By Liz Kearney
Saturday Sep 5 2009

Like most young men, Si Ng loved his food. When it came to doing the weekly shop, he'd spend hours in Tesco, scanning the shelves for his favourite products before returning home to carefully stock his kitchen cupboards with pasta, tinned foods and plenty of sweet treats, such as biscuits and chocolate.

Si loved to cook for his girlfriend too, spending hours in the kitchen preparing lavish meals with a loving flourish before settling down for the evening. The only difference was that Si didn't actually eat the food he bought, then so carefully prepared. The packets of biscuits remained on their shelves, unopened and untouched. While his girlfriend tucked into her dinner, Si would push the food around his plate and pretend to have already eaten. Later on, he'd nibble at a rice cake before going to bed.

"I knew there was something strange going on, but I didn't know what," says Si (29). 'I wanted the food around me for comfort reasons -- to be close to it without having to eat it. My body was crying out for food, but I wouldn't let it have any. Then I'd be proud that I hadn't given in. I felt really in control.'

Although he didn't realise it at the time, Si was one of a growing band of adult men who are falling prey to eating disorders such as anorexia and bulimia. They are afflictions we readily associate with teenage girls, but we are less inclined to accept that men are also at risk. Yet increasingly, they are.

Dr John Griffin, who runs the eating disorder unit at St Patrick's Hospital in Dublin, says the increase is significant. "When I first started working here, 5pc of our patients were male. Now, I would say that figure has increased over the past few decades to closer to 15pc."

It's a similar story in the adult unit at St John of God Hospital in Dublin. And often, says senior nurse Imelda Redmond, men's eating disorders are more advanced. "By the time they arrive here, they are quite unwell and it is quite a severe case as it often takes men a very long time to come for treatment."

Traditionally, doctors believed that men accounted for 10pc of all eating disorders. But more up-to-date research suggests the figure could be far higher, and its true prevalence could be masked by misdiagnosis and our reluctance to believe that men are at risk, says Marie Campion, a counsellor at the Marino Therapy Centre in Dublin.

"I think it's very dangerous to believe that only 10pc of sufferers are men," she says. "We've mistakenly jumped to the conclusion -- based on 15-year-old studies -- that only young girls suffer from eating distress. We generalised too much and forgot to look at who was really suffering.

"But from my experience, in 17 years of treating people with eating disorders, the problem affects women and men 50/50," says Campion. "The reason we aren't so aware of the men is because males find it much harder to go and get help. They don't want to be seen as suffering from a female addiction. The shame and the stigma is unbelievable.'

Shame and stigma

At a time when we've managed to destigmatise so many health issues, mental-health problems tend to be the final arena where people feel reluctant to speak out. So men -- and women -- with eating disorders become well-practiced in the art of denial: denying that they have stopped eating; denying they have binged; denying -- to themselves and to others -- that they are sick. For male anorexics, this denial is all the more entrenched. If you're going to own up to an illness, who really wants to admit to a 'female' disorder?

"So often, anorexia is seen as a 'girlie' disease," says Dr Griffin. "Men think, 'I couldn't admit to having that' or 'I'm too ashamed to admit to that particular illness'."

"Denial was a big thing for me," says Si, who now works as a paralegal. "I thought that anorexia was a female thing, and thinking like that just helps you to push the issue under the carpet and not deal with it."

It was the same for civil engineer John Stack (33), who developed the illness when he was in his late teens. "Although I knew something was wrong, I didn't want to accept it for so long because men just aren't supposed to have this thing. In the end, when the doctor told me I had an eating disorder, it was almost a relief because I was sick of fighting it."

We shouldn't really be surprised that men are catching up on women. While obsessive scrutinising of our bodies may once have been strictly a female affliction, magazines and ads targeting men have proliferated in recent years. Take a look at the bathroom cabinet of any young couple: his shelf is likely to be almost as well-stocked as hers. Men moisturise, exfoliate, wax and work out with the same diligence as any woman.

And they are encouraged, in exactly the same way women are, to compare their bodies -- chest, arms, legs -- with one another and to work hard at perfecting the things that don't quite fit. Men's magazines such as GQ include features on choosing the best fake tan for your skin tone, while the popular Men's Fitness urges its readers to work harder to lose that unsightly gut. With all of this to contend with, why wouldn't men feel body-conscious?

"I don't think those ads are ever going to actually cause an eating disorder, but when you see the guys in magazines with six-packs and big shoulders, and even knowing that they have probably been Photoshopped, they are still in incredible shape physically and you feel resentful and envious," says John. "If you are in the throes of an eating disorder, that is going to bring you down even more because you are being told that this is the way you should look."

And while those impossibly good-looking billboard hunks at least give the appearance of being healthy, there's another raft of male icons who, frankly, don't. Open the pages of any music magazine and you'll see scores of skinny indie boys, posing with oversized guitars slung nonchalantly against jutting hip-bones. There's nothing new in this -- for decades, rock music has been in thrall to skinny, from the barely-there physiques of Mick Jagger and Keith Richards to the wasted wiriness of The Ramones, right through to today's crop of indie waifs.

Heroin chic -- whether real or simply affected -- has long been the 'in' look for the fashion and music glitterati. In fact, of the men in the public eye who have admitted to anorexia, three of the most prominent are rock stars: the long-disappeared Richey Edwards of the Manic Street Preachers, Daniel Johns, singer with Australian rock group Silverchair and former husband of pop star Natalie Imbruglia, and Kings of Leon frontman Caleb Followill.

In the gut-wrenching 4st 7lb, Richey Edwards wrote about his "Cheeks sunken and despaired/So gorgeous sunk to six stone/Lose my only remaining home/See my third rib appear". Daniel Johns gave interviews in which he described how anorexia had almost killed him. Johns's music had a particular resonance for Si, who today has the words 'Please die Ana' -- the opening lines to the Silverchair track Ana's Song -- tattooed across his slim midriff.

"That song is really powerful to me because it uses the whole idea of Ana being a person," he says.

"It talks about Ana's thoughts -- that it's like having another person in your head thinking for you and controlling you, and you just want it to go away."

The word 'control' matters far more to anorexics than the cultural landscape that sets the scene for their illness. It tends to go like this: you feel like part -- or all -- of your life is spinning out of control, so you wrest back the little pieces of it that you can. A particularly dangerous time for young men is adolescence, when change is inevitable and even a small setback can take on monstrous significance. Often, bullying at school or a childhood trauma can push a teenage boy into dangerous territory.

Having been bullied relentlessly at school himself, Si Ng can relate to this. He was taunted for being different -- his parents were Chinese -- skinny, and unathletic. At home, his parents were strict and demanded academic excellence.

"I felt as though I wasn't living my own life or wasn't in control of it. It was almost as if I was living one day at a time without really knowing what was going on. And then there was this breakthrough: one day, during a family row, my mum shouted up at me that it was time for dinner, but I just said no. As soon as I said no, I felt as if I was taking control and standing up for myself. It just spiralled from there. I was in control of where and what I ate, while everything else was all over the place."

By the time Si reached college, he was only eating one meal a day and weighed less than seven stone. "I wouldn't eat until the end of the day. I was afraid that if I ate early on that I would want to eat more and more, but if I ate later on, I couldn't eat any more as I would be going to bed."

John Stack's problems also began as a teenager. Having moved from a small Co Kerry town up to Dublin for college, he struggled to get along with flatmates, and he failed his first-year exams. Determined to pass the summer repeats, John, a keen dancer, settled into a strict regime of study and exercise, cycling for 30 miles each morning before settling down at his desk. At the same time, he started to eat less and less. But still he convinced himself he was getting fat.

"Looking back on it now, I wasn't really interested in losing weight -- I just had to be in control all the time. I've heard girls tell themselves that they were dieting because they just wanted to lose weight and believe it, but I think overexercising and dieting are still all about control; the deep, subconscious motivations are all the same."

Sadly, anorexia is as dangerous for men as it is for women. Without sufficient nutrients, your organs, skin, hair, nails and teeth all suffer and your immune system is seriously weakened. Many anorexics have potentially fatal heart problems.

"I was pretty much bedbound," says Si. "I always had cold hands and cold feet. I couldn't play the drums any more because I didn't have the strength. But when I looked in the mirror, I didn't see how skinny I was. I just saw me, and I still didn't really like me.'"

John became so ill that, at the age of 25, he was forced to take a whole year out of work. At his lowest point, his well-built, six-foot frame weighed just seven stone.

The treatment for anorexia has traditionally been counselling to address both the issues around food and the self-esteem problems or trauma that precipitated the illness in the first place. John and Si found counselling sessions enormously helpful, and they set them on the road to recovery. Once an anorexic looks for help, the chances of recovery are very good. But taking the first step can be the toughest part.

"You are terrified of changing," says John. "You are terrified to lose control of your own life. I was afraid that all of the things I'd suppressed -- the self-hatred and low self-esteem -- would all come flooding out. And I was afraid of not being able to deal with that. That was the hardest part. When you go into hospital, and are told you are not allowed to exercise, you think, 'I am going to get fat'. But you have to look beyond all that."

"Being able to speak to someone and to know that it's not just me was a great help," says Si. "For all those years I thought that I was the only one. As a guy with an eating disorder, you think you are a freak. But hearing someone say that it is an illness, that it's not your fault and that you're not the only one, is a huge relief.

"If I hadn't gone through the therapy, I don't think I would be feeling so positive now. I have a great girlfriend, great job prospects and, for the very first time, I am planning for the future."

- Liz Kearney

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