I see women in my practice every week who suffer from eating disorders (ED). I never used to see men with ED but that has changed. Still, the incidence is much less frequent than with women and, when it does present, it is often much less severe in nature. I used to see it more in gay men but now I see it far more in heterosexual men. I also encounter it more often as a condition on the disordered eating spectrum with most men regardless of sexual orientation, rather than a full blown ED.
In medical school I recall how many of the women I knew who would food restrict. I only knew of one male who would food restrict. I actually got very thin myself, but quickly realized I needed food to stay awake most nights on call.
What’s on the menu?
It feels like we don’t know how to eat anymore. There is Keto this, low carb that, low fat vs clean eating. In the end we are at war with our bodies and food has become the enemy. When and why did food become a moral issue? I hear my patients say they were “so bad” because they had an extra piece of pie at a holiday dinner. It’s hard to imagine a world where we would accept the bodies we have rather than the bodies we wish we had. What will this imagined body bring us? Will it provide the elusive happiness we have been searching for?
Exercise is Healthy, right?
One of the latest eating disorders that has fallen on the more acceptable realm is ” Exercise Induced Bulemia.” Make no mistake it is still a compensatory way to maintain a lower body weight, but somehow it became socially acceptable to run, cycle or attend workouts at gyms that burn many calories. I frequently see women trying to keep up with their male partners. Sometimes it is the only way to spend significant time with them especially if they too have body image issues. Granted we are a more sedentary culture, but this is beyond going for the evening walk to move those stiff muscles at the end of the day.
Novel concept: eat when hungry
I am unsure of how to win this war on our bodies and the war on food. If my patient hates her body, I will ask her what about it she hates. She will usually say her double chin or her belly that hangs too low. What ever the “perceived defect” is, it likely originates from a place of self hatred. I listen and reflect back the negative and harsh feeling she feels at liberty to use against herself. Sometimes patients leave quickly if I won’t join them in this ritual of self hatred. Hopefully they stay and we can keep going deeper to understand this vicious attack on the self.