Newswise — As a global professional association committed to leadership in eating disorders research, education, treatment, and prevention, the Academy for Eating Disorders (AED) has partnered with the National Association for Males with Eating Disorders (NAMED) to comment on the recent media articles discussing extremely restrictive diets and fasting. This latest round of media “buzz” on intermittent fasting began with an interview with Twitter founder Jack Dorsey who reported eating approximately 1,000 calories per weekday and abstaining from food on the weekend. The public and media response to his interview have illustrated two areas where AED and NAMED would like to provide a formal response to educate the public.
The difference between a diet (or ‘biohack’) and an eating disorder.
Diets, ‘bio-hacks,’ fasting for religious reasons—they all have shared behaviors with eating disorders such as restricting caloric intake and/or eliminating food groups. Jack Dorsey, for example, has restricted his calories to 1,000 kcals per weekday and zero calories on weekends, and reported eliminating food groups such that he mainly eats vegetables, meat, and some fruit. These behaviors become a part of a disorder when they continue despite negative physical, emotional, and functional consequences.
Physical consequences of calorie restriction may include cardiac arrest, electrolyte imbalances, loss of fertility, and non-reversible osteoporosis.[1] These medical complications highlight the severity of eating disorder diagnoses which have among the highest mortality rates of any mental illness, second only to substance use disorders.[2] We recommend that anyone participating in caloric restriction, regardless of why they are reducing calories, be seen regularly by their physician.
Emotional consequences of calorie restriction and/or eliminating food groups may be easier to hide, but may also produce more suffering than the physical consequences. Theorized to be an evolutionary mechanism designed to preserve our species, caloric restriction can result in excessive thoughts about food.[3] Many people find their mind becomes monopolized by thoughts of their body and food, resulting in increased anxiety and depression.
Functional consequences of calorie restriction and/or eliminating food groups can go hand-in-hand with the emotional consequences. When adhering to a restrictive diet limits your ability to socialize with friends, attend a work dinner, or feed your family—your diet is impairing your functioning. While many people with severe eating disorders can maintain a high level of functioning at work or school, their roles as a friend, partner, and parent may suffer due to their adherence to their diet.
Regardless of why people are restricting their calories and/or eliminating food groups, AED and NAMED recommend that they are monitored by a medical team and that they cease their restriction if any physical, emotional, or functional consequences emerge. When an individual is unable or unwilling to stop the eating behaviors that are leading to the negative physical, emotional, and/or functional consequences, that is when we use the term eating disorder.
Finally, most people are physically unable to sustain a diet as restrictive as Mr. Dorsey, and thus striving for such a goal may add further mental and biological strain. In fact, strong biological mechanisms can override any previous intentions and propel people towards nourishment. However, neurobiological research is showing that a small percentage of people ARE able to severely restrict their calories, and they tend to be the same people with specific temperament traits: altered interoceptive awareness (e.g., they can study through fatigue and play through pain), high attention to detail and ability for extreme focus (e.g., when they set their mind to something, they achieve that goal). These traits can contribute to professional and/or academic success for many people—however, these same traits may make some people vulnerable to eating disorders.
Men have eating disorders too:
Importantly, the glorification of males engaging in intermittent fasting behavior can normalize what may be physically, emotionally, and functionally unhealthy behavior for many men (and women). While Mr. Dorsey was applauded for his discipline and innovative ‘bio-hacking,’ some journalists opined that if Mr. Dorsey were female, people would have labeled his behaviors as pathological (an eating disorder) and derided him for being a poor role model.
One potential reason for this discrepant response is that despite up to 25-40% of people with eating disorders identifying as male,[4] eating disorders are still largely seen as exclusive to females. Both perception of eating disorders as “feminine” and our culture’s glorification and normalization of male toughness, may lead men to feel “weak” for admitting to having a problem with their eating. This stigma may be in part, why males are less likely to be diagnosed and less likely to seek treatment for an eating disorder.[5]
AED and NAMED would like to remind the public that research has shown:
- • As many men as women want to change their weight or shape, however, men may report either wanting to lose or gain weight[6]
- • 4% of girls and 23.9% of boys endorse that their weight and shape are among the most important factors in their self-evaluation or self-esteem[7]
- • Up to 24% of college men engage in fasting (≥ 8 hours without eating) to influence their weight or shape[8]
- • Fasting behavior in males occurs at similar rates to females[9]
- • Fasting/extreme dieting behavior in males increased at a faster rate compared to females from 1998 to 2008[10]
- • Traditional eating disorder assessments that were developed for females often underestimate problematic eating in males[11]-[12]
Among the goals of this response are to: increase awareness about eating disorders, note the differences in how they physically present in males, note the language and culture that may contribute to these unhealthy behaviors, and normalize the use of mental health services to overcome these disorders for individuals of all genders.
In conclusion, for all genders, dieting is a risk factor for an eating disorder and adhering to restrictive diets can have unintended physical, emotional, and functional consequences. AED and NAMED urge caution, medical monitoring, and eating disorder screening when considering a highly-restrictive diet or ‘bio-hack’.
References
[1] Academy for Eating Disorders. (2016). Critical points for early recognition & medical risk management in the care of individuals with eating disorders (3rd ed.). Reston, VA: Academy for Eating Disorders. https://www.aedweb.org/resources/publications/research-practice-guidelines
[2] Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry, 13(2), 153-160.
[3] Keys, A., Brozek, J., & Henschel, A. (1950). The biology of human starvation. Minneapolis, MN: University of Minnesota Press.
[4] Hudson J.I., Hiripi E., Pope H.G., Kessler R.C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 61(3):348-358.
[5] Griffiths, S., Mond, J., Li, Z., Gunatilake, S., Murray, S. B., Sheffield, J., & Touyz, S. W. (2015). Self-stigma of seeking treatment and being male predict an increased likelihood of having an undiagnosed eating disorder. International Journal of Eating Disorders, 48(6), 775-778.
[6] Keel, P. K., Baxter, M. G., Heatherton, T. F., & Joiner, T. E., Jr. (2007). A 20-year longitudinal study of body weight, dieting, and eating disorder symptoms. Journal of Abnormal Psychology, 116(2), 422-432.
[7] Ackard, D. M., Fulkerson, J., & Neumark-Sztainer, D. (2007). Prevalence and utility of DSM-IV eating disorder diagnostic criteria among youth. International Journal of Eating Disorders, 40(5), 409-417.
[8] Lavender, J. M., De Young, K. P., & Anderson, D. A. (2010). Eating Disorder Examination Questionnaire (EDE-Q): norms for undergraduate men. Eating Behaviors, 11(2), 119-121.
[9] Mitchison, D. & Mond, J. (2015). Epidemiology of eating disorders, eating disordered behaviour, and body image disturbance in males: a narrative review. Journal of Eating Disorders, 3, 20.
[10] Mitchison, D., Hay, P. J., Slewa-Younan, S., & Mond, J. (2014). The changing demographic profile of eating disorder behaviors in the community. BMC Public Health, 14.
[11] Darcy, A. M., Doyle, A. C., Lock, J., Peebles, R., Doyle, P., & Le Grange, D. (2012). The eating disorders examination in adolescent males with anorexia nervosa: How does it compare to adolescent females? International Journal of Eating Disorders, 45, 110–114
[12] Darcy, A. & Lin, I. H.-J. (2012). Are we asking the right questions? A review of assessment of males with eating disorders. Eating Disorders, 20(5), 416-426.
ABOUT
The Academy for Eating Disorders (AED) is an international professional association committed to leadership in eating disorders research, education, treatment, and prevention. The goal of the AED is to provide global access to knowledge, research, and best treatment practice for eating disorders. For additional information, please contact Elissa Myers at (703) 626-9087 and visit the AED website at www.aedweb.org.
NAMED is a nationwide professional association committed to leadership in the field of male eating disorders. We aim to provide support for males affected by eating disorders, provide access to collective expertise, and promote the development of effective clinical intervention and research in this population. Please take a few moments to browse our website, take advantage of our resources, and connect with our community.
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