Male eating disorders: the hidden epidemic
As numbers of men and boys with disorders soar, rugby union referee Nigel Owens tells India Sturgis about his battle with bulimia.
Nigel Owens, the international rugby union referee, is relaying a deeply personal incident from his work trip to Argentina, last month, for England's summer Test.
He had been enjoying a rare day off, and a barbecued banquet laid on for a group of fellow referees on a small island off the coast, when he realised there was nowhere on this small patch of land to discreetly purge himself of his dinner afterwards - and anxiety kicked in.
"There was only one small cubicle there, which was pretty public," he says. "People would have heard or seen me. By the time we went back to the shore and I could get to a toilet it was two or three hours later and the food had been digested.
"I tried to make myself sick but hardly anything came up." A sleepless night followed, "feeling down, annoyed and angry with myself for not being able to do it earlier."
Owens, 46, has suffered from bulimia on and off for nearly three decades. In the two weeks he spent in Argentina, he estimates he made himself sick five times, often sneaking off within minutes of finishing a meal.
Though known for his no-nonsense attitude on the field, it is only now he is seeking professional help for the first time - and laying bare his personal battle in Monday's Panorama: Men, Boys and Eating Disorders on BBC, in order to tell the much broader and even more troubling story of a generation of young men in crisis.
Eating disorders, which have the highest fatality rate of any mental health illness, are often assumed to be the preserve of teenage girls and young women. But of the estimated 1.6 million sufferers in the UK, around 400,000 are now believed to be men and boys; a figure that is on the up and what some are now calling a hidden epidemic.
In 2010, the Royal College of Practitioners registered a 66 per cent jump in male hospital admissions for eating disorders over the previous decade. And according to the BBC's research, the number of men in England receiving outpatient treatment for eating disorders has grown by 27 per in the last three years; twice as fast as for women.
The reasons are manifold, but many blame the daily assault of perfect abs and lean limbs on vulnerable young minds (those aged 13 to 17 are now at most risk of developing an eating disorder) via social media and advertising, coupled with rocketing academic and employment pressure.
In gyms around the country, as many as one in 10 men is believed to have bigorexia, a form of body image dysmorphia when a person believes they're too small despite being overly muscular, leading to obsessive exercise and steroid misuse.
What's more, the few published studies pointing to a surge in incidence may be the tip of the iceberg, as so few men still come forward for treatment. Beat, a charity that supports those with eating disorders, estimates that just one in 10 men suffering from one seeks help.
Tom Quinn, director of Beat's external affairs, blames it on the stigma attached. "It can be viewed as a female illness. Studies show that eating disorders make males feel less of a man, so they feel even more ashamed and are more reluctant to get help.
"Family and friends are also less likely to pick up on the warning signs for men. The same is true for health professionals, as GPs are more likely to attribute [symptoms of] eating disorders in men to other mental health problems, such as anxiety or depression."
Men are also more adept at hiding dramatic weight loss, as higher muscle mass makes their BMI less likely to plummet, disguising the condition.
In tomorrow's Panorama, Owens meets James Downs, 27, a Cambridge student who suffered from bulimia for years; feasting during the night, then hiding buckets of sick in his cupboard, out of sight. He has done lasting damage to his stomach and teeth.
James Mannon tells Owens he became addicted to dieting while at university. After losing 7st in a year, he became too weak to walk upstairs and had to quit his studies to move back home. He now has an NHS dietitian, but has been told to expect a significant wait for the psychological help he needs to manage the ongoing obsession with his weight. Most tragically of all, Owens meets Melanie Brazier, the mother of Steven, whom she found dead in his bed at the age of 19 in 2014. He had suffered a cardiac arrest after plummeting from 19st to just 8st in two years (purging up to 25 times a day). He had become obsessed with losing the weight he had put on after being involved in a motorcycle accident when he was 15.
For Owens, who grew up in the small Carmarthenshire community of Mynydd Cerrig, the trigger was coming to terms with his sexuality - and realising he didn't measure up to the men he was attracted to. "I was 16.5st. My belly was hanging over the front of trousers. There was no way these guys were going to fancy me looking like that." Soon he was throwing up after every meal, sometimes leaving the table between main course and dessert to be sick, but able to use his colitis - an inflammation of the colon - as "cover" for frequent bathroom trips. "I was really thin and pale and my face was drawn. Pretty much every day I was worried I would put the weight on. If I could see my stomach coming through my shirt I felt too big."
Obsessive workouts led to a steroid addiction, depression and, in his mid-20s - unable to reconcile the dissonance between his professional and personal lives - a suicide attempt. It was, he said, "a very dark place". The bulimia recurred until he was 36, when his mother was diagnosed with terminal cancer. He says: "I thought, here is my mum fighting every day to spend more time with us, with an illness that she can't do anything about, and here I am with an illness I can stop."
He believed he largely had the condition under control, until three years ago, when the pressure of passing fitness tests ahead of the Rugby World Cup proved too much.
"I needed to lose a couple of pounds and slipped back into losing weight the wrong way. I've suffered from it pretty much every month or so ever since. Not only does it do damage to your body but it's the mental side too. It's the anxiety," he explains. "You can't enjoy yourself when you go out to have food. You worry about eating too much and the bulimia coming back. It affects so much of your life."
His hope is that speaking candidly about his experience will encourage others to do the same. "There is a fear that men can't show signs of weakness and it is embarrassing to admit that something is wrong. We are supposed to be strong. But what I realise now is it is actually a great sign of strength to be able to confide to a friend, colleague, doctor or family member."
The even greater worry then is that, though experts agree that early intervention is vital in breaking destructive behaviour patterns, there is an average wait of 28 weeks from referral to receiving mental health treatment in some postcodes.
"That is not good enough," says Owens, emphatically.
No one who watches his powerful documentary could disagree.
Panorama: Men, Boys and Eating Disorders is on BBC One Monday at 8.30pm
-The Sunday Telegraph
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