SALT LAKE CITY — Josh Novak didn’t mean to develop an eating disorder.
At 17, he discovered weightlifting in his search for an outlet to help him cope with low self-esteem and recurring depression.
He eventually began eating past the point of feeling full, then hitting up the gym for five hours or running 15 to 20 miles to rid himself of extra calories. For days he would restrict his eating until his starving body would propel him into binge eating and renew the cycle. This behavior was accompanied by guilt, Novak said.
"It took a little bit to be like, ‘Oh, boy. This is something that, you know, is a huge struggle, and how do I overcome it?’”
An estimated 10 million men nationwide “suffer from a clinically significant eating disorder at some time in their life,” according to the National Eating Disorder Association. The association estimates that one out of every 10 people with an eating disorder, who come to the attention of a mental health professional, is a man.
In Utah, an estimated 30,126 men had eating disorders in 2007, according to data from the National Comorbidity Survey Replication.
"We're seeing more eating disorders with each passing year. So we know that the numbers are increasing," said Michael Spigarelli, division chief for adolescent medicine in the department of pediatrics at the University of Utah.
Spigarelli said he's not sure whether the increase is in proportion to the population growth, and he sees the numbers as more of an estimate.
"There is no good study that shows what those numbers are," he said.
Tracey Cornella-Carlson, an adolescent and adult psychiatrist and medical director at Wisconsin-based Rogers Memorial Hospital, said people now feel “comfortable coming forward” because teachers, parents, coaches and young people are better educated about eating disorders.
“They’re kind of coming out of the woodwork, so to speak. I don’t think the incidence or prevalence is any different. I think that it’s just the acceptance factor,” she said.
'A measure of shame'
The numbers are underreported for a variety of reasons, health officials said.
Often those with eating disorders will seek help for secondary problems, such as a sore throat or high blood pressure, but not for the disorder itself, Spigarelli said.
The individual may receive treatment from a primary care physician or may fail to report their struggle because of the negative stigma attached to what some see as a woman's disease.
"I think there's an added measure of shame in men," said Timonty Schaat, a specialist in addictions and substance dependency at Lone Peak Family Medicine in Draper.
Michael Weiss said he felt this firsthand. An overweight child, his parents wanted to put him on a diet at 7. He grew up in what he described as a dysfunctional home and began eating as a way to soothe his emotional pain.
"The first thing I learned to cope with was food," Weiss said.
When he was about 12, Weiss resorted to throwing up in an attempt to control his weight gain. It did not help him lose weight, he said.
The behavior led to $10,000 in dental repairs, problems with his heart, and a perpetual dissatisfaction with himself that bled over into rocky personal relationships.
"I was just never really happy with myself at all," Weiss said.
For years he cycled through addictions to drugs, alcohol, exercise or steroids before facing his eating disorder. Weiss said a breakthrough moment came when he was in a meeting with 20 other men in a drug abuse treatment facility and confessed his struggles with food.
"I've never been so scared in my life, to be honest with you," he said.
To his surprise, other men in the group admitted to similar struggles.
At that point, Weiss was willing to do anything to recover.
"I was so sick of being sick," he said.
Weiss began attending group meetings specifically for eating disorders — the only man among 15 women.
There weren't many other resources for Weiss, who said most of his recovery had to be done on his own or one-on-one.
Getting to the root of his addictions meant getting to the root of his eating disorder.
From his own experience and in his work as a therapist, Weiss said there are parallels between eating disorders and other addictions.
"The only difference is we need food and we don't need drugs," he said.
Schaat said the brain stimulus is similar with eating disorders and drugs.
"There is a degree of euphoria, a certain kind of reward that happens when they act out on the behavior," he said, adding that the release of dopamine and endorphins give an incentive for the behavior to continue.
A variety of triggers
The root cause for eating disorders is different for everyone, Spigarelli said.
"Sometimes by that's caused by stress. Sometimes that's caused by being overweight and being teased. Sometimes it's connected to fear of puberty and growing up and being an adult," he said. "In some cases, it's probably related to sexual abuse."
Rising obesity levels can be triggers as well, Spigarelli said. With obesity on the rise, people are worried about gaining weight, and "that pressure for people who are susceptible to eating disorders can bring out an eating disorder," he said.
People tend to use weight as an indication of health, Spigarelli said, and "as a society, we disproportionately focus on weight gain, not unhealthy weight loss."
"In reality, it's bad to not be at a healthy weight,” he said.
The criteria to diagnose someone with an eating disorder are essentially the same between men and women, Spigarelli said.
A person with normal weight who thinks they’re fat, someone who does not appear to have control over their eating, people who engage in extreme diets, or someone at a normal weight who takes weight loss supplements could be exhibiting signs of an eating disorder, he said.
Spigarelli said most of his clients spend 15 to 16 of their waking hours thinking about food or exercise.
"That really shocks the people that they're with because no one understands that it's an every waking moment concept," he said.
Those with eating disorders also tend to be socially isolated, because it's difficult to avoid drawing attention to their eating behavior.
“They get away for a while by saying, ‘Oh, I ate right before I came,’ or ‘I have a blood test in the morning, and I have to be fasting for it,’ or something," Spigarelli said. "But you can only use those excuses so many times before people catch on.”
It is not something someone can stop on their own, he said, although that is often what misguided but well-intentioned loved ones do.
Although men suffer from anorexia, most commonly they are found to be like Novak — binge eating and/or going to extremes to maintain a muscular physique.
It becomes a problem when it begins interfering with their day-to-day functioning, according to Kary Woodruff, a sport dietitian at The Orthopedic Specialty Hospital in Murray.
"I always present the question of: ‘What are you having to do to maintain this?’" Woodruff said.
At his worst, Novak’s cycles lasted for days during a period of one to two years. He estimates he suffered from an eating disorder for four to six years.
“I didn't have any resources," he said. "I didn't know where to go.”
The secretive nature of the addiction often makes it hard for family and friends to recognize symptoms, Spigarelli said.
“That, to me, is the biggest tragedy in this whole thing,” he said.
Society has adopted the incorrect assumption that when someone who is normal weight says they're fat, it is solely a symptom of insecurity, Spigarelli said.
"So when somebody says to their parents or friends or to their significant other 'You know, I'm feeling kind of fat,' the general expectation of the public is that they're looking for some kind of compliment, not that they’re saying they have a symptom of a disease,” he said.
Spigarelli encourages family and friends to speak up if they notice that a loved one may be struggling with an eating disorder.
"I think we learn to not see them, and I think part of that is because we worry that we might be offending somebody," he said.
The bottom line, Spigarelli said, is "treatment works and people get their lives back."
What matters most is “how bad the disease is, how long it's gone on for and what their personal beliefs are as to what the disease does for them in a positive way," he said.
"If you think about people who by definition are afraid of becoming overweight, the disease provides some reassurance to that fear,” Spigarelli said.
Because of this, he tries to help patients see that he will not make them become overweight, but will help them reach a healthy weight.
Ideally treatment comes in a trifecta, where a nutritionist, therapist and doctor will work together, said Alyssa Anderson, a registered dietitian at St. Mark’s Hospital.
A good indicator that someone is on their way to recovery is their willingness to talk about their disease, she said.
“Eating disorders thrive in secrecy,” Anderson said.
Treatment options range from seeing an eating disorder specialist, nutritionist and perhaps a therapist for a handful of visits for mild cases, or residential treatment for those with more severe conditions, Spigarelli said.
Novak now studies eating disorders in men as part of his doctorate work at BYU. He has been able to use his experiences to help others struggling with similar issues.
Novak went to therapy for the depression that was the root of his eating disorder, but he was never asked about his relationships with food and exercise.
He eventually began developing friendships with other men and felt more accepted, which led to his recovery.
The eating disorder is still something in the back of Novak's mind. When he misses a day at the gym or eats food that is not as healthy, he has to remind himself to not feel guilty.
“Everybody has to negotiate their experience with food and exercise,” he said.
Weiss now meditates for an hour every day, an integral part of his recovery, and said he is glad he sought help.
"Because I've dealt with this, I'm extremely happy today," he said.
Weiss admitted that it is difficult to find residential treatment for men with eating disorders. One thing he hopes to see is an increase in awareness to help the disease move out of the shadows.
"I'm just interested in a dialogue," Weiss said.
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