On Monday, I featured in a BBC Panorama special on men, boys and eating disorders. Fronted by international rugby referee Nigel Owens, the programme followed his personal story from early struggles with body image and sexuality through decades of intermittent mental health problems including recurrent bulimic behaviour. His bravery is undoubtable. Despite the positive impact brought about by individuals telling their story, it is never easy to expose yourself - whether to friends, family, or in a therapy room - never mind on national television.
It is sad that awareness of eating disorders is still lacking to the extent that we need public figures to bring attention to the experiences of people like myself and others featured in the programme, who have struggled with a range of life-limiting eating problems. That being said, we are where we are, and this much-needed programme has prompted so much invaluable discussion around eating disorders, particularly in men and boys.
But eating problems are not straightforward, and media soundbites can only go so far in illustrating the complexities of this subject. Anticipating the tendency for public debate to oversimplify complex phenomena, here are my 5 key points to remember as we start to see more awareness about eating disorders in men:
1) Eating disorders are not a lifestyle choice
Eating disorders are complex neurobiological conditions situated within the intricate bio-psycho-social world of human experience. Life events, the environment, and elements of lifestyle might provide triggers for eating problems where there is an underlying biological predisposition, but these are not ever the sole cause in themselves. We would never consider a physical illness such as inflammatory bowel disease - which is likewise caused by a combination of environmental and biological conditions in susceptible individuals - to be a choice.
If you want to look at eating disorders through the lens of choice, then consider whether it is a free choice, or even remotely compares to lifestyle choices such as the hobbies you enjoy or the clothes you wear. We chose things because we want them, they are desirable or confer benefits. If choosing an eating disorder is somebody's best option, then imagine the kind of life and conditions that makes this the case.
2) Eating disorders represent a complex range of problems not confined to eating and weight
Whilst the symptoms of eating disorders are focussed on unhelpful feeding behaviours and their destructive consequences, we must look beyond the way food is being used to the reasons why. There is never a sole cause of an eating disorder, the causes are many and different for everyone. Eating disorders might represent issues with anxiety or control, they might be a response to trauma, they might be socially maintained by harmful environments or loneliness - the possibilities are endless. Only one part of this is how disordered eating can physiologically perpetuate disordered eating. Eating disorders are just as importantly maintained - in too many cases - by a lack of access to support.
They also occur irrespective of outward appearance. A minority of people with eating disorders are underweight - most are a normal weight. The way a person looks or behaves in public can never exclude the possibility that they might have a hidden eating problem.
When you have an eating disorder, you can feel as though the human basis of your problems goes unseen if those helping you relentlessly focus only on eating, weight and shape. Whilst the physical and psychological risks of eating disorders need to be managed, and safety is a priority, changing the behaviour itself isn't the real aim for me. The ideal solution is to remove the need to rely on such damaging behaviours in the first place.
3) No one eating disorder is the same as another
I don't mean that anorexia is not the same as bulimia. I mean that one person's experience of anorexia is never same as another person's experience of anorexia. I mean that the many reasons behind my experience of bulimia will never match anyone else's, and my pattern of symptoms are unique to me within the context of my individual situation. Of course, its great that people want to know more about what defines different eating disorders and the causes behind them. But learning about different symptom patterns, or the common factors predisposing anyone to developing an eating disorder, should never supersede an awareness that everyone is different.
Eating disorders are profoundly complex and have to be viewed within the whole context of someones life - their biology, their family, their interaction with society, and more. As awareness increases, we need to keep away from presupposing what anyone with an eating disorder might be going through. Increasing training for GPs and other health professionals is essential, but only if they remember that knowing a list of common symptoms, causes and cures will only take you so far. The individual and their unique context is what matters.
4) Eating disorders happen to people, not to boys or girls
Whatever genitalia we might have - whichever gender, sexual orientation, ethnicity or social background - eating disorders are conditions suffered by people. It's encouraging to see awareness broadening to include how males can struggle with eating problems too, but we shouldn't be framing experiences of eating disorders in terms of the kinds of people they may happen to in the first place. The differences between any two people with eating disorders are going to extend far beyond differences in gender. NHS guidelines state that responses to eating problems must be 'gender-appropriate', but more important than this surely is the need for support to be 'individual-appropriate'. Gender is only one aspect of any of us.
5) Speaking out is great, if matched by appropriate responses to need
Role models such as Nigel Owens are increasingly speaking out about their experience of mental health problems and encouraging others to do the same. Being open has its benefits in counteracting stigma, personal shame and the silencing power of mental health problems. But not everyone is so lucky as to have supportive people to speak out to. Even if they do, social support in the form of family, friends and understanding workplaces, however therapeutic, is NOT a therapy or a treatment. Supportive social networks might play a part in helping prevent illness in the first place, but they are NOT a substitute for timely access to appropriate, specialist services.
If anything, we can hope that increased openness will raise the pressure to provide the resources needed to treat eating disorders. More people coming forward will compel GPs to have the training they ought to, and will hopefully force commissioners to fund services to support people before they become critically unwell and their lives are put at risk. In the mean time, society may have to pick up the pieces for the lack of support available, but this shouldn't be the case.