Last year, Kathy Noyes began to notice that her 12-year-old son, Jonathan, was eating more than usual. She caught him eating late at night. She found empty peanut butter jars and chip and cookie bags stashed around the house.
She didn't know what to make of it. Her friends said, "Well, my boys eat a lot too. They're growing boys. Just wait till you get your grocery bill when they're 16."
But Jonathan soon started to be sent home from school frequently because he was sick.
"He started vomiting a lot," recalls Noyes. "And then afterward he'd be fine. He wasn't feverish, he wasn't pale. So I'd send him back to school and he'd be sick again."
That's when she realized something was seriously wrong. She took Jonathan to a doctor who diagnosed him with the eating disorder bulimia nervosa.
Eating disorders are commonly thought to be a problem for girls and women, but an estimated 10 million American men have an eating disorder at some point in their lives, according to the National Eating Disorders Association. Psychologists and psychiatrists who treat eating disorders say those numbers are on the rise. The condition can be life-threatening.
"Over the last five, six years, I've been seeing younger and younger boys who are struggling with these problems," says Roberto Olivardia, a clinical psychologist affiliated with Harvard Medical School, who has been working with boys and men with eating disorders for nearly two decades.
Like girls with eating disorders, the boys tend to be perfectionists and may have mental health problems, including obsessive compulsive disorder, anxiety or depression. Eating disorders tend to kick in during especially difficult life changes.
Jonathan Noyes began binge eating three years ago, when he was 10. He and his family had returned from a vacation when his whole life seemed to fall apart. His father lost his job, which added stress to his parents' relationship. His grandmother got diagnosed with cancer and moved in with his family. And his cat died.
The first food he binged on was peanut butter.
"At first I thought I could stop doing it whenever I want; it's not a big deal," Jonathan says. "You know, it's just a thing I do." But soon he realized "I can't stop this. I'm helpless. I need peanut butter."
That need brought with it an overwhelming sense of guilt, he says. So he started purging. Every time he felt he had overeaten, he says he would lock himself in the bathroom and stick his fingers in his throat until he threw up.
"I felt the relief, but there was still the guilt and pain there," Jonathan says.
He has always been a little chubby and has been bullied at school for it. "I'm the butt of jokes," he says. "I'm the guy that everyone makes fun of."
Increased social pressure for boys and men to be lean and muscular is at least partly responsible for the rise in males with eating disorders, Olivardia says. "In the early '80s, there was this real significant increase of advertising showing shirtless men, where the body became more of a commodity."
Even comic-book superheroes and GI Joe toys have become more muscular in recent years, Olivardia says.
And though eating disorders in boys share many similarities with those in girls, treatment programs tailored to girls may not feel like the right fit.
Jonathan was the only male patient at an eating disorder program at Hartford Hospital in Connecticut. "A lot of the stuff didn't really apply to me," he says. "Like the stuff about body image, and how you feel, and what's going on in your head and stuff."
"I don't know what it is, but something about having an eating disorder as a boy and having an eating disorder as a girl makes it very different."
Still, the program helped. Jonathan feels better about his own body. He no longer purges, and for the most part doesn't binge.
The lack of eating disorders treatment tailored for boys and men is all too familiar to psychiatrist Theodore Weltzin, the director of the nation's only residential program for boys and men, at Rogers Memorial Hospital, a nonprofit psychiatric hospital in Oconomowoc, Wis.
"One of the biggest concerns for men is they feel a little bit like a fish out of water when they go and seek treatment for an eating disorder," says Weltzin.
Collin Schuster entered the program at Rogers Memorial Hospital after six years of bingeing. When he first walked into a room full of boys and men, he felt a weight lift off his shoulders.
"I didn't realize that there were other guys out there who were struggling with similar issues," says Schuster, 18. "That was the start of, OK, maybe this is something that's more common or more manageable than I thought."
Earlier this year, Schuster returned home from the program to Old Saybrook, Conn. When he learned that another boy in his hometown was also struggling with an eating disorder, Schuster reached out to him; he called Jonathan Noyes.
The two now meet regularly. Over video games they talk about their struggles with eating disorders. Schuster has become a friend and a mentor to Noyes, now 13.
Jonathan says that friendship has made him much more confident that he will recover. "It's been difficult, but I'll make it through. I know I will."
RENEE MONTAGNE, HOST:
It's MORNING EDITION, from NPR News. I'm Renee Montagne.
STEVE INSKEEP, HOST:
And I'm Steve Inskeep, good morning. Today in Your Health, we'll talk about eating disorders. That term generally brings to mind images of painfully skinny girls and women suffering from anorexia or bulimia. But boys and men are increasingly being diagnosed with these disorders, too. And the age of those being affected is getting younger and younger.
NPR's Rhitu Chatterjee reports.
RHITU CHATTERJEE, BYLINE: Thirteen-year-old Jonathan Noyes started binging three years ago.
JONATHAN NOYES: I remember the first food I binged on a lot was peanut butter.
CHATTERJEE: He says he and his family had just returned home to Old Saybrook, Conn., from a vacation when his whole life seemed to fall apart. His father lost his job. His parents began arguing. His grandmother was diagnosed with cancer, and his cat died. He says that's when he started overeating.
JONATHAN: At first I thought, well, I can stop doing this whenever I want; it's not a big deal. You know, it's just a thing I do. But after a while and after eating for a long time, I realized that I can't stop this; I'm helpless. I need peanut butter.
CHATTERJEE: He says that need brought with it a overwhelming sense of guilt. You see, he'd always been a little bit chubby and was bullied at school for it. And the overeating made him feel worse about his body and himself. He began to purge, sticking his fingers into his throat till he threw up.
JONATHAN: I felt the relief, but there was still guilt and pain there.
CHATTERJEE: And so the cycle of binging and purging continued. His experience is very similar to that of girls going through the same thing. But neither he nor his family knew that boys could develop an eating disorder. For two years, he managed to hide it, eating behind closed doors or late at night. But last year, when he was 12, his mother, Kathy Noyes, began to notice all the empty peanut butter jars, bags of chips and cookies.
Now, if her teenage daughter had been doing the same thing, Kathy says she might have suspected something. But with Jonathan, she says, the thought never occurred to her.
KATHY NOYES: Because boys that age are growing so much that a lot of times, it's easier to camouflage. Even friends said to me, well, my kids eat a lot too. This - you know, they're growing boys. Just wait till you get your grocery bill when they're 16.
CHATTERJEE: It was only when Jonathan started to be sent home from school sick quite frequently, that she realized there was a problem.
NOYES: And it almost became - I don't want to say a joke; not funny but almost like come on, how many times am I going come here and get you when you're sick? And I would come home and get him ginger ale and pillows. And I would get everything squared away for him when he didn't have a bug.
CHATTERJEE: She took him to the doctor, who diagnosed him with bulimia nervosa. According to the National Eating Disorders Association, this makes him one of the estimated 10 million American men who have an eating disorder at some point in their lives.
Roberto Olivardia is a clinical psychologist affiliated with Harvard Medical School. He's been working with boys and men with eating disorders for nearly two decades. He says it's becoming increasingly common to see boys as young as 9 and 10 getting diagnosed.
ROBERTO OLIVARDIA: Over the last, I would say five to six years, I've been seeing younger and younger boys who have been struggling with these problems.
(SOUNDBITE OF FLIPPING PAGES)
CHATTERJEE: He flips through his book of referrals.
OLIVARDIA: You know, as you can see, Children's Hospital referral for an 11-year-old boy with severe bulimia nervosa, who had been binging and purging up to 10 times a day. Here's an individual, 9 years old, he's talking a little bit too much about body fat and trying to cut out carbs.
CHATTERJEE: He says as with girls, the disorder often kicks in when life gets particularly difficult. And patients also tend to be perfectionists and may have other mental health problems, like obsessive-compulsive disorder, anxiety, depression. But there are differences. Olivardia says most girls with eating disorders tend to be thin to begin with. But boys and men usually have a history of being chubby.
OLIVARDIA: A lot of these men reported being teased, being taunted when they were very young, and developed a real consciousness about their body as a result of that.
CHATTERJEE: And boys don't want to be skinny. They want to be lean and muscular. Olivardia says media pressure to have a ripped body is at least partly responsible for the rise in males with eating disorders. He says it's no coincidence that the numbers started rising about 30 years ago.
OLIVARDIA: In the early '80s, there was this real significant increase of advertising showing shirtless men, where the body became more of a commodity. I mean, if we look at even movie stars in the '80s, the biggest ones - Sylvester Stallone, Arnold Schwarzenegger, Jean Claude Van Damme - their body was very much a part of their persona.
CHATTERJEE: He's found that even comic book superheroes and GI Joe toys have become more muscular in recent years. That means even toddlers or 5- and 6-year-olds are growing up with a certain image of what men should look like. This really worries Benjamin O'Keefe. He's 18, lives in New York City, and used to suffer from anorexia. He's trying to draw attention to how all these images connecting success with a perfect body affects kids.
BENJAMIN O'KEEFE: Let's Google, you know, Abercrombie and Fitch advertisement. You know, look - the first thing that comes up is a naked man. No face in the picture, just the abs. And we see these people who are wearing Abercrombie, or wearing these - clothing; and they're happy, and they're smiling, with their shirts off. And that's what young people are going to aspire to be.
CHATTERJEE: O'Keefe is drawing on his own struggle with anorexia, to raise awareness about the plight of boys and men with eating disorders. He says boys and men feel alone and stigmatized because most of the information and treatments are aimed for girls and women.
Thirteen-year-old Jonathan Noyes, who you met earlier, went to an eating disorder program at Hartford Hospital.
JONATHAN: It was kind of awkward being there as the only guy.
CHATTERJEE: The program helped him. He feels better about his body. He no longer purges and for the most part, doesn't binge. But, he says, the process felt weird.
JONATHAN: A lot of the stuff didn't really apply to me - like, the stuff about body image; like, how you feel, and what's going on in your head and stuff. I mean, I don't know what it is but something about having an eating disorder as a guy, and having an eating disorder as a girl - like, makes it very different.
CHATTERJEE: This is all very familiar to psychiatrist Theodore Weltzin. He directs the only residential program for boys and men at Rogers Memorial Hospital, a nonprofit psychiatric hospital in Wisconsin.
DR. THEODORE WELTZIN: One of the biggest concerns for men over the years, seeking treatment, is just feeling a little bit like a fish out of water when they go and try to seek help for an eating disorder.
CHATTERJEE: He says it's time health professionals realized that information about these disorders shouldn't just be directed at girls - because there's a growing need for information and treatment programs for boys and men as well.
WELTZIN: Men will really feel much more comfortable getting treatment in a setting where they're around other men who, particularly, have the same problem.
CHATTERJEE: This was certainly the case for 18-year-old Collin Schuster. He entered Weltzin's program after six years of binging and restricting on food. He says when he first walked into a room full of boys and men, it was a huge weight lifted off his shoulders.
COLLIN SCHUSTER: I didn't realize that there were other guys out there who were struggling with similar issues that I had. That was the start of, OK, maybe this is more common - or at least more manageable - than I thought it could be.
CHATTERJEE: Earlier this year, Schuster returned home from the program to Old Saybrook, Conn., the same town where 13-year-old Jonathan Noyes lives. He decided to reach out to Jonathan, knowing how isolated he must feel.
(SOUNDBITE OF VIDEO GAMES)
CHATTERJEE: They meet regularly, mostly to play video games.
JONATHAN: Come on, I don't want to stay here. There are monsters.
SCHUSTER: I've got your back.
CHATTERJEE: But they do talk about what they're struggling with.
SCHUSTER: They make a big deal out of every single meal now, ever since I've been diagnosed.
JONATHAN: I know the feeling. Believe me, I do.
CHATTERJEE: Schuster has now become a close friend, and a mentor, to Noyes.
SCHUSTER: And if you need absolutely anything, you have my number. You can send an owl or a pigeon or a smoke signal. I respond to any form of communication. (Laughter)
JONATHAN: Yeah. Definitely.
CHATTERJEE: Jonathan says being able to share his experiences with Collin has made him much more confident about his recovery.
JONATHAN: It's been difficult, but I'll make it through. I know I will.
CHATTERJEE: Rhitu Chatterjee, NPR News.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.