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The Body Images Men Can't Shake

By Donna Koehn The Tampa Tribune

Published: September 29, 2007

Video: Author J. Kevin Thompson shares his thoughts about signs and symptoms of body disorders.

Forum: Join the discussion on body images.

When Charles Atlas warned boys in the 1930s not to let bullies kick sand in their faces, he advertised his bodybuilding program with other novelties in comic books.

As they gave up the funnies, young men usually left their dreams of a Mr. Universe physique behind.

It was easy enough to do then. Matinee stars such as Clark Gable and Humphrey Bogart were no musclemen, and they still got the girls. Even into the 1960s, pop-culture icons were more brain than brawn. The toy G.I. Joe was a regular-looking guy.

Today, G.I. Joe's proportions are freakishly huge. Buffed, well-cut men display their shirtless physiques in movies and on television. Even Charles Atlas Ltd. now sells dietary supplements online.

In 1972, a Psychology Today study found that 75 percent of men felt fine about how they looked. When the study was repeated 25 years later, the number had fallen to 33 percent. Today, some studies report that 97 percent of men are dissatisfied with at least one part of their bodies.

"There seems to be pressure on men now from Madison Avenue and the media to achieve an ideal of bodily perfection which before now seemed to be only focused on women," says Kevin Thompson, psychology professor at the University of South Florida.

Some men resort to silicone muscle implants. Others starve to lose weight. Some use steroids and other dangerous substances to build muscles.

"It's kind of mind-boggling and hard to explain," one young man from St. Petersburg says. "It's the only thing I can control. You can't control the way your face looks, but I can control the way the rest of my body is."

Barbie Isn't The Only One With An Impossible Physique

TAMPA - Perfectionist teenage girls aren't the only ones who loathe their reflections in the mirror.

Most young men share the angst about some part of their bodies, although that's not something they would share with even their best buddies. Too embarrassing. Too unmanly.

But a number of them - perhaps more than 2.5 million - take those concerns to dangerous extremes. They starve themselves, gorge on food and then vomit, or binge-eat to the point of misery. Unknown numbers risk their health by using steroids and other illegal substances to bulk up. Their obsessions with food and relentless trips to the gym disrupt their work and personal lives.

In the first national study of eating disorders, published this year after almost 10,000 face-to-face interviews, Harvard researchers discovered that men account for a quarter of anorexia and bulimia cases and almost 40 percent of binge eaters. Because researchers interviewed only adults, no one knows how many teenage boys are affected, even though the debilitating habits are thought to begin in the peer pressure-cooker of adolescence.

Experts blame a number of factors: advertising, with its increasing emphasis on the half-dressed man as a sales tool; high school athletics that pressure teenagers to add muscle; and media that offer facile explanations for childhood obesity and condemn kids as fat and lazy.

Despite the growing realization that men need help, too, treatment options are scarce, and insurance companies willing to foot the bill are rarer still.

Because the social stigma is so great, all the men and parents interviewed for this story requested anonymity.

Michael's Story

He has suffered the indignity of a feeding tube running down his nose into his belly. Osteoporosis weakens his bones. Fragile from self-imposed starvation, he recently needed a wheelchair to get around.

Still, Michael, 27, repeatedly checks his jeans' waistband for the dreaded snugness, his watchband to be sure it still slides easily along a boney wrist. He knows now how irrational that is, but it's tough to lose the habit.

On a recent morning, he woke up with a chocolate-chip muffin on his mind.

"I said to myself, 'Oh, no. I've got a fear food coming up.' All morning, the voice kept telling me that normal people don't eat chocolate."

Michael refers to the negative thoughts as the ED (eating disorder) Voice, an evil, undermining foe he must learn to ignore.

He psyched himself up and managed to get half of the muffin down as he sat at a table surrounded by languid teenage girls. He didn't enjoy it but understood it to be medicine or fuel.

Michael is midway through his five-month-long treatment for anorexia at Fairwinds Treatment Center in Clearwater. Because he could find no options in his home state of Georgia, he journeyed here. He shares a room with the only other male patient.

Frail, with a mop of brown hair and kind, soulful eyes, Michael started counting calories in high school. His physique mattered less to him in college as he fell in love and pursued a marketing degree. Sometimes his fiance made cracks about his weight, which had steadily crept up to 188 pounds.

Then, after five years of dating, his girl dumped him just three months before their wedding.

He would show her. He restricted his diet to egg whites, plain fish and steamed broccoli, then hid his weight loss from his parents.

After they went to bed, he exercised to exhaustion, doing 1,500 sit-ups and 1,200 to 1,400 push-ups. He weighed himself at least 10 times a day, panicking if he gained a half-pound.

"It made me feel proud that I was able to do it," he says. "It made me feel in control."

Pauline Powers, professor of psychiatry at the University of South Florida and medical director of Fairwinds, says that if the brain is deprived of proper nutrition long enough, thoughts become jumbled.

By the time his parents helped him get into Fairwinds, Michael weighed 81 pounds, couldn't stand, had a heartbeat of 31 beats per minute and required hospitalization to stay alive.

"When we speak of the ED Voice, it's not a hallucination," says Susan Wachter, Michael's therapist. "We direct them to think of the messages they tell themselves as an abusive relationship - it's dishonest, isolating, berating. It knows their vulnerabilities."

Michael's worries have begun to shift to what he has put his parents through.

"I wonder if I deserve to recover. That's the biggest challenge now, at least to me. Am I worth it?"

Jon's Story

Like Michael, Jon worries about body fat. At 6 foot 1, the 21-year-old weighs in at a muscular 215 pounds and is intimidating enough to work as a bouncer at a St. Petersburg club. But no matter how lean and muscular he gets, he's never satisfied.

"It's kind of mind-boggling and hard to explain," he says. "I change from minute to minute almost. I know I want to be real big, so I go to the gym. I'm one of the bigger guys there, and people tell me I'm big. Sometimes I feel that way, but then I'm always thinking that I want to be bigger.

"Then you get bigger and you notice you have put on all this body fat and you're not as cut as you were or as vascular as you'd like. So you're like, 'Man, I need to cut down so I can see my abs again.' Then you lose the weight and you feel small. It's a constant battle. I don't know if it's that way with all men, but for me it is."

Jon was born with a cleft palate and was attacked by a dog at age 5. Both required multiple facial surgeries, and although people tell him he looks fine, he doesn't believe it. Childhood was a torment of taunting and cruelty by other kids.

"I've been teased my whole life," he says. "But middle school was the worst. I was picked on, beat up, stole from - you name it. As far as self-confidence, I have nil, none, zero because of that.

"I figure since I'm so hideously ugly, I might as well have a nice body. It's the only thing I can control. You can't control the way your face looks, but I can control the way the rest of my body is."

He started playing sports at age 4. He ran track and played football, baseball and basketball in high school. In his senior year, he needed a class to fill a time slot and discovered weight training.

"From that day on, I was in love."

The state of his body rarely leaves his mind, although it's not something he has ever discussed.

Kevin Thompson, a professor of psychology at the University of South Florida, says it's not unusual for men to keep such concerns to themselves for fear of ridicule. Doctors often pat them on the back for their apparent good health.

What's easy to miss is how their interest in self-improvement can lead to disruptions in their work and social life. Thompson, who edited "The Muscular Ideal" (American Psychological Association, 2007), says that when bodybuilding is taken too far it becomes muscle dysmorphia, sometimes called reverse anorexia.

"It can be delusional," he says. "They're too exacting about their appearance because they genuinely have a misconception about how they look."

Even though muscular men may appear to be the physical ideal, the extreme fasting and binging that often accompanies bodybuilding can lead to problems with blood pressure and metabolism. Steroids, often the dirty secret behind huge abs, can trigger a host of physical and mental problems including jaundice, blood-filled liver cysts, hypertension, strokes and pulmonary embolisms.

Some studies suggest steroid use also causes mood changes, psychotic episodes and increased aggression and hostility.

Treatment Dilemmas

When family physicians see weight loss in a male patient, they often test first for AIDS or other diseases.

But even in a case as obvious and perilous as Michael's, few options are available.

Treatment is designed for adolescent girls. Even the questionnaires devised to hone in on anorexic behavior ask about the cessation of menstrual cycles and concerns about fat thighs.

Few facilities nationwide accept male patients, and with only a couple of exceptions, the majority of their patients are female. Therapists say it is difficult for men to open up in group therapy in front of female patients.

Even if a man finds suitable inpatient care, it might be unaffordable. Most insurance companies refuse payment for the treatment, which can take many months to succeed and cost more than $100,000. Parents often use up college savings or take out second mortgages. Some put the cost on credit cards and hope their child is well before their finances collapse.

Powers says insurance companies have been short-sighted.

"It's cheaper to treat someone early on, as it costs much more in the long run," she says. "Early intervention and appropriate treatment make a huge difference in outcome."

Often, eating disorders are accompanied by obsessive compulsive disorder, depression, anxiety and social phobia - although sometimes it's difficult to determine which came first. Genetics is thought to be involved, as some patients' families also have a history of eating disorders, substance abuse or mental illness.

Marjie Ruth, who leads ED support groups in Tampa, says it's tough for parents to learn to deal with the problem without contributing to it.

"Your instinct as a parent is not always what is needed," she says. "I believe it is an addiction, and addicts can be manipulative. For example, a young man may say he doesn't want to eat meat. The parents will agree to that. Eventually, the parents are cooking an entirely separate meal for their child, begging and pleading with him to eat.

"Usually these are great kids, very smart and well-spoken. The young man will put his arm around his mom and be really sweet and will do things to placate his parents."

Some of the mothers in her groups are afraid their sons might lash out physically in anger as their thinking becomes more confused.

Amy, a St. Petersburg mother, remembers a day she came home from work and found her 15-year-old son distraught and incoherent. She took him to an emergency room.

"A couple of his friends came there, and one started telling me that my son was bulimic and was drinking and doing drugs. I am so grateful to that boy."

At 18, her son still struggles, despite Amy's attempts to find suitable treatment for him.

"ED dictates an awful lot. School didn't go well. He doesn't have a job. It affects his thoughts and worries. As much as I would do anything for him to change this, as it's truly life-threatening, I can't do it for him.

"I don't want my son to become homeless, but it may come to that."

Fighting The Trend

In August, a Lady Lake man pleaded guilty to giving his young son steroids to enhance his competitiveness - in roller skating.

"Even in sports you wouldn't think of as needing power and strength, adolescents and even some adults think they need to be more powerful to achieve in those sports," Thompson says.

Athletic success is one of the primary ways boys achieve peer acceptance, and any hope of a career in professional sports hinges on attaining significant muscle mass. The temptation is great to get there any way possible.

The availability of steroids and other dangerous drugs makes the quest for muscles harmful and sometimes deadly.

Eating disorders also can take root during adolescence when athletes such as wrestlers stop eating and induce vomiting before matches. After weigh-in, they gorge themselves.

"It gets to be the social norm," Thompson says.

If it's not parents applying the pressure, it's the peer group. Boys who don't play sports, or who are much smaller or larger than others their age, often are ostracized, Powers says. That can lead to unhealthy habits.

She also criticizes a media that name-calls, branding a generation of children fat and lazy.

"We need to learn how to send the message to the specific children who need the help and determine how to help them, rather than make blanket statements that don't do anyone any good," Powers says. "We're not making a dent in obesity this way."

Just as parents are encouraged to talk to their daughters about detrimental media images, experts say boys need to hear the message, too.

At an early age, boys begin noticing impossible physiques in their Power Ranger and WWE Wrestling action figures. They grow up surrounded by ideals that are difficult to achieve: Abercrombie & Fitch shopping bags with six-pack male torsos, singer Usher dancing shirtless in music videos, a buff Tiger Woods on the golf course.

Studies show that 95 percent of women find extreme bodybuilders "repulsive," and men regularly overestimate the amount of muscles women prefer by 25 to 30 pounds.

It's normal for an adolescent boy to try to improve his appearance, experts say. Don't berate him if he is too slender or overweight, but encourage healthy eating and exercise.

"There's nothing wrong with working out," Thompson says. "The key is doing it in moderation."