10/25/2008 05:12 am ET | Updated Nov 17, 2011

Man oh Manorexia

It was almost a medical mystery. Last week, the New England Journal of Medicine (NEJM) published a provocative case study: a 19-year-old man staggered into the emergency room of Massachusetts General Hospital in Boston, complaining of abdominal pain.
Beyond bloating and nausea, the man suffered at a level he rated 8 (on a scale of 0 to 10, with 10 indicating the most severe pain). Yet, he did not abide the usual intestinal woes: diarrhea, constipation, fever, or chest pain. After a battery of tests, most proving negative, the doctors reached back into his history and found the culprit: a diagnosis of anorexia nervosa, made 4 years earlier.

At 5'2" and 86 pounds, the man had not gained weight since he was 11 years old.
Familiar with eating disorders, doctors at Mass General put him on a 5000-calorie a day diet. He gained 5 pounds within about a week. Not to anyone's surprise, the abdominal pain soon disappeared. Ironically, the man and his family both seemed worried that the amount of food prescribed was excessive.

They just didn't get it.

Boys and men fall prey to anorexia nervosa, too. And their numbers seem to be increasing -- or at least media attention to male eating disorders is increasing. This month, the BBC ran a news program on the topic, dubbed "manorexia." John Morgan, who runs the Yorkshire Centre for Eating Disorders in Leeds, reported that one in five men are suffering "some degree of quite extreme distress," related to appearance. That, in part, has fueled a "big rise" in the number of men with anorexia and bulimia. The exact numbers are hard to tally, in part because of males who have it often don't realize they're ill. Or they are very reluctant to come forward. Eating disorders conjure up connotations of homosexuality.

But heterosexual males get sick too.

Why? Pretty much the same reasons as females The cause of eating disorders is a perfect stew of genetic predisposition, a proclivity to perfectionism and anxiety, and pressure to perform to the extreme in athletics --as well as academics. Of course, we cannot forget the media besotted with cultural idols, in the case of men, extremely buff or extremely ripped.

The man in NEJM is a college student, who lives alone in a one-person dormitory room. He excels academically. He plays sports, as well as running 5 miles and lifting weights on alternate days. His mother had participated in diet programs -- and lamented her weight. His father suffered high cholesterol and panic attacks.

The man took his mom's dieting and father worry to the extreme. His thoughts now are so distorted by his eating disorder that, in the hospital, he continued to limit his caloric intake and was observed doing sit-ups in bed. (He denied that he was exercising.)

The NEJM message for doctors is to lookout for eating disorders, even in male patients. Also, that medical criteria for diagnosis are arcane. To actually have anorexia, individuals need to have lost their periods for at least three consecutive months. This obviously doesn't apply to men and so right now they technically cannot have anorexia, even if 86 pounds and doing sit-ups while refeeding in hospital wards. (Imagine what insurers do with this no-period loophole for men who want coverage).

For everyone else, stop thinking of the eating disorders as the scourge of girls who want to look like fashion models. It's scary to say, but with eating disorders, males are on their way to achieving equality with females. God help us.

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