Tuesday, February 20, 2018

Men have body image issues too

I have lost and gained weight several times in my adult life. It wasn't a problem when I was younger and working construction. An "ideal" office job 30 years ago started the yo-yo effect. I don't have any more weight to lose, but the potential of gaining it back is always there.

Over the last dozen years, my weight has fluctuated within a 150-pound range. I have never liked to talk about it much either way. If I was doing well by my standards, I didn't want to jinx it by hearing someone else's experience. If I wasn't, I certainly didn't want to go there.

If The Biggest Loser comes on, I can't change the channel fast enough.

My reluctance to engage on the subject has caused me to come across as cold at times or even antisocial. I regret the perception. I suppose it stems from a failure of imagination on my part, by which I mean not coming up with the right response when someone invites me to comment on my body.

For me, the intertwined subjects of weight loss and food — even exercise, to some extent — are deeply personal. They are the regulators by which we move closer to what we want for health and well-being, or further away.

I don't think most men talk about their bodies in any significant way. I don't mean workout routines, which you'll find in most any men's lifestyle magazines. None of those magazines feature a plus-sized male model on the cover. We don't think of that, let alone talk about it.

I was more than "plus-sized." Ten years ago my weight peaked at 333 pounds. Clothes didn't fit, suspenders were about 100 years out of style, and belts didn't work. Even after I found pants at the big-and-tall store, keeping them up was a real problem. Either you're applying a tourniquet to the midsection or it's somewhere around the hips, or it's too loose, which defeats the purpose of a belt. It's one of a thousand odd facts about living with too much weight, which cumulatively led me to resolve to take it off.

You are not what you eat

It's hard — impossible, really — to talk about our relationship with our own bodies without talking about food.

Food tempts and seduces, it betrays and sustains us. It giveth and taketh away.

Two things separate problems with food from other behaviors that are often called addictions. One is that abstinence is not possible. The second is the idea that these issues disproportionately affect women, a perception that may be changing.

"Eating disorders have historically been considered among the most gendered of all psychiatric illness presentations," begins an article in this month's Current Psychiatry Reports.

The Mayo Clinic defines eating disorders as persistent behaviors around food that negatively affect health, emotions and ability to function in important areas of life. For a large part of the 20th century, mental health professionals didn't think men suffered from these behaviors at all.

That perception shifted to a belief that men comprise one in 10 cases of eating disorders, the psychiatry journal states. More recent studies show the number may be closer to one in four.

"We think, 'Oh, men don't care about their looks, and if they do, they're just simply being whiny,' " said J. Kevin Thompson, a University of South Florida psychologist for 37 years and a longtime researcher on eating disorders.

Men started showing up in eating disorder studies about 15 years ago, but have since closed the gap in one category.

"With binge eating disorders, you're pretty much talking equal rates between men and women," Thompson said.

Genes might influence who develops eating disorders, experts say. Regardless of the cause, interactions with others can make problems dramatically worse, as demonstrated in the suicides of teenagers who have been teased.

"If you talk to teachers, they understand that body image issues affect boys, maybe not as much as girls but it's a real problem," Thompson said.

The term "body image" bears virtually no relation to a person's appearance, so much as perceptions about appearance.

I had a variety of camouflages that were supposed to disguise the way I felt about the way I looked. Triple-X shirts with the shirttail out. Sweatpants. This image of pretending to not care about my appearance was itself a pose.

Push something down enough, you can almost make it go away. But sometimes, reality breaks through.

One evening in my above-300-pounds period, as I was preparing to step on a grocery store scale, I slipped off my shoes, as always.

Just then, a couple leaving the store noticed me removing my shoes. They nudged each other, whispered and laughed. To them it was good clean humor — perhaps even to be shared with me, enjoyed by me — the fat man taking off his shoes so he wouldn't weigh quite so much. A Norman Rockwell moment, a wonderful gift.

Highs and lows

I'll acknowledge yo-yo dieting. Heck, I'm a textbook case.

I was somewhere in the 290-pound range in 2010 when I got pneumonia. A week in the hospital took off 30 pounds. I kept going as I recovered, picking up Nutrisystem and spinning.

I stopped at around 210 pounds, which for me at 6 feet 3 was fine.

A decision to stop spin classes to save cost led to weight gain, to 270.

I took some off, gained some back, then redoubled my efforts. Now I'm at about 190 and have been for months. I spin or run, something I can do again with less weight to carry. I still eat Nutrisystem on occasion. When I go out, I eat what I want.

The bizarre thing is what happens when you take weight off. I felt great. The pounds were going away, I was buying new clothes and starting to like what I saw in the mirror.

But the obsession with body — mine or anyone else's — does not disappear with the weight.

Other than a trainer with whom I worked out for six years, I've never had nor sought much advice. It comes my way just the same. Lately, people tell me I'm too thin, I'm anorexic and I should gain weight. I ignore almost all of it.

I ignore it because I feel good now and don't want to go back to feeling bad. By feeling bad I am referring to shortness of breath, knee and lower back pain, high blood pressure, sleep apnea and putting myself at risk for Type 2 diabetes.

Yet this is no victory story. "Recovery" is tenuous, and ravenous eating never feels far away. Cravings are unnerving.

In social situations, I'm torn about which questions to answer. What is there to explain? I feel good in my clothes — and the fact that I am even interested in clothes. I walk without pain and no longer have sleep apnea. Eventually I'll hit the weights again.

Even being asked for summary comment can be disconcerting. That's not surprising, given the evidence that comments of others influence how we feel about our bodies.

In past studies, Thompson and colleagues have developed a scale of subjects' responses to positive and negative commentary. Examples might be "You've put on weight" or "You look good today."

"Negative commentary made people feel more body-image conscious," Thompson said. "But positive commentary makes them feel more self-conscious, too. It's almost like objectification, they've reduced you to something that's to be labeled."

Does that mean it's wrong to compliment someone? I don't think so. I like compliments. I'm even fine with specific questions about weight loss from people who seriously want to know, maybe because they are trying to do the same thing.

But appearance is tricky, maybe even more so for men, if for no other reason than there are fewer support systems.

"Women have risen up about Barbie, whereas men haven't found their voice," said St. Petersburg therapist Kathleen Bishop, a licensed clinical social worker. "They're thinking, 'Maybe the reason the girl is not interested in me is that I'm not as buff as the dude in the corner.' "

A study in which Thompson participated a decade ago, of west-central Florida boys ages 13 to 17, found that 5 percent took anabolic steroids. Three other studies of teenage boys, from 1992 to 2005, show that same figure or higher.

And the May 2017 Current Psychiatry Reports correlated extreme measures by adolescent males to look both muscular and lean, including steroid use, with more conventionally defined eating disorders among females. In some cases, boys being treated for anorexia shifted from "thinness-oriented" to "muscularity-defined eating disorders presentations." The authors concluded with a plea for more research into traditional and muscularity-defined eating disorders in males.

Signals from popular culture seem to run in two different directions. In the 40 years since Star Wars debuted, Thompson said, action figures have bulked up significantly.

"Han Solo has increased in size dramatically," Thompson said. "The Hulk 30 years ago was not that big. The Hulk today is huge."

At the same time, millennial male models appear almost gaunt, and it's hard to imagine a muscular man fitting into their slim-cut clothes.

"You look at professional golfers, there is no more muscularity anymore," Thompson said. "They all have the same body type. They are lean, they talk about the speed of the club doing the work. Look at Hollywood actors other than the Rock (Dwayne Johnson). Look at Ryan Gosling or Ryan Reynolds or almost any leading male actor. They are all really skinny."

Thompson thinks he knows the best way to find out how males feel about their bodies. Ask them.

"It's almost like we need to do a focus group, get 10 or 20 boys together, 15 to 18, and say, 'What's your ideal body type and why?' I don't think we know."

My own ideal has changed several times, from muscular to lean to whatever comes next. I still struggle with fear. I look forward to the day when eating doesn't feel like taking a panther for a walk. Will it stay on the leash?

At the same time, not being in crisis is a tremendous relief. I remember in my most stressed-out moments that I am alive and healthy. I take a deep breath, then another.

Andrew Meacham is the Times' performing arts critic. Contact him at [email protected] or (727) 892-2248. Follow @torch437.

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