those targeted at men contained more shape articles and advertisements (e.g., fitness, weight lifting, body building, or muscle toning). The magazines most read by females ages eighteen to twenty-four had ten times more diet content than those most popular among men in the same age group.
Gymnasts, runners, body builders, rowers, wrestlers, jockeys, dancers, and swimmers are vulnerable to eating disorders because their professions necessitate weight restriction. It is important to note, however, that functional weight loss for athletic success differs from an eating disorder when the central psychopathology is absent.
Nemeroff, Stein, Diehl, and Smilack suggest that males may be receiving increasing media messages regarding dieting, ideal of muscularity, and plastic surgery options (such as pectoral and calf implants).
The increase in articles and media reports on males with eating disorders is reminiscent of the early years when eating disorders in females first began to get public attention. One wonders if this is our early warning of how frequently the problem with males really occurs.

The studies indicating that somewhere between 5 and 15 percent of eating disorder cases are males are problematic and unreliable. Identifying males with eating disorders has been difficult for several reasons, including how these disorders are defined. Consider that until DSM-IV, the diagnostic criteria for anorexia nervosa included amenorrhea, and since originally bulimia nervosa was not a separate illness but rather absorbed into the diagnosis of anorexia nervosa, a gender bias existed for both of these disorders such that patients and clinicians held the belief that males do not develop eating disorders.

Walter Vandereycken reported that in a 1979 study, 40 percent of internists and 25 percent of psychiatrists surveyed believed that anorexia nervosa only occurs in females, and that in a 1983 survey 25 percent of psychiatrists and psychologists considered femaleness fundamental to anorexia nervosa. Being overweight and overeating are culturally more acceptable and less noticed in males; therefore, binge eating disorder also tends to go underrecognized.

As it now stands, the three essential requirements for the diagnosis of anorexia nervosa—substantial self-induced weight loss, a morbid fear of becoming fat, and an abnormality of reproductive hormone functioning—can be applied to males as well as females. (Testosterone levels in males decrease as a result of this disorder, and in 10 to 20 percent of cases, males remain with features of testicular abnormality.) The essential diagnostic features for bulimia nervosa—compulsive binge eating, a fear of fatness, and compensatory behaviors used to avoid weight gain—can also be equally applied to males and females.

For binge eating disorder, both males and females binge eat and feel distress and out of control over their eating. However, the problem of identification continues. Males with eating disorders have been so rarely acknowledged or encountered that the diagnostic possibility of anorexia nervosa, bulimia nervosa, or binge eating disorder is overlooked when males present with symptoms that would lead to a correct diagnosis if presented by a female.

Diagnostic criteria aside, the problem of identifying males with eating disorders is heightened by the fact that admitting to an eating disorder is difficult for anyone, but even more difficult for males due to the perceived notion that only females suffer from these illnesses. In fact, males with eating disorders commonly report fears of being suspected of homosexuality for having what is considered a "female problem."

GENDER IDENTITY AND SEXUALITY
As far as the sexuality issue goes, males with all variations of sexual orientations develop eating disorders, but studies have indicated a possible increase in gender identity conflict and sexual orientation issues among many males who do develop eating disorders. Dieting, thinness, and obsession about appearance tend to be predominantly feminine preoccupations, so it is not surprising that male eating disorder patients often present with gender identity and orientation issues including homosexuality and bisexuality. Tom Shiltz has also compiled the following statistics on sexuality, gender identity, and eating disorders, reprinted here with his permission.

GENDER DYSPHORIA AND HOMOSEXUALITY
Fichter and Daser found that male anorexics saw themselves and were seen by others as more feminine than other men, both in attitudes and behavior. In general, the patients appeared to identify more closely with their mothers than their fathers.
Homosexuals are overrepresented in many samples of eating disordered men. While the proportion of male homosexuals in the general population cross-culturally is estimated to be 3 to 5 percent, samples of eating disordered men are commonly twice as high or higher.
Several authors have noted that homosexual content preceded the onset of the eating disorder in up to 50 percent of male patients.
Conflict over gender identity or over sexual orientation may precipitate the development of an eating disorder in many males. It may be that by reducing their sexual drive through starvation, patients can temporarily resolve their sexual conflicts.
Homosexual men may be at an increased risk for devel-oping an eating disorder because of cultural pressures within the homosexual community to be thin. Herzog and colleagues found that homosexual men weighed significantly less than heterosexual men and were more likely to be underweight and to desire an underweight ideal weight. Compared to the heterosexuals, homosexual men were less satisfied with their body build and scored significantly higher on the "Drive for Thinness" scale of the Eating Disorder Inventory (EDI).
Body image concerns may be important predictors of eating disorders in males. Wertheim and colleagues found that a desire to be thinner was a more important predictor of weight loss behaviors than psychological or family variables for both male and female adolescents.
Kearney-Cooke and Steichen-Asch found that the preferred body shape for contemporary men without eating disorders was the V-shaped body, whereas the eating disordered group strove for the "lean, toned, thin" shape. The authors found that most of the men with eating disorders reported negative reactions from their peers. They reported being the last ones chosen for athletic teams and often cited being teased about their bodies as the times when they felt most ashamed of their bodies.
SEXUAL ATTITUDES, BEHAVIORS, AND ENDOCRINE DYSFUNCTION
Anorexic males display a considerable degree of anxiety with regard to sexual activities and relationships. Fichter and Draser compared male and female anorexics and found that males displayed significantly more sexual anxieties than did females. The authors noted that 80 percent of the males in their study grew up in families that regarded sex as a taboo subject. Corresponding with the reported sexual anxiety, low levels of sexual activity among the anorexic males were also noted.
Burns and Crisp found that male anorexics in their study admitted "obvious relief" at the diminution of their sexual drive during the acute phase of their disease.
Eating disordered males differed significantly from eating disordered females in terms of sexual experience in a study conducted by Herzog and colleagues. Males with eating disorders were significantly less likely to have had premorbid sexual relations or to be involved in a sexual relationship at the time of evaluation than were females with eating disorders. Bulimic males, however, appeared to be more sexually active than anorexic males, both premorbidly and at the time of their illness.
A study by Andersen and Mickalide suggests that a disproportionate number of male anorexics may have persisting or preexisting problems in testosterone production.
One problem with eating disorder and gender studies is that what are often considered feminine traits, such as a drive for thinness, body image disturbance, and self-sacrifice, are the hallmarks of eating disorders in both males and females. Therefore, using these traits to determine the degree of femininity in anyone with an eating disorder, male or female, is misleading. Furthermore, many studies involve self-reporting and/or populations in treatment settings, both of which may provide unreliable results. Since many individuals find it difficult to admit they have an eating disorder, and since the admission of homosexuality is also a difficult matter, the actual incidence of homosexuality among males with eating disorders in the general population is an unclear and undetermined issue.

Since females identified with eating disorders outnumber males by a large margin and gender issues such as homosexuality or bisexuality seem prevalent in reported cases involving males, there has been much speculation on why this should be the case. According to Dr. Arnold Andersen, who edited the only book on this subject to date, Males with Eating Disorders (Brunner/Mazel, 1990), definitive answers are not available, but sociocultural influences appear to play a much bigger role than biological ones. (An upcoming book by Andersen, Leigh Cohn, and Tom Holbrook entitled Making Weight: Healing Men's Conflict with Food, Weight, and Shape will be available in December 1999 from Gürze books.)

Andersen and other researchers, such as George Hsu, agree that the most important factor may be that there is less reinforcement for slimness and dieting for males than for females. Dieting and weight preoccupation are precursors for eating disorders and these behaviors are more prevalent in females. Andersen points out that by a ratio of 10.5 to 1, articles and advertisements concerning weight loss are more frequent in the ten most popular women's versus men's magazines.

It is more than interesting that the 10.5 to 1 ratio parallels that of women to men with eating disorders. Furthermore, in subgroups of males where there is a great emphasis on weight loss—for example, wrestlers, jockeys, or football players (such as in the above-mentioned case of Super Bowl defensive end Dennis Brown), there is an increased incidence of eating disorders. In fact, whenever weight loss is required for a particular group of individuals, male or female, such as in ballerinas, models, and gymnasts, there is a greater likelihood that those individuals will develop eating disorders. From this it can be speculated that as our society increasingly places pressure on men to lose weight, we will see an increase in males with eating disorders.

In fact, it is already happening. Men's bodies are more frequently the targets of advertising campaigns, leanness for men is increasingly being emphasized, and the number of male dieters and males reporting eating disorders continues to rise.

One final note is that, according to Andersen, eating disordered men differ from eating disordered women in a few ways that may be important for better understanding and treatment.

They tend to have genuine histories of pre-illness obesity.
They often report losing weight in order to avoid weight-related medical illnesses found in other family members.
They are likely to be intensely athletic and to have begun dieting in order to attain greater sports achievement or from fear of gaining weight because of a sports injury. In this respect, they resemble individuals referred to as "obligatory runners." In fact, many eating disordered men may fit another proposed but not yet accepted diagnostic category, referred to as compulsive exercise, compulsive athleticism, or a term coined by Alayne Yates, activity disorder. This syndrome is similar to but separate from the eating disorders and is discussed in this book in chapter 3.
TREATMENT AND PROGNOSIS FOR MALES
Although more research needs to be done on the specific psychological and personality features of males with eating disorders, the basic principles for treatment currently promoted are similar to those for treating females and include: cessation of starvation, cessation of binge eating, weight normalization, interrupting binge and purge cycles, correcting body image disturbance, reducing dichotomous (black-and-white) thinking, and treating any coexisting mood disorders or personality disorders.

Short-term studies suggest that the prognosis for males in treatment is comparable to that for females, at least in the short term. Long-term studies are not available. However, empathetic, informed professionals are necessary, due to the fact that males with eating disorders feel misunderstood and out of place in a society that still doesn't understand these disorders. Even worse, males with eating disorders are often made to feel uncomfortable and otherwise rejected by females similarly afflicted. Although it may turn out to be true, it is often mistakenly assumed that males with eating disorders, most particularly anorexia nervosa, are more severely disturbed and have a poorer prognosis than females with such disorders.

There are good reasons why this may appear to be the case. First, since males often go undetected, only the most severe cases come into treatment and thus under scrutiny. Second, there seems to be a contingent of males with other serious psychological disorders, most notably obsessive-compulsive disorder, where food rituals, food phobias, food restriction, and food rejection are prominent features. These individuals end up in treatment mostly due to their underlying psychological illnesses, not for their eating behavior, and they tend to be complex, difficult-to-treat cases.

STRATEGIES FOR PREVENTION AND EARLY INTERVENTION OF MALE EATING DISORDERS
Recognize that eating disorders do not discriminate on the basis of gender. Men can and do develop eating disorders.
Learn about eating disorders and know the warning signs. Become aware of your community resources (e.g., treatment centers, self-help groups, etc.). Consider implementing an Eating Concerns Support Group in the school setting to provide interested young men with an opportunity to learn more about eating disorders and to receive support. Encourage young men to seek professional help if necessary.
Athletic activities or professions that necessitate weight restriction (e.g., gymnastics, track, swimming, wrestling, rowing) put males at risk for developing eating disorders. Male wrestlers, for example, present with a higher rate of eating disorders than the general male population. Coaches need to be aware of and disallow any excessive weight control or body building measures employed by their young male athletes.
Talk with young men about the ways in which cultural attitudes regarding ideal male body shape, masculinity, and sexuality are shaped by the media. Assist young men in expanding their idea of "masculinity" to include such characteristics as caring, nurturing, and cooperation. Encourage male involvement in traditional "nonmasculine" activities such as shopping, laundry, and cooking.
Never emphasize body size or shape as an indication of a young man's worth or identity as a man. Value the person on the "inside" and help him to establish a sense of control in his life through self-knowledge and expression rather than trying to obtain control through dieting or other eating disorder behaviors.
Confront others who tease men who do not meet traditional cultural expectations for masculinity. Confront anyone who tries to motivate or "toughen up" young men by verbally attacking their masculinity (e.g., "sissy" or "wimp"). Dem-onstrate respect for gay men and men who display personality traits or who are involved in professions that stretch the limits of traditional masculinity (e.g., men who dress colorfully, dancers, skaters, etc.).
Research has shown that a man who develops an eating disorder presents the following profile: he appears to lack a sense of autonomy, identity, and control over his life; he seems to exist as an extension of others and to do things because he must please others in order to survive emotionally; and he tends to identify with his mother rather than with his father, a pattern that leaves his masculine identity in question and establishes a repulsion of "fat" that he associates with femininity. With this in mind, the following suggestions for prevention can be made:
Listen carefully to a young man's thoughts and feelings, take his pain seriously, allow him to become who he is.
Validate his strivings for independence and encourage him to develop all aspects of his personality, not only those that family and/or culture find acceptable. Respect the person's need for space, privacy, and boundaries. Be careful about being overprotective. Allow him to exercise control and make his own decisions whenever possible, including control over what and how much he eats, how he looks, and how much he weighs.
Understand the crucial role of the father in the prevention of eating disorders and find ways to connect young men with healthy male role models.
Source: Used with permission of Tom Schlitz, M.S., C.A.D.C., of the Rogers Memorial Hospital Eating Disorder Center.

With more time and research devoted to analyzing and understanding the sociocultural, biochemical, and gender-related factors in the roots of the problems of males with eating disorders, optimal prevention and treatment protocols will be revealed.
Back To Top

Eating Disorders Not Just a Girl Problem

Although fewer men than women suffer from eating disorders, a new study indicates that the number of men with anorexia or bulimia is much higher than previously believed. Despite this, men, whose treatment needs are the same as those of women, do not seek help and, therefore, do not get adequate treatment.

"[Eating disorders] have been seen largely as an issue affecting women, and because of that, I think men have been far less likely to identify themselves as affected by it or to seek out treatment -- much in the same way as men with breast cancer tend to show up in breast cancer clinics much, much later," says the study's author, D. Blake Woodside, MD.

Because there are few large studies of men with anorexia and bulimia, Woodside, who is with the department of psychiatry at the University of Toronto, evaluated and compared 62 men and 212 women with eating disorders with a group of almost 3,800 men with no eating disorders.

Although more than twice as many women as men had eating disorders, there were more men affected than would be expected, suggesting that the occurrence of eating disorders may be higher among men than the current National Association of Anorexia Nervosa and Associated Disorders estimates. According to the group, men are thought to make up about 1 million of the 8 million Americans with eating disorders.

In terms of symptoms and unhappiness with their lives, there was little difference between men and women with eating disorders. Both sexes suffered similar rates of anxiety, depression, phobias, panic disorder, and dependence on alcohol. Both groups also were much more unhappy with how things were going in their lives than men with no eating disorders.

Woodside says his study supports the assumption that anorexia and bulimia are virtually identical diseases in men and women.

A number of reports in the medical literature suggest that gay men account for a significant percentage of male anorexia. Woodside's study did not look at this issue, but he says it should be studied further to rule out whether gay men may simply be more likely to seek treatment for anorexia, though not necessarily more likely to suffer from the disorder than heterosexual men.

"Perhaps it may have a bit of a 'snowball effect,' because men may feel if they come forward they will be thought of as homosexual, even if they are not," Woodside says.

Another expert who treats eating disorders says society has a tendency to glamorize eating disorders while at the same time making fun of the people who have them.

"The media and society believe it's all about these beautiful models trying to lose weight, when that's really not what eating disorders are about," says Mae Sokol, MD. "They're less about food and eating and much more about people's sense of self-esteem and identity and who they are."

Sokol says anorexia may be less noticeable in men than women because men can still have muscle mass even though they are thin.

"In fact, it's more dangerous for men to develop anorexia nervosa than for females ... because when males get down to the lowest weight ranges, they've lost more muscle and tissue, whereas [fat] is something you can lose for a period of time without repercussions," says Sokol, a child and adolescent psychologist at Menninger, a psychiatric hospital in Topeka, Kan.

Despite the media's focus on anorexia, bulimia, and other eating disorders, Sokol says that men are still brought up to believe it's not something that's supposed to happen to them.

"The public thinks of it as a 'girl disease,' and these guys don't want to have to come out and say, 'I have a girl disease.' Plus, to have to come to a [treatment facility] where most of the patients are women -- they don't feel good about that at all," she says.

Woodside agrees that feeling uncomfortable may be a big part of why men are less likely to go for help for an eating disorder.

"I think, for a lot of them, it's definitely a case of 'Do I fit in here?' when men come in [to a treatment center]," he says.

In an editorial accompanying Woodside's study, Arnold Anderson, MD, writes that men seeking treatment "are often excluded from programs by gender alone or are treated indistinguishably from teenage girls."

Anderson , of the department of psychiatry at University of Iowa Hospitals and Clinic in Iowa City , says more research comparing men and women with eating disorders is welcomed because it will help identify factors that may lead to different treatment approaches.
Back To Top

Body Image Problems Not Just in Women

Men may still hesitate to ask for directions or give up the TV remote, but they're apparently crossing the gender line into another area once firmly dominated by women: Obsessing about their body image and developing eating disorders.

In the past two decades, reports the British Medical Journal, the number of men who openly report dissatisfaction with their physical appearance has tripled -- and today, nearly as many men as women say they are unhappy with how they look. Meanwhile, therapists report seeing 50% more men for evaluation and treatment for eating disorders than they did in the 1990s.

And the root of this trend may be a new type of disorder -- an obsession for six-pack abs and bulging biceps that seems especially common in athletes and other fitness enthusiasts.

Though statistics show that about 10% of men suffer from the two best-known eating disorders -- anorexia and bulimia -- a growing body of evidence suggests that men may be especially vulnerable to muscle dysmorphia, a condition in which one obsesses about lacking muscle definition and mass, even with a muscular body. This condition is not unlike that satirized in Saturday Night Live sketches featuring the Schwarzenegger-like, sweatsuit-wearing Hans and Franz, whose mission was to "pump you up."

Laughs aside, the problem is so real that in the March/April issue of ACSM's Health & Fitness Journal, published by the American College of Sports Medicine, Ball State University nutritionist Katherine A. Beals, PhD, RD, highlights the growing trend among fitness buffs and offers advice to athletic trainers on spotting the problem in weight lifters and other fitness center regulars. "Millions of boys and men today harbor a secret obsession about their looks and are endangering their health by engaging in excessive exercise, bingeing and purging rituals, steroid abuse, and overuse of nutritional and dietary [products]," she writes.

Although a relatively new area of medical research, many experts believe this disorder is grossly underreported. But those at particular risk, says Beals: men who constantly seek instant results from workouts and frequently check their progress in mirrors or on scales. Though her findings are geared to athletes -- or those who want to be -- others say that less-athletic men are not immune to muscle dysmorphia and related body image problems.

"As far as we know, all men are prone to these types of issues," says Katharine Phillips, MD, director of the Body Image Program at Brown University's Butler Hospital and author of several books on men's body image problems, including The Adonis Complex: The Secret Crisis of Male Body Obsession. "The reasons why haven't been well studied, but one factor may be the availability of anabolic steroids, which are potentially dangerous but can make men become much more muscular than Mother Nature ever intended."

Another possible reason being explored: Feelings of threatened masculinity. "Perhaps this is the one domain left where men can feel like men, since women can do everything that men can do, except they can't bench-press hundreds of pounds," she tells WebMD. "What has happened over the years is there's an increasing emphasis on men's appearance, and in particular on looking muscular, and it coincides very nicely with the increasing equality women have attained in society."

Whatever the causes, and likely there are many -- including life experiences or even genetics -- there's no denying that some men are feeling the pressure. Even GI Joe dolls have bulked up in recent years.

"In women with eating disorders, the focus is usually on thinness, but men tend to want to be muscular and gain weight," says Catherine Loomis, PhD, psychologist at the Eating Disorders Center at Rogers Memorial Hospital in Oconomowoc, Wis., one of the nation's few treatment centers that specifically treats men with eating disorder and body image problems. "A lot of it has to do with cultural pressures placed on men to look a certain way. As a result, they may develop a fear of certain foods and anxiety over the way they eat."

Even boys and teens -- especially those who are overweight -- are suffering emotional trauma in their quest for bigger muscles, and setting themselves for possible future medical problems. "They may try to eat lot of protein but limit fat, and they often develop a fear of foods and an anxiety that results from restrictive eating," she tells WebMD. "Often, these are people who are perfectionists and have or could develop obsessive-compulsive disorder."

So when do men cross the line from a healthy workout to an unhealthy and potentially dangerous obsession? One hint: Exercising more than once or twice each day, with no days off from weight lifting.

"I usually note four points that determine whether you've crossed the line or not," says Roberto Olivardia, PhD, another Adonis Complex author and psychologist at McLean Hospital and at Harvard Medical School who specializes in men's body image problems:

Distortion of body image: "If you see yourself as being fat or puny, but others around you say that you're muscular, that's a red flag," he tells WebMD.
Exercise interferes with other areas of life. "If your relationships, job, or school suffer because of your exercise routines, that's a warning sign."
Your harm yourself in pursuit of fitness. "If you're taking steroids, tearing joints or ligaments because of overtraining, or you're fainting because you're not taking in enough liquids, that's a sign of trouble."
Your self-esteem is based solely on your appearance. "If you feel that the perfect body is the only way you can feel good about yourself, that's another warning sign. You need to get self-esteem from many areas in your life -- and not only from your muscles."
Back To Top

Men Have Body Image Problems, Too

Mirror, mirror on the wall, who's the puniest man of all? For many avid weightlifters, that's the nagging question that just won't go away -- no matter how much time they spend at the gym or how toned and ripped they become.

A new study shows that a growing number of men may be at risk for developing a distorted body image syndrome called muscle dysmorphia. The syndrome affects very muscular men who, regardless of their actual physique, are convinced they look puny and out of shape.

With body image a national obsession, and working out a socially desirable activity, the condition has become increasingly common. But while women tend to suffer from disorders that drive them to be thinner, muscular dysmorphia drives men to be ever bigger and more muscular.

Muscle dysmorphia is a new form of a known syndrome called body dysmorphic disorder. But instead of being exceptionally dissatisfied with one particular body part, men with muscle dysmorphia are unhappy with their entire body.

To find out more about the condition, Precilla Choi, PhD, of the School of Human Movement , Recreation and Performance at Victoria University in Melbourne , Australia , and colleagues interviewed 24 Boston-area male weightlifters who'd been diagnosed with the syndrome and compared their responses with those of 30 comparable weightlifters without the condition.

Their study appears in the October issue of the British Journal of Sports Medicine .

The researchers found that men with muscle dysmorphia saw themselves as not only less physically attractive, but also less healthy, than the other men. They say studies in women show an association between having an attractive body and feelings of overall good health. This may now be the case for men, as well.

The men with muscle dysmorphia were also more likely to be dissatisfied with their overall body appearance, muscle tone, and weight than the other group. They had a strong desire for bigger muscles and were very concerned about not gaining any fat.

The researchers say that as more men hit the gym solely to improve their physical appearance and muscle tone, the incidence of muscle dysmorphia is likely to grow.
Back To Top

Never Buff Enough

When pumping iron becomes an obsession, some young men develop a little known and often-secret syndrome called muscle dysmorphia. Focusing totally on getting big and buff, they exercise compulsively, shutting out much of the rest of their lives. The problem, though, is no matter how big they may get, they still feel they look small.

The disorder, according to a study in the August issue of the American Journal of Psychiatry, not only causes emotional problems but can also lead to the use of anabolic steroids, putting the men at risk for serious physical and mental side effects.

"Our study showed that men with muscle dysmorphia are very different from normal weightlifters," says author Roberto Olivardia, PhD, a clinical psychologist and research fellow at Harvard Medical School's McLean Hospital in Belmont, Mass. "So weightlifting is only a problem when it interferes with relationships or school and work performance." Still, the incidence is on the rise and media images of an ideal V-shape may be the culprit, the authors suggest.

To study the little-known disorder, Olivardia interviewed over 50 male weightlifters, aged 18 to 30. All the men could bench press their body weight 10 times or more, but about half were still preoccupied with their perception of looking small. Along with comparing their exercise behavior, steroid use, and childhood environment, the researchers probed for eating disorders, depression, and anxiety.

Even though the men were actually big, those with muscle dysmorphia were less satisfied with their bodies, used more anabolic steroids, and had more eating disorders than the comparison group. Often describing shame or embarrassment, they also had a significantly higher incidence of depression and anxiety. But the study didn't find a clear pattern of how the disorder emerged, highlighting the need for further research, the authors suggest.

"Boys and men are now bombarded with the same unrealistic body images that girls and women are," says Katharine Phillips, MD, an expert in body image issues and an associate professor of psychiatry at Brown University School of Medicine in Providence, R.I. Phillips, Olivardia, and a co-author of this study all co-authored a book on the growing trend of muscle dysmorphia and similar conditions called The Adonis Complex. Citing action heroes or fashion models as their ideal, Phillips tells WebMD that some young men become overly preoccupied with the pursuit of bigness. "Kids often give us clues when they're getting into trouble, but we tend to ignore them. So keep an eye out for the following warning signs," she urges.

Exercising more than two hours a day, at the expense of friends, hobbies, or homework
Using large quantities of dietary supplements such as creatine and protein powder
A sudden onset of disproportionately large neck or shoulders
Preoccupation with muscularity
Avoiding social situations
If this sounds like your son, you may want to talk it over with him. "Kids often want to discuss what's going on, but we tend to minimize their concerns or hope that they'll go away. There's no need to panic," Phillips says, adding that it's a good idea to take the following initial steps:

Listen thoughtfully to your son, without criticizing, blaming, or teasing
Point out that muscular men in the media may have used anabolic steroids
Encourage other sources of self-esteem like school performance and hobbies
Unfortunately, some kids may need more than parental support. "If your son remains primarily focused on weightlifting, he may need professional help," Phillips tells WebMD. "Treatment of muscle dysmorphia is still under study, but antidepressant drug therapy is very effective," she explains. Drugs such as Prozac, Anafranil, Luvox, Paxil, and Zoloft are especially helpful in controlling these types of obsessive/compulsive symptoms.

Behavioral therapy is often combined with drug therapy. By using simple strategies to help reduce symptoms and modify distorted thinking, this practical approach allows young men to face the situations they've been avoiding. "Developing a weekly plan with less time devoted to exercise and more time with friends is one example," Phillips suggests.
Back To Top

Eating Disorders Don't Discriminate

When it comes to eating disorders such as anorexia and bulimia, the spotlight has been almost exclusively on women, so much so that men with these disorders often fall through the cracks. But, experts say, the disease is as serious in men as it is in women and can lead to many of the same complications.

"We've been concerned with a number of issues," Arnold Andersen, MD, tells WebMD. "One of them has been the unavailability of services and the relative neglect -- both in recognition and in treatment -- of eating disorders in males." Andersen is the director of the Eating Disorder Services and in the department of Psychiatry at the University of Iowa College of Medicine.

Eating disorders affect about 5% of adolescents, and it's estimated to be six to ten times more common in women than in men. There are three main subtypes: anorexia nervosa with food restriction, anorexia nervosa with binging and purging (through vomiting and/or laxatives) and bulimia nervosa (the binging and purging without major weight loss).

Andersen says that about 15% of his clinic's patients are male. Katherine Halmi, MD, says about 10% of her clinic's patients are men. Halmi is director of the eating disorders program at the New York-Presbyterian Hospital -- Westchester Division.

"There is very little difference between males and females," Halmi tells WebMD. "Psychologically, it is the same factor: they are very preoccupied with their body image. ... They lack self-confidence. And because of that, they place too much emphasis on their appearance. If you have self-confidence then you aren't so overly preoccupied with how you look. It doesn't mean that much to you."

The course of the illness is similar in men and women, says Halmi. "It can be a single episode with treatment and cure, or it can be a chronic prolonged course with multiple weight gains and relapses, or it can be a constant downhill course to death," says Halmi.

"There is no difference in prognosis in males or females: about one quarter of the patients will be cured, and one quarter will remain very seriously and chronically ill and have an early death rate. The other half retains problems but they are not seriously ill: they are constantly preoccupied with weight, they may eat peculiar diets, they may exercise a lot, but they are able to function," she says.

"Treatment involves a cognitive type of psychotherapy in which we teach patients how to monitor their thoughts and emotions," says Halmi. "We teach them logical exercises like cognitive restructuring in which they take a malfunctioning idea, like 'I am too fat,' then examine the evidence to support that thought, the evidence against it, and then force themselves to reach a reasonable conclusion about it. We also teach them problem-solving techniques. ... Actually, it is very easy for us to treat men and women in the same unit."

Andersen, however, isn't so sure that male and female patients are alike in every way. He says he's found that men diet for different reasons than women, who often feel cultural pressure to look thin. "They dieted to avoid ever being teased again for being a 'fatty boy;' they dieted to improve sports performance; they dieted to avoid getting dad's medical diseases related to weight; and they dieted to become slimmer and fitter to improve a gay relationship. So men have very specific personal reasons as opposed to a cultural endorsement."

Another difference, he says, is a male's perception of fatness. "Five to 10% above average is when men start perceiving any fatness. Women feel fat at 13 to 15% below normal. So they have a different threshold for being fat," he says. "And they have a different body image to achieve. ... The kind of image men have now is becoming equally impossible to achieve -- but the specifics are very different."

Because of these differences, Andersen believes treatment should include some gender-specific components. "Sure there are gender-neutral aspects of treatment [such as] nutritional rehabilitation, normalization of eating patterns, and changing core beliefs," he says.

At his clinic, men also attend all-male support groups and are taught how to develop a different body. This sometimes involves testosterone, which can be very low in men with eating disorders, to build lean muscle mass. "If they leave with a technically normal weight on the scale but a belly, they are going to go right back to starving," he says. It also involves a "prescription" for exercise, which can be tricky because some men overexercise to control their weight.

Andersen recently uncovered another problem associated with exercise: many men with eating disorders have evidence of bone thinning; therefore, there is a higher risk of a break. Bone thinning -- medically known as osteoporosis or osteopenia depending on the severity -- is a well-established complication in women with eating disorders, but its prevalence among men is unknown.

When Anderson and colleagues analyzed data from 31 men who were patients at his clinic, he found that a measure of bone health was substantially lacking in more than 35% of the men. He also found that some of the men even had more severe bone thinning than women with eating disorders.

"The average anorexic male has the bones of an 80-year-old man," says Andersen.

"This is really the first [study] that I have seen that has shown that osteopenia and osteoporosis is a problem in men as well as women," Cynthia Bulik, PhD, tells WebMD. "I think most clinicians are alert to this [problem] in women but they perhaps don't order the tests as readily in men." Bulik, an associate professor of psychiatry at Virginia Commonwealth University and the director of the Eating Disorders Program at the Medical College of Virginia, was not involved in the study.

In all, Andersen would like to see more attention paid to males with eating disorders and more resources available to them. "My goal has been to evolve gender-specific treatments that don't treat guys with eating disorders like girls," says Andersen. "They come from different social learning backgrounds, they have different medical needs, different psychological needs, different body image needs, and they are headed back to a different role in society."

Vital Information:

Doctors say that even though eating disorders are much more common in women, men do suffer from them and follow a similar disease course, although motivations and thought patterns are usually different.
Experts note that while the reasons men and women may develop eating disorders may differ, there is no difference between the sexes in their prognosis: A quarter will be cured; a quarter will remain seriously ill over time and die prematurely; and half will still be troubled by the disease long term but will not become seriously ill.
Doctors should realize men with eating disorders often suffer from osteoporosis and related diseases and should be treated for them.
Back To Top

Family Meals Help Prevent Eating Disorders

In today's on-the-run society, the traditional sit-down family meal has pretty much gone by the wayside. But researchers say restoring regular family meals can help teenage girls avoid dangerous eating disorders.
"It doesn't have to be a home-cooked meal. The idea is to bring people together," University of Minnesota researcher Dianne Neumark-Sztainer, PhD, MPH, RD, says in a news release.
Armed with data from more than 4,700 ethnically diverse adolescent girls and boys, Neumark-Sztainer and colleagues examined family meal patterns and eating behaviors.
They found that those who regularly ate meals in a structured, positive atmosphere were less likely to show signs of eating disorders, such as vomiting, chronic dieting, and using diet pills.
Nearly 18% of girls who ate one to two family meals each week showed signs of eating disorder behaviors. This number fell to 9% of girls who had family meals three to four times a week. Girls who ate five family meals weekly had an even lower risk of eating disorder behaviors. While boys also benefited from the family meals, the association between eating disorder tendencies and family meals was not as strong.
"Making family meals a priority, in spite of scheduling difficulties, emerged as the most consistent protective factor for disordered eating," the authors write in the November issue of the Journal of Adolescent Health.
Researchers suggest that parents keep conversation light and positive at the dinner table, especially if their children have issues surrounding food.
Back To Top

Moms: Are You Nursing an Eating Disorder?
The style in which an infant nurses -- rapid and vigorous or slow and lackadaisical -- may offer some revealing glimpses into the future of her emotional health. When combined with a mother is who is anxious about her body weight and shape, these very early patterns of feeding can point to the baby's subsequent development of an eating disorder such as anorexia or bulimia, according to research presented here at the annual meeting of the American Psychiatric Association.

As young as two weeks of age, infants of mothers with eating disorders appear to have distinct styles of feeding and sucking that may predispose them to developing eating disorders themselves, says Stewart Agras, MD, a psychiatrist at Stanford University School of Medicine.

For instance, a pattern of rapid and vigorous sucking -- in a child with a family history of eating disorders -- might be a precursor to bulimia or binge eating.

Meanwhile, very slow, apathetic sucking might herald anorexia nervosa.

Previous research has indicated that "picky eating" among toddlers and small children has been associated with later onset of anorexia, Agras explains, and children who were identified as "picky eaters" at age 3 had also displayed very slow, nonvigorous sucking behavior as infants.

In their study, Agras and colleagues looked at the children of 41 women with eating disorders and 153 women without. In particular, the researchers compared the feeding patterns of the babies in the two groups.

"What we are seeing are early patterns of feeding behavior that persist through childhood," Agras tells WebMD. "When we looked at the offspring of eating-disordered mothers, their daughters sucked more quickly than [the offspring of] non-eating-disordered mothers or ... sons of [eating-disordered mothers]. Eating disordered mothers also complained that they had a tremendous problem getting their daughters off the bottle."

The researchers were also able to determine that the moms with eating disorders fed their children on a less regular schedule and demonstrated much more concern about their daughter's weight, as early as age 2.

What's more, by age 5 the daughters of eating-disordered mothers displayed more negative signs, such as depression and whininess, than did the offspring of non-eating-disordered moms, according to Agras.

The combination of a daughter who eats eagerly and quickly with a mother who is concerned about the baby's weight is a recipe for the daughter eventually developing eating problems of her own, Agras tells WebMD.

Agras stresses that these persistent feeding patterns are risk factors and not hard-and-fast blueprints: Many babies who display those patterns will never develop eating disorders.

The most crucial element of the equation, he says, is the mother's anxiety about the body weight and size of her daughter.

Agras also reported new research showing that it is the mother's anxiety about a child's body weight and size -- and not the father's -- that is most associated with development of eating disorders in children. And that maternal anxiety tends to be directed at their daughters, not their sons, he says.

The research is part of an emerging picture of anorexia and bulimia as illnesses that are related to an underlying -- and long-lasting -- pattern of anxious and obsessive behavior, says Walter Kaye, MD, a psychiatrist at the University of Pittsburgh School of Medicine.

Kaye says a chemical in the brain called serotonin is heavily involved in eating disorders and in the anxious and obsessive behavior that accompanies them. People with eating disorders seem to produce and process this chemical in different ways from those without the disorders -- and they continue to do so even after they have been treated for their disorder, Kaye says.

Studies of the antidepressant Prozac, which helps regulate serotonin in the brain, found that people with eating disorders who received the drug did significantly better than people who received a placebo, Kaye says.
Back To Top

Many Girls With Diabetes, PKU Have Symptoms of Eating Disorders

Girls and young women with metabolic disorders such as diabetes or phenylketonuria (PKU) must often follow restrictive diets that will last throughout their lives. A new study shows that some of these girls and women develop serious eating problems and behave in ways that may worsen their health.

The findings suggest that living with diseases that have strict dietary requirements may affect patients' eating behaviors and attitudes toward food, increasing their risks of developing eating disturbances, researcher Joan C. Chrisler, PhD, writes in the Journal of Developmental and Behavioral Pediatrics.

"There's almost an epidemic of eating disorders in this country among young girls," Chrisler, of Connecticut College in New London , Conn. , tells WebMD. "There's a lot of bulimia, binge eating and chronic dieting. ... We were concerned about girls with chronic illnesses who are on diets that they must maintain for their metabolic health and safety. We wonder