Dan Pashman: Please note this episode contains discussion of eating disorders and includes a mention of suicide.

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CLIP (ARNOLD ATIENZA): Mashed potatoes and gravy and turkey and three kinds of pie and—man, I just, you know, I went to town. And knowing that I could, you know, throw it all back up later....

CLIP (GALEN MUSKAT): People had told me, my parents, oh, you're doing damage to your body. And I didn't—never believed them. 

CLIP (JACK GILLIES): It was really an obsession. It was looking at the scale and it was a little bit down and I was like—I was like giddy. It was almost addictive. 

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Dan Pashman: This is The Sporkful, it’s not for foodies, it’s for eaters. I’m Dan Pashman. Each week on our show we obsess about food to learn more about people. Back in October, we revisited one of your favorite episodes, "Katie’s Year in Recovery". It followed Katie Hacker, a baker in Virginia, for one year, as she went through recovery for an eating disorder. Public discussions about eating disorders tend to focus on women. In the past, so have our episodes on the subject. So after reconnecting with Katie, we put a call out to ask men to share their stories. Because, while it’s true that most people with eating disorders are women, according to a National Institutes of Health study, 1 in 4 are men. This affects millions of men in the US, but they’re less likely to be diagnosed, and less likely to seek treatment.

Dan Pashman: Today, we’ll hear stories from three men. They all said they wanted to share their experience so that other men who are struggling don’t feel so alone. And we’re asking: How is this different for men? How is it the same? What are the triggers for their disorders, and the barriers to treatment? And how do their ideas about masculinity affect their relationships to food? 

Dan Pashman: We’ll start with Jack Gillies. Jack lives in Mono, Ontario, a small town north of Toronto. He’s 16, in 11th grade, and lives at home with his parents and sister. The whole family is very into athletics. His parents used to do multi-day endurance runs; his sister is a competitive skier. Jack runs, skis, and mountain bikes. And they do a lot of it together. Growing up, Jack says he always had a big appetite. People would tease him about it, playfully. But two years ago, when he was 14, those comments began to hit him differently.  

Jack Gillies: Maybe it was just my own—my own interpretation of the comments. Especially, the ones that talked about metabolism and how lucky I am to be a teenager with this kind of body right now. I think I interpreted that as someday I won't have that.

Dan Pashman: Around this time, Jack and his sister decided to go on a plant-based diet, and they convinced their parents to do the same. Now, this was not the first time the family did something like this. When Jack was 8, they cut out processed grains and sugar and moved towards a paleo diet. 

Dan Pashman: And when the whole family would go on one of these diets, was there one person in the family who was usually the one deciding or sort of driving that? 

 Jack Gillies: Well, first thing I'd say is, I would find by circumstances call them diets. It was it was lifestyle changes. These weren't short term things. We would change our eating habits for years and we'd never go back to the way it was before. It was a complete lifestyle shift. 

Dan Pashman: The family’s switch to plant-based coincided with Jack getting more competitive about his running. He heard other runners talk about the idea of race weight, getting your body to a lower weight for races to make you a little lighter and quicker, give you an edge. And Jack wanted any advantage he could get.

Jack Gillies: How can I become faster? What's going to make me drop a few spots? And unfortunately, it seemed like dropping a few pounds was the solution that made the most sense to me at the time. 

Dan Pashman: At this point Jack was close to 6 feet tall, 155 pounds. He decided to get his weight down to 140. That number didn’t come from any formula or expert. He just came up with it on his own.

Jack Gillies: I just—I started eating less. I wanted to eat more, but I was telling myself to eat less. I trained a lot. I didn't really let myself ever sit down. I had this obsession that I had to just keep going, keep moving, keep burning. Part of me is like, well, it should be happening faster. And another part of me, there was a small part that was saying, well, if I'm not losing weight, maybe it's because I shouldn't be losing weight. And some of that internal conflict, it made me anxious. And ultimately, I think the side that said you should be losing more, won over.

Dan Pashman: What did you think was driving that? Like why did that side of the internal conflict win out?

Jack Gillies: You know, in all honesty, I think an Athlete’s curse. When we set a goal in different sports, we stick to those goals. And we expect that at some point in your journey, something's going to face you. It's going to tell you that you can't achieve it, that you won't get there. And a big part of athletics is you have to push past those barriers. And my athletic mindset really drove me into the fact that this is just an obstacle in my way. I'm going to...I'm going to get to my goal. 

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Dan Pashman: That first year with this new approach, Jack did some of the hardest training, and best running, of his life. He was running a 5k in under 18 minutes. The next year, he did even better, shaving off nearly two minutes more from his time. The thing is, the way race weight is supposed to work, a runner drops a few pounds before a race, then gains it back after. But Jack didn’t want to gain the weight back. In fact, he couldn’t stop losing it.

Jack Gillies: It was really an obsession. It was looking at the scale and thinking to myself, "Oh, it should come up," but every morning I saw it and it was a little bit down and I was like...I was like giddy. There was almost some part of me that found it exciting. It was it was weird. It was almost addictive.

Dan Pashman: What started as something to help his running had become a goal in itself. And on top of that, Jack’s times were getting better. And there was another factor, when he lost weight, he liked the way he looked.

Jack Gillies: There’s this idea that veins should stick out. You should have a six pack. That was my one of my big obsessions was that I had always have really, really well defined abdominal muscles. And regardless of what my numerical goal was at first, once I got down to that level, it became it became something that I was afraid I would lose when I looked in the mirror.

Dan Pashman: Who did you talk to about this? 

Jack Gillies: For a while, for a while, no one. I really kept it in. I tried to hide it from my family. First person I talked to about it was probably my sister. My sister had had similar struggles with food. I think it's fairly common for athletes. So she somewhat understood what I was going through and she recognized that I was doing a lot of the same things that she had used to do. One of the biggest groups that's helped me through this, that's not my family, is a group of girls at school that I've been great friends with. They are one of the only non-family members that I've really mentioned and spoken to this issue about. And part of it's because I've seen a lot of them have had their own struggles with food.

Dan Pashman: At this point, his family hadn’t said anything about the change in his eating, or his weight loss. He says that they didn’t seem to notice it. During Easter 2019, his grandmother made a comment, in front of the family, that he looked skinny. But the conversation quickly moved on. Jack continued pushing himself to run faster, while eating less. He got his weight down to 140. In the fall of 2019, he was in a big regional championship race. 

Jack Gillies: And I was right up there in the top. I...I could have won. And as I was about 20 feet from the finish line, I went unconscious. And I mean, to me, it felt like maybe 10 seconds had passed, but I remember getting up and trying to crawl and falling and standing up and stumbling and I fell across the line. I've been down for quite a while longer than I had thought. And I wound up lying in an ambulance for the next hour and a half or so. My heart rate wouldn't come down. Something was wrong and we just weren't sure what it was. 

Dan Pashman: The paramedics working there determined Jack didn’t need to go to the hospital. He says having a racer pass out during a race isn’t actually that unusual. A few days later, Jack’s parents took him to the doctor. Initial tests came back normal. Jack says neither he nor his doctor brought up the idea that he wasn’t eating enough. He hadn’t told his parents that he was restricting his eating, that he was trying to lose more weight. And he says he didn’t even see a connection between his restricting and his passing out. Jack’s parents were nervous about him racing again, but they left the decision to him. Less than 2 weeks after collapsing, he was back running. It was a frigid day in northern Ontario. The course was packed with ice. About halfway through the race...

Jack Gillies: My vision started was spotty, my legs started to go numb. And I remember telling myself for about the next 400 meters, "Oh, well, it's just the cold. This is common. It's the cold. It's what—this is happens when you run in the cold." And I actually, I ended up realizing as I was going up probably the big hill of the course that this isn't the cold. This is—it's happening again. And I was seeing spots and my vision was spiraling. And it shouldn't have happened again. And it did. 

Dan Pashman: In December of 2019, after more tests, Jack was diagnosed with anemia. His doctor prescribed iron supplements, and said Jack should consider eating meat again, but that there were plant based foods that could help, too. His parents were worried about the anemia, but weren’t aware of the deeper issue. Still, they decided to intervene, to try to take some control over what Jack was eating, to help bring up his iron levels.

Jack Gillies: I was definitely getting a little more pressure and little more push, that, yeah, you gotta eat more, eat this after dinner, eat...get that next helping. Like, there's a definitely a lot of concern and a lot of fear in my family. And for a while, it—I think it did get better.

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Dan Pashman: But that period of improvement quickly turned into more of a day-to-day, up-and-down struggle, especially, with the added stress of COVID. Jack did put on some weight, at times he rediscovered his love of food. But he also started serving himself when the family was eating, so he could have more control over his portions.  

Jack Gillies: You know, if I could cut back on something, I would cut back on something. And I think there is just this fear of gaining weight again.

Dan Pashman: This time, however, he was finally able to open up to his parents about the fact that he’d been restricting his eating.

Jack Gillies: I think they felt bad. At first, I know they felt a little guilty because they were worried that they had caused it, which they hadn't. And I think to a degree, there is a bit of a sense that they had to do something to fix it. I think we all came to the realization that I just needed support and that if they just supported me through all of it, that I could...I could get myself out of this. 

Dan Pashman: Jack says in recent months, that support from his family has been helping. 

Jack Gillies: Right now, I feel like I'm climbing the ladder. I'm certainly nowhere near at a spot where I could say that I am fully past this. I'd say most days I have at least a moment or two where I question what I'm eating. And I might have a moment of anxiety. It's been really trying to walk myself through being OK with food, eating for fulfillment and for enjoyment.

Dan Pashman: Have you talked to any of your male friends about this? 

Jack Gillies: Uh, not sure why I took a second answer that. It's...it's a simple no. I haven't spoken to almost any male figure about this. I...I've had trouble speaking to my own dad about this. The day before we had this...this conversation, recording this, he asked me in the car, "Well, what are you going to talk about?" And because he knew the issue was there, he knew, I say, the overall gist of it. But in the moment, I don't know why. I just I couldn't explain it to him. 

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Jack Gillies: And what he knows is far more than what any other male figure in my life knows. My struggle with this, is that it just really...it really isolated me. And that’s something I hope can end.

Dan Pashman: As of now, Jack hasn’t told his doctor about this issue, and hasn’t sought any professional treatment. 

Jack Gillies: It’s a hard thing because I really wish I could help—ask for help sometimes. And to a degree, I think I found a compromise where I can ask for help and in people's support and for some people's advice. But I still want to do this myself because I need that independence that I got myself into this. I need to be able to get myself out. 

Dan Pashman: I mean, look, I'm not an eating disorder's expert but this sounds like—what I suspect a lot of people think, but especially, I think it's probably more common for boys and men, that to ask for help would be a sign of weakness. 

Jack Gillies: Yeah, I think you nailed it right on the head. I think that's something that anyone's who's had to experience it at some point in their life definitely knows that feeling. 

Dan Pashman: If you had broke your leg, even if you felt that it was your own fault, you would never say, "I got myself into this, I'm gonna get myself out of it. I'm gonna set my own bone and put on my own cast and do my own X-rays.

Jack Gillies: I, certainly, hope not. That wouldn't end very well. 

Dan Pashman: But the approach that you're trying to take with your issues around food may be this sort of eating disorder equivalent of that. 

Jack Gillies: For sure. I, totally, agree. It shouldn't be a separate issue from the leg and, yet, it just—it often feels like there's something different about it. 

Dan Pashman: Right. So what do you think would have to happen to persuade you to see some sort of treatment or professional help?

Jack Gillies: If I was to take a worst turn again, I think I would seek help. Now, that I have formed a better support system with family and friends I might have the confidence now. If things were to get bad again, I would ask for help. 

Dan Pashman: I'm not going to tell you what to do but I do think, generally speaking that—and maybe this is just something that comes with age, but I think that, you know, you get to a point where you realize that asking for help isn't an indication of weakness or failure, that we all need to ask for help sometimes in our lives. 

Jack Gillies: I'd say going through this experience has helped me realize that, majorly, and that's part of the reason I'm almost grateful I've gotten through this. 

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Dan Pashman: Later in the show, we’ll talk with two more men who’ve struggled with eating disorders, both older than Jack and at different points in their journeys. But first, I wanted to talk with an expert. Dr. Roberto Olivardia is a clinical psychologist and lecturer at Harvard Medical School. He’s spent 25 years studying and treating men and boys with eating disorders. That includes anorexia, which is a restrictive eating disorder, and bulimia, which involves binging and purging. 

Dr. Roberto Olivardia: For a lot of men that I've worked with over the years, they feel a lot of shame. So they're struggling with having an eating disorder. And then they feel really bad about the fact that they're struggling that they have an eating disorder, because they feel that somehow it's an assault on being a man and their masculinity.

Dan Pashman: So the biggest way this is different for men? They’re much less likely to get help. Men make up about 25 percent of people with eating disorders. But they’re only 10 percent of the people getting treatment. Dr. Olivardia says part of that is the perception that men just don’t get eating disorders. And part is that we have very different ideas about how boys and men are supposed to eat. 

Dr. Roberto Olivardia: With men that you'll often see, you know, behaviors like binge eating behavior, for example, that might go unnoticed or unrecognized because of, you know, we think of men eating a lot. And so a lot of times when men are bingeing, it's sort of just looks like, "Oh, he just has a really big appetite," when he could have a really problematic behavior. 

Dan Pashman: There is this idea that, you know, that eating a lot is masculine.

Dr. Roberto Olivardia: Absolutely.

Dan Pashman: That there's something manly about sitting down in front of a gigantic plate of food and eating all of it. 

Dr. Roberto Olivardia: There's something...right, manly about eating a lot. And there's something that's feminizing in some ways about watching what you eat.

Dan Pashman: These ideas not only make it harder for men to seek treatment. They also make it less likely that doctors will raise red flags when a male patient’s weight fluctuates wildly. But in other ways, eating disorders for men and women are strikingly similar, now more than ever. While there’s still more pressure on women to look a certain way, Dr. Olivardia has seen a change in body image expectations for men in recent decades, along with the rise of a more traditionally masculine version of diet culture.

Dr. Roberto Olivardia: In the late 90s, you know, early 2000s, you know, when I would ask men in the intake, men I work with who have eating issues, I say, you know, do you take diet pills? Do you take laxatives? And they'll say, no. That's almost like too girly. I—and I'll then say, do you take any health supplements? And they'll say, oh yeah, I take this thermogenic fat burner, blah, blah, blah... And I said, that's a diet pill. I mean, it has all the ingredients of everything that's in these diet pills, but the packaging is thermogenic anabolic, you know, it has like a muscle in it, but it's...it's all the same ingredients. And in the 80s, it was about just being big. Steroids started to become a much bigger problem. I would say that there became a shift, though, where looking too big started to be associated with kind of dumb or insecure. But I remember, in particular, when the movie Fight Club came out, then I started hearing in patients, I want to look cut. I want to look lean. And I also want to have my muscle striations and definitions and six-pack and those kinds of things. There's a lot more attention on body. And social media absolutely put gasoline, you know, and to that flame, because studies show that teenage boys are just as susceptible to body dissatisfaction and being impacted by photographs on social media as girls are. 

Dan Pashman: And I feel like a lot of the messaging today, which is sort of like, your body is a machine. You must optimize by filling it with the right fuel. 

Dr. Roberto Olivardia: Yes. 

Dan Pashman: Almost feeds into that. But by treating like your body is this separate thing, to have the nuts and bolts tightened as opposed to like you, you know, as opposed to a part of you.

Dr. Roberto Olivardia: Absolutely. So you’ll often hear words like pure, clean, optimal. When I ask people, when's the fist time you noticed something kind of happening, and it usually, for people, say, oh I went on a diet. I went keto, I went paleo, I went vegan. I wanted to cut out sugar. And sometimes it starts out, again, very—and it's not like, nobody ever goes into it saying, I’m going to have an eating disorder. And it jus really gets out of control. 

Dan Pashman: Dr. Olivardia is quick to add that, of course, there are folks who would benefit from healthier eating. And many people go on these diets and don’t end up on that slippery slope. Diets are one of the most common triggers for eating disorders but that’s not the only factor. He says the people who are most susceptible often have certain personality traits. So for people with anorexia, who restrict what they eat...

Dr. Roberto Olivardia: You’ll see perfectionism is very high in this group of men, who have eating disorders. 

Dan Pashman: While people with bulimia tend to fit a different profile.

Dr. Roberto Olivardia: There's an addictive nature to bulimia. It's not uncommon to see men with bulimia, who also have a history of substance abuse issues. 

Dan Pashman: Why why that connection in particular?

Dr. Roberto Olivardia: So with bulimia—is an impulsive eating disorder, versus anorexia is more compulsive. Someone who is almost like thinking so much, you know, about things? With bulimia, it's associated with more impulsivity, which is why you see attention deficit hyperactivity disorder, which is more impulsivity. Substance abuse is also related to impulsivity. So even in genetic studies, it's we’re sort of mapping genes and things like that. We see this overlap of bingeing, binge eating, addictive behaviors, ADHD, that they all sort of aggregate in the same kind of way, the same sort of personalities. But purging also creates a euphoric feeling in the brain. 

Dan Pashman: What is the role of sports and athletics in triggering or leading to eating disorders for men?

Dr. Roberto Olivardia: So there are a lot of men—I’ve seen it go in both directions. So I've worked with lots of men who have had eating disorders and gravitated toward a sport that they knew would sort of cultivate that eating disorder. Wrestling, where you have to make weight and you have to be super careful. And then I’ve also seen it where men who don't have eating disorders, and this is true for women, as well, that go into a sport and if they have a high degree of perfectionism, high achievement orientation, and high competitive spirit, that they want to compete and sometimes they feel, they're in this culture, that basically says "Hey, you gotta do this and you might have to purge, or you might have to take laxatives, or you might need to restrict for a couple days," and then it sort of develops. But overall, like I don’t want to demonize athletics. I mean, sports and athletics is very healthy and a wonderful thing in so many, you know, respects. And even with the patients that I’ve worked with, who, it doesn’t mean they have to get out of the sport, necessarily. But they have to work harder to regulate that and making sure they don’t fall into that hole. 

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Dan Pashman: Coming up, we hear from two men who have spent years battling eating disorders, and who now face them in very different ways. Stick around.

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+++ BREAK +++

 

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Dan Pashman: Welcome back to The Sporkful, I’m Dan Pashman. In last week’s episode I talk with Julián Castro, former secretary of Housing and Urban development in the Obama Administration. When he ran for president in 2020, he made hunger one of his key campaign issues. We discuss why hunger has become a partisan issue, and his boycott of Goya. And there are plenty of light moments too, like when we get into the politics of splitting the check during group dinners: 

CLIP (JULIÁN CASTRO): What I hate, though, is when that happens and you're the one that got the short end of the stick and you end up paying the same amount, like, "Oh, now, let's split it up equally."

CLIP (DAN PASHMAN): Almost, as if, like...like if you make much less money than somebody else, but yet, they're taxed at a lower rate. 

CLIP (JULIÁN CASTRO): Yes, yes. 

CLIP (DAN PASHMAN): Fortunately, that would never happen. 

CLIP (JULIÁN CASTRO): Yeah, not in any sane country. No. 

Dan Pashman: That episode includes a philosophical discussion on a plate of nachos as a microcosm of society. If you want to hear that one and make sure you don’t miss future episodes, connect with our show in your podcasting app in Spotify, hit follow. In Apple Podcasts, subscribe. In Stitcher, favorite. You can do it right now while you’re listening. Thanks.

Dan Pashman: Now back to our look at how eating disorders affect men. Galen Muskat is 27. He’s from the small town of Sandwich, New Hampshire. Not to be confused with Sandwich, Massachusetts. 

Dan Pashman: Did you still grow up with police officers driving around in cars labeled sandwich police? 

Galen Muskat: Yes. Yes, exactly. Always a highlight.

Dan Pashman: But I digress. Like Jack, who we heard from earlier, Galen is an athlete, a runner and a skier. In 10th grade, he went to an intensive ski camp led by a former Olympian from Russia.

Galen Muskat: The first week we were there, over in Vermont, doing roller skiing, she took out a pair of calipers to measure body fat.

Dan Pashman: And she's like literally pinching around your body and measuring different places? 

Galen Muskat: Yup, exactly. She did—like on the chest. She did the upper thigh. She did our our side. 

Dan Pashman: That moment by itself didn’t change much for Galen, but he didn’t forget it. Three years later, in college, he developed terrible stomach pains. He went to the doctor, and got diagnosed with a severe gluten intolerance. He’d have to go gluten-free. For a person who always got a lot of pleasure from food...

Galen Muskat: It completely altered my sense of myself, changed my relationship with the kitchen. Suddenly, I had to be careful. 

Dan Pashman: Galen had transferred to Amherst college, so when he started his sophomore year, he was at a new school and didn’t know anyone. He says he had also been struggling with depression for years. On top of all of that, he was dealing with the stress of this new diagnosis, trying to figure out what he could eat. He felt embarrassed about having to explain it to others. 

Galen Muskat: that really started to affect me. So it became easier for me to just sort of avoid that altogether, not only by starting to sit alone in the dining hall but also sometimes avoiding meals altogether. 

Dan Pashman: Cutting gluten was medically necessary. But Galen began restricting his eating even further.

Galen Muskat: First, there was grains. No brown rice, nothing. It was just easier, or so I thought. And I started to lose a little weight. My brother told me at one point, kind of good naturedly, like I'm—I said, "How do you drink your coffee?" And he said, "Oh, I don't...don't put sugar in it, anymore. I'm trying this thing of no added sugar." Growing up, my brother and I were opposite in the sense that if you gave me a task, I would do it until I got it perfectly. A drawing, I would crumple it up and start over if I went outside the lines. And I took my brother's challenge like, huh, I'm going to try this. And I successfully removed things from my diet: sugar, grain, etc.. So by that point in March, I was doing that with various things: egg yolks, olive oil, milk...you name it. I felt like I was doing something good. Part of me, some weird, twisted part at that time, really started to take pleasure in feeling really different and isolated and alone. 

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Dan Pashman: At the start of that semester, Galen weighed 166 pounds. When his dad picked him up at the end of the semester, he weighed 114. In 4 1/2 months, he had lost 52 pounds. 

Galen Muskat: And yeah, my dad picked me up and he was speechless. Didn't talk to me for two and a half...two and a half hours the whole drive home. And I would learn later in a family therapy session that when he got out of the car in our driveway and saw my mom, he said, "You know, when you see Galen try not to cry."

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Dan Pashman: Over the summer, Galen was diagnosed with anemia and took a medical leave from school. When he returned, his depression and anxiety persisted. He told his brother he was suicidal. Just a week into the school year, Galen’s parents picked him up to bring him home. They knew he needed treatment for an eating disorder, but insurance wouldn’t cover inpatient treatment, because they said he weighed too much to qualify. 

Galen Muskat: That...that was shocking, because I was still at that point, 45 pounds below what I—my target—my ideal weight should have been. 

Dan Pashman: Galen's parents fought the insurance company, and they got Galen admitted for outpatient treatment. The program included therapy, art classes, and writing workshops. Galen graduated out of the program after four months. He says in some ways it was a frustrating experience, because he’s someone who likes accomplishing things without help from others. But it led him a realization.

Galen Muskat: There were a lot of times that I was sitting around a table, where being faced with other people's predicaments gave me that shred, like a little shred of self compassion that I was so lacking that first term at Amherst. And it helped me see something that has today guided me, which is, you know, in a weird way, maybe a fear of of being in that position again. It was it was frightening to see...to see that things could get worse because I really didn't think they could until I went there. 

Dan Pashman: Still, after leaving treatment, Galen’s struggles continued. And this is something we’ve heard on this show from others, who’ve struggled with eating disorders. There are so many ups and downs. Just when you think you’re finally headed in the right direction, the bottom falls out on you. Galen sought various forms of help, whether that meant going to family therapy, or his parents helping him maintain healthier eating habits. There were times he enjoyed eating again, put on some weight and times he felt like he was back at square one. This ebb and flow went on for five years. 

Dan Pashman: In April of 2019, he started seeing a dietician, but still couldn’t stop exercising compulsively.

Galen Muskat: I was around 125 and I would go for...hmm, a ten-mile run or so almost every day. And I was out on a run. It was May, it was beautiful. I was running along the Charles River and I felt something explode in my groin and I thought, "Oh no." 

Dan Pashman: For two months, doctors told him that it was a lightly torn muscle. But it just kept getting worse.

Galen Muskat: And suddenly my back started to hurt. I would go to work and I would stay and I would get these awful spasms throughout my lower body. I was walking home one day and I got—my right leg went numb. 

Dan Pashman: After three months in pain, Galen got an MRI. He was walking around with a stress fracture in his pelvis. He had lost critical bone mass in his spine, and developed osteoporosis, all at age 25. For Galen, this diagnosis was rock bottom. 

Galen Muskat: People had told me, my parents, "Oh, you're doing damage to your body," and I never believed them. 

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Dan Pashman: Today, it’s unclear how much Galen’s bones will be able to heal long term, how much of the damage is permanent. But after months on crutches, and physical therapy, he is now able to walk without pain. He’s gained some back weight and he’s developing a better relationship with food 

Galen Muskat: Yeah, I'm back to 160 pounds. Um, enjoy some chocolate every night, am walking again. Not sure if I'll ever run, but, um, I'm just grateful to be able to walk and, uh, pick up some pastries at the gluten free bakery. 

Dan Pashman: Galen’s dietitian told him the injury, because it slowed him down, might actually have saved his life. Galen continues to work with her, along with a therapist, and says they’ve been crucial to his recovery. 

Galen Muskat: It's always felt like they saw something that I couldn’t see. There's no judgment. It's like you're you're allowed to be—you're allowed to make a mistake. And to see that it's OK not to be perfect just because we're—I mean, striving for perfection all the time and in work, in cooking, you name it. The message is, be perfect. 

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Galen Muskat: And to have two hours every week where I'm told otherwise, um, has really just helped me see, like, yeah, you did injure yourself. But that's not your fault. 

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Dan Pashman: You sent me a couple of photos, some from before your eating disorder, some from right in the middle of it and some more recent. Why did you want to share those? 

Galen Muskat: Um...I guess because I'm...I'm sort of proud. And I didn't let myself feel pride for a really long time, I mean, I didn't feel like I had anything to be proud of. But I also shared because I wanted to show that it's possible to recover from one of these. 

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Dan Pashman: So Galen has identified his eating disorder. He’s getting treatment for it. And even if the road is long and winding, he feels now that there is a road to recovery. But not all people with eating disorders seek or receive help. Like Arnold Atienza, who’s been dealing with food and eating issues for over 40 years. Arnold's 57. He was born in the Philippines. He grew up in Cleveland, one of five kids.

Arnold Atienza: You know, there'd be like seven people sitting around the table. And my mom would just, like, cook all this food, put it in the middle of the table. And when it was gone, dinner was over. So I think, at a relatively young age, I became aware of like that that food was like a limited resource. My mother's nickname, for me, it's a Filipino nickname. It's tabachoy, which really kind of translates into like chubby or fatty. And I think in in Asia, you know, that is not—it's not a big deal. But as a kid, you kind of internalize that, you know, that becomes kind of your identity.

Dan Pashman: When he was 13, Arnold joined the wrestling team. Now, in wrestling, you only compete against other people in your weight class. So weight becomes central to your place on the team. It’s a huge focus. I can remember being at lunch in high school one time. And one of the guys I was sitting with was on the wrestling team and he didn’t eat a bite. He just kept spitting into an empty Snapple bottle. He was trying to get every ounce of liquid out of his body so he could make weight for a match. Arnold still remembers the first time he heard his teammates talk about their methods for cutting weight. 

Arnold Atienza: This is Black Friday, you know, the morning after Thanksgiving. We're all rolling into practice. And this kid, Sam, he's just talking animatedly about his Thanksgiving dinner. He goes, you know, there were mashed potatoes and gravy and turkey and three kinds of pie. And man, I just, you know, I went to town. And knowing that I could, you know, throw it back up later and, you know, that turkey hits you, man. And, you know, I think I passed out.

Dan Pashman: In other words, this guy Sam ate a ton of food, planning to purge. But then he fell asleep after the meal and by the time he woke up, the food was digested. As he put it to Arnold... 

Arnold Atienza: I come to a couple of hours later in a panic and my baby bump was gone. I go try to throw it all up and, you know, two piece come out, and that was it. And we all just kind of laughed and he goes, I'm going to go run extra. And, you know, that's when it hit me. It's like, wait...what? [

Dan Pashman: This pattern of binging, and then purging, is a hallmark of bulimia. But 13-year-old Arnold just thought of it as a great solution. A way to be able to eat all the food he loves, while also competing as a wrestler.  

Arnold Atienza: You don't want to let the team down. If you can't make weight and there's nobody else at that weight, you know, your team forfeits. If I've got the school, depending on me, you know, you do what you need to do to make weight.

Dan Pashman: So Arnold started purging during the wrestling season. Throughout high school his weight fluctuated dramatically, from 119 when he was wrestling, to 150 in the off season. Once he left high school, and stopped wrestling, Arnold did stop purging. He says now he’s come to understand that he does better when he has a purpose and structure that give him healthier things to focus on. He graduated college and went to law school, but he dropped out. He started working in bars and restaurants, and began drinking too much, got into drugs, got addicted to both. He struggled with that addiction until he was 40, when he got sober. But sobriety left a kind of hole in his life. 

Arnold Atienza: Don't smoke, can't drink, can't use. You know, it's like my thing was, what do I have left?

Dan Pashman: Arnold turned to food. He started eating a lot, and gaining weight. But he also tried to find other, healthier ways to fill the void. He went back to school for social work, got into yoga, kept attending AA meetings. During this phase he also got married. When he was 51, his wife got a job in Singapore, so they moved there, but he wasn’t able to work cause of visa restrictions. That left him with a lot of time on his hands. He started exploring, and eating his way through the city. 

Arnold Atienza: The whole culture was kind of like food obsessed. And I just fit right in. And so that's when the eating to fill the void thing starts up again. But that's not what it feels like. That's not what it looks like. It feels like, oh, I'm in this culture and I got to take advantage of, you know, these and—oh, I've never had that before. Oh, what is this? 

Dan Pashman: Arnold’s eating led to health issues, including gout, which made it difficult to walk. Gout is a complex form of arthritis, it’s often connected with a high sugar diet and obesity.

Arnold Atienza: And so I went to the doctor and, you know, they ran all the tests. And he's like, well, you know, the..the gout is really the least of your problems, and I'm like, what, 

Dan Pashman: Arnold had a whole host of issues related to his weight. The doctor said he had to start taking a bunch of prescriptions. But if he lost 10 percent of his body weight, he could go off some of the meds.

Arnold Atienza: And so I like—I panicked and I knew what was going to get the weight off like...yeah. And so that's when the purging started up again.

Dan Pashman: And do you remember the first time that you threw up after not having done it for so long? 

Arnold Atienza: Oh, I'm sure it was that night. I'm like, you know, if it's there, why wait to use it? 

Dan Pashman: And how did you feel that first time doing it again after so long? 

Arnold Atienza: It's like getting back together with a hot ex-girlfriend, that you know is crazy. She's got just got a hold of you. That's kind of what it felt like. Like I was having an affair.

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Dan Pashman: The first month, Arnold lost 20 pounds. He got off some of the prescriptions, but he wanted to keep slimming down. He kept purging, lost another 10 percent of his body weight the next month. But he waited before going back to the doctor, so it wouldn’t look like he lost so much so quickly. The doctor took Arnold off more of the meds. Even though Arnold knew deep down it was a dangerous way to get there...

Arnold Atienza: It worked. You know, that's the insidious thing about this.

Dan Pashman: Dr. Olivardia, the expert we heard from earlier, says this is often part of the struggle for people with eating disorders. In one way or another, the behavior gets rewarded. In Arnold’s case, it’s getting off his meds. Maybe for others, it’s that they get more compliments on how they look, more romantic interest. But for Arnold, just like in high school, what started with a specific purpose kept growing. And the whole time, he was hiding it from his wife.

Arnold Atienza: I just remember in Paris, you know? We're in Paris, for God's sakes. We just had just amazing food. And of course, I overdid it because I knew I was going to purge that night. But, you know, my wife was all jacked up and jet lag and she just wouldn't frickin fall asleep, man. And that's not how you should be enjoying Paris with your wife, you know, psychically willing her to fall asleep so you can purge. 

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Dan Pashman: Two years after that first doctor’s visit, Arnold and his wife moved back to the States. And things got somewhat better for him. He got back into yoga and other exercise. He felt like he had more to keep him busy. Last year, they were supposed to move to Beijing but then COVID hit. The stress of the move being canceled, and the pandemic, took a toll. Arnold’s yoga studio closed and it became harder for him to maintain his healthier habits.

Arnold Atienza: I don't have the same outlets that I had and I'm stressed out. So I'm eating. And again, my old crazy ex-girlfriend is there waiting,

Dan Pashman: In the spring of 2020, Arnold starts purging again. But after a few months, he turns to intermittent fasting. For him that means on weekdays, he eats just one meal a day, dinner, with his wife. On weekends, he’ll have lunch and dinner. He hasn’t purged in months. That’s where he’s at right now. 

Arnold Atienza: It seems to be a sustainable, socially acceptable way to manage my weight. So that's been working for me. 

Dan Pashman: Are you hungry during the week? 

Arnold Atienza: Oh, all the time. You know, if it's there all the time, you don't even notice it. Like if you live in the monkey house, you don't notice the stench. So it's always a part of my conscious being. 

Dan Pashman: Dr. Olivardia says that intermittent fasting can be an effective way to manage weight for some people, but for those with histories of eating disorders, it can be a trigger for binge eating. He says you should consult with your doctor before adopting this practice. 

Dan Pashman: Have you ever talked to your wife about your purging?

Arnold Atienza: No.

Dan Pashman: Why not? 

Arnold Atienza: Because if I talk to her about it, it might—I might have to, like, give it more attention than I want to give it. There might have to be like, you know, doctors and whatever brought into this. And it's shameful, Dan, to say you're a middle-aged bulimic is not...is not the...yeah. It's—I just, I don't want to do it, Dan. 

Dan Pashman: Do you think—is your wife going to hear this?

Arnold Atienza: I think so. I think she needs to. Maybe thats part of the reason I wanted to come on here is, you know, I was telling myself the main reason I wanted to do it is to share my story with other guys out there that have a problem with disordered eating. But maybe it was a way for me to confront it and to talk about it and to, you know, bring it out into the light where it needs to be. You know, again, I'm afraid—I think, I'm just afraid that she'll look at me differently, that she'll—you know what I mean? Like, this is not what I signed up for. This is not the guy that I married. And I know that's crazy. I know that she loves me and that she will love me unconditionally. And again, there's that nagging, you know, doubt in my mind. And that's just—I think that's the disease going, don't talk about it.

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Dan Pashman: Before we wrap up, I tell Arnold about Jack, the teenager we heard from earlier in the show. Arnold’s been dealing with disordered eating on and off for nearly 45 years. What would he say to Jack?

Arnold Atienza: Dude, you are perfect exactly the way you are, where you are right now. You don't have to fix anything. You don't have to change anything. You don't have to be anything. You just are exactly who you're meant to be in this moment. 

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Dan Pashman: So if Jack, or Arnold, or any other boy or man, were to get professional treatment for an eating disorder, what would that look like? Here again is Dr. Roberto Olivardia.

Dr. Roberto Olivardia: If a boy or man goes into a program, an eating disorder program, there’s no question they’ll be in the minority, in terms of gender. That the majority of people will be women, sometimes they might be the only male in the program. But there's this universality of this sort of experience that men, who go to these programs who are very hesitant and worry about, like how's it going to be, they say within a couple of days they feel comfortable and they feel understood and they feel like there's something very freeing about it. You know, I've never worked with someone who goes into it and and comes out of it thinking, oh, my God, that was the worst experience. It was—it's hardl, just like rehab, you know? And sobriety is very hard, but it's totally it's worth it.

Dan Pashman: For people grappling with disordered eating, Dr. Olivardia has this message.

Dr. Roberto Olivardia: Please, please get help. People who struggle with eating disorders longer tend to have a worse prognosis, but that doesn't mean they can't recover. I once worked with a 72-year-old man, who struggled with eating disorders for—since he was 12-years-old and he recovered at 72 and lived, I think, 13 more years. And he said those were the best 13 years of  his life. 

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Dan Pashman: My thanks to Jack, Galen, and Arnold for sharing their stories with us. And special thanks to Dr. Roberto Olivardia, Clinical Psychologist, and lecturer in the Department of Psychiatry at Harvard Medical School, for his help with this episode. If you or someone you know is struggling, reach out to the National Eating Disorders Association at neda.org.

Dan Pashman: Next week on the show, St. Patrick’s Day in America started as a celebration of Irish culture, a response to anti-Irish prejudice. Today, it’s embraced by much of the country, which is great, but often by enacting the worst stereotypes of Irish culture—not so great. Now, we see Lunar New Year celebrations in America extending beyond Asian-Americans. As that happens, how can we do better than St. Patrick’s Day? We’ll discuss, and I’ll attend a Passover seder where I’m the only Jew. That’s next week.

Dan Pashman: While you wait for that one, check out last week’s show with Julián Castro. And please connect with our show in your podcasting app. In Spotify, hit follow. In Apple Podcasts, subscribe. In Stitcher, favorite. You can do it right now while you’re listening. Thank you.