29-year-old Sam Thomas is the founder and director of Men Get Eating Disorders Too (MGEDT), an organisation set up to do exactly what the name suggests - raise awareness of the fact that men get eating disorders too, and offer peer-led support to those men who are affected. He speaks to RSCPP about the charity's work, and how it all got started.
"The organisation began from my own experiences of having had bulimia throughout high school," Sam says. "For numerous reasons I struggled to get help, and I think the issues around men and eating disorders were barely recognised back then."
Having struggled with bulimia from the age of 13 to about 21, Sam saw a "gap in the market, so to speak" for men in need of support.
"It's kind of reflecting my own experience. I thought, given the fact that my bulimia was very intense and severe, that if I was a woman with the same set of situations and symptoms then surely I'd have been diagnosed a lot quicker and referred onto services," he explains.
I struggled to get help for my bulimia; the issues around men and eating disorders were barely recognised back then.
"That prompted me to investigate the support and see what was out there, just assuming there must be something in the world for men with eating disorders. I searched online and found absolutely nothing, apart from a few blogs written by men who were suffering severely with anorexia." Although generic eating disorder services and information are and were available, Sam says a lot of these websites didn't seem to have anything specifically for men.
According to NHS statistics, around one in ten people affected by eating disorders are male, although Sam believes this is "a significant underestimate" because so many male eating disorders go unreported and undiagnosed.
"It became quite obvious that I had to do something online, so people could seek information anonymously, in confidence, so that's what I did," he says. And so, in 2008, the idea for MGEDT was born. In its infancy, the organisation gained support from ITV's Fixers, and the website launched in spring 2009.
We got emails from men across the world who were struggling.
"Following the launch of the website we got emails from men across the world who were struggling, so it became obvious it couldn't just be a five minute campaign, it had to be a charity," Sam says. Six years on, MGEDT now offers online peer support, training for health professionals, and recently announced their first national conference, which will take place in Brighton on 10 July. "In terms of what we do, it's really to raise awareness of the issue, but also to provide online spaces so men who are struggling, as well as their friends and families, can get support," he explains.
Besides links to resources and services, this support primarily takes the form of MGEDT's recently launched online peer support service, which runs every Wednesday. "Men can access the live chat via the bottom of the homepage. You click and it pops up - similar to Facebook chat in many respects - and you can talk to someone anonymously. It's like a helpline really, but just via our website," Sam explains. These live, one-on-one chat sessions are run by trained peer supporters, offering men a safe space to talk about their experiences and how they can get support.
Typically, the people who use the live chat have never really spoken about their eating disorder before.
"The peer supporters are people who have been through it themselves and are in recovery, who are in a position to be able to support someone else who's in crisis, in need of urgent support. Typically, the people who use the live chat service are people who've never really spoken about it before, because they can't speak to family members, peers, or even professionals - so it's people who really are in need," Sam says.
As well as offering support to men with eating disorders, MGEDT also works with healthcare professionals, offering training on how best to engage and support male service users. "I think, historically, a lot of eating disorder charities, in particular, and services, were just not in a position to be able to engage with reasonable numbers of men, and equally I think men just didn't feel as if they could approach those services, especially because they were quite feminised, for instance," Sam says.
"Since then I think we've moved on, and I think services are now beginning to become what I would describe as gender inclusive, and all-round inclusive, so they're more aware of the specific needs for men, and the hesitance men may have with coming forward or speaking about their own experiences. But I still think that a lot of men just don't engage with those services still."
Historically, men didn't feel as if they could approach eating disorder services.
The training MGEDT offers to professionals is focused on helping them to recognise the symptoms of eating disorders in men, create environments in which men can feel welcomed, and better support those men who are suffering. "It's partly to enable professionals to feel they can have a space to reflect on their own professional practice, and what they could do to improve that in order to best support men; in order to improve service provision, ultimately," he says.
"So how we do that is by exploring the different issues, particularly the barriers and how those can be overcome, and also the different experiences of men who have attempted to get treatment, for instance, and not been able to; or, when they have, what worked and what didn't work. Really it's just about enabling them to feel more confident in being able to support a man with an eating disorder in relation to their role or service, so it's a space to explore and also learn from others."
"When I actually started the charity it was in the height of 'size zero', which was being heavily debated in the media," Sam says. "It seemed like there was coverage every single day, in the newspapers, on television, in magazines, so that to me was just reaffirming a sense of the stereotypes, particularly around gender but also around eating disorders themselves. It often seemed that it was coming across as an issue that was linked to fashion, celebrity culture, all those things that I personally did not relate to at all. I think a lot of people would agree that those things have nothing to do with the reasons why they developed an eating disorder."
There a lots of groups in which there are probably men suffering in silence because they're not able to reach out for help.
Tackling these kinds of stereotypes is another important aspect of MGEDT's raison d'etre. "There are many misconceptions about eating disorders - besides gender, obviously there's also the issue of age. I think we have a tendency to think that people with eating disorders are just younger people, adolescents even. We're now starting to see a lot more older men coming forward for the first time, having had eating disorders for many years, and also relapsing around mid-life. Typically you don't ever hear of people who are BME having eating disorders, or people of faith, so there are lots of groups in which there are probably men suffering in silence because they're just not able to reach out for help," Sam says.
For men, one of the biggest knock-on effects of these stereotypes is that they may be less quick even to recognise eating disorder symptoms in themselves. "Men can have an eating disorder for quite some time but be oblivious to it - they might know they've got some kind of issue around food, eating and self-image, but not link that to eating disorders; then, when they do, they may be in denial for quite some time," he explains. "Often it's the people around them who will spot the signs long before they do - particularly the women in their lives; wives, girlfriends, mothers, sisters, flatmates are the ones who tend to pick up on it first.
For men there are certain issues that are specifically to do with the stereotypes that people still typically associate with eating disorders.
"Then, in the GP's surgery, I don't think a man would find it so easy to sit there and say 'I think I've got an eating disorder'. In fact, when men do try to seek help, even their GPs are perhaps not so quick to spot the signs and make the diagnosis, so there are numerous hurdles that men have to go through. That's not to suggest that women aren't subject to some of the same issues as well, but obviously for men there are certain issues that are specifically to do with the stereotypes that people still typically associate with eating disorders."
For Sam, another problem in terms of awareness is the prevailing association of 'eating disorders' with 'anorexia': "Actually, anorexia's the least common of the four main eating disorders, and I think there are many other eating disorders that kind of slip the net of the diagnostic criteria, which typically would be categorised under EDNOS - eating disorders not otherwise specified," he explains. "I think we're starting to see eating disorders become a lot more complex in terms of their presentations, in terms of behaviours, but also how they manifest themselves as well, so I think we're starting to see that eating disorders themselves are becoming more diverse, if you like."
While the exact causes of eating disorders are both diverse and complex, Sam does believe that men today are under more pressure than ever, in terms of their appearance and identity, and this has played a significant role in the rise of men seeking help for eating disorders.
"I think, in these modern times we're living in, we're becoming more exposed to different images all the time, and I think in turn we're probably becoming more conscious about how we look, how we feel about ourselves, and how we're perceived by others. I think men are perhaps becoming more aware of that now; 20 or 30 years ago, men probably weren't so conscious about their body image and identity in the same way," he says.
Men are becoming more conscious about how we look, how we feel about ourselves, and how we're perceived by others.
In some ways, Sam says, men are now subject to the same pressures that women have faced for much longer: "It's been an untapped market, really. Even 10 years ago you wouldn't walk into Boots and find a whole department for men's cosmetic products - 10 years ago it was probably a shelf - and there seem to be more and more men's magazines now, and sports products. These are indicators telling us that perhaps men are feeling more pressure to look good, or even in terms of how they want to look."
In terms of supporting men through eating disorders, Sam says the most powerful thing is for men to speak about their own experiences: "Obviously people relate to other people, so if they hear about a story of a man with an eating disorder - whether it be on our website or in the media - they can relate to that and come forward to get the help they need. Now that MGEDT can provide online peer support, we're able to do just that."
Besides bringing men's stories out into the open, MGEDT hopes to make people more mindful of how they talk about eating disorders, remembering that they are "ultimately indiscriminate", without replacing one stereotype for another. Remember too, says Sam, that men may tend to approach their feelings in a different way from women: "Men are perhaps a bit more matter of fact; it's almost like they use a different emotional language, which could potentially be another barrier to getting help. Men might just talk about the behaviours, as opposed to the feelings and emotions - so they may talk about very obsessive compulsive behaviours around eating, rather than how they feel."
It's almost like men use a different emotional language - they might just talk about the behaviours, as opposed to the feelings.
If you are concerned about a man in your life, Sam says "first and foremost, don't tackle the eating disorder head-on. If you directly ask a man 'have you got problems around food or eating?' I think the chances are they're going to shut down." His advice is to ask more general questions about how they're doing, or if there's anything you can do to help. "It's really important to be mindful that a man might take some time to open up, so it's important not to pressure them in any way."
He adds: "This sounds really obvious, but just let them know that there is information and support out there so they're able to access it when they're ready. Make sure they don't feel as though there isn't anything for them, being a man."