Why this matters
Eating disorders are often seen as a female issue, but many male athletes struggle with eating disorders that can go unnoticed and have serious health consequences.
Patrick Devenny had a sculpted body. People admired him for his hard work and dedication at the gym. They flocked to him for nutrition advice. But below the well-toned surface, Devenny’s mental and physical health were in such bad shape that he even contemplated suicide.
Because Devenny fulfilled society’s expectations of what a fit man should look like, few suspected he was struggling with binge-eating disorder and exercise-induced bulimia.
A former football player at the University of Colorado, Devenny found himself caught in a cycle of avoiding food, binge eating to the extreme, and then intensely exercising for three hours or more. He avoided social settings and would isolate himself at home, where he could control what he put into his body.
“I would literally avoid my best friend’s birthday party because I could not eat during those hours,” said Devenny. “Performance mattered so much. I knew that if I went, I would have to explain my diet or make up a lie.”
Devenny’s story is not unusual among male athletes. An 1999 study found that among college athletes, 35 percent of women and 10 percent of men were at risk for anorexia nervosa, and 58 percent of women and 38 percent of men were at risk for bulimia nervosa.
A 2004 study by the Norwegian University of Sport and Physical Education concluded that Norway’s elite athletes were nearly three times more likely to have an eating disorder than the average Norwegian. The study found that 13.5 percent of the athletes evaluated had an eating disorder, compared with 4.6 percent of the general population.
“There is a misconception that eating disorders are disorders for females. The reality is that men struggle with eating disorders just like women do,” said Erin Rubenking, associate director and clinical care coordinator for the University of Colorado Athletic Department’s Psychological Health and Performance program. “It often takes men a much longer time to get help because of that. And sometimes it can look a little different. Sometimes it can be more focused around muscle toning and getting bigger and building more muscle.”
“There is a misconception that eating disorders are disorders for females. The reality is that men struggle with eating disorders just like women do.” - Erin Rubenking, associate director and clinical care coordinator for the University of Colorado Athletic Department’s Psychological Health and Performance program.
Matthew Stranberg, the lead nutritionist and exercise science advisor for Walden Behavioral Care’s GOALS program for athletes with eating disorders or their more subtle cousin, disordered eating, said research indicates binge eating and eating disorder not otherwise specified (EDNOS) are the two most common eating disorders for male athletes, and eating disorders are understudied.
“Research and experience typically demonstrate that many athletes underreport symptoms and often consider their habits and behaviors benign, or even a sign of commitment to their training,” Stranberg said.
Stranberg explained that EDNOS is the most prevalent diagnosis “because often you need to meet certain criteria in order to be diagnosed with anorexia, or bulimia, or binge eating disorder.” But eating disorders that do not meet these criteria can be just as dangerous, if not more dangerous, Stranberg noted.
“These habits and beliefs are frequently causing huge disruptions in the athlete’s mental, physical and social health and are frequently missed by peers and coaches because the athlete might not look sick, or the behaviors are regarded as societally acceptable,” Stranberg said.
Based on his clinical practice, Stranberg suspects exercise bulimia may be one of the most prevalent diagnoses for male athletes, especially in weight-class sports.
“Many athletes tend to conflate confidence and performance with weight and body composition and utilize a variety of restrictive and bulimic behaviors in an attempt to manipulate these variables,” he said.
Devenny’s eating disorders began his sophomore year of college, when he was moved from quarterback to tight end.
“I needed to go from about 218 pounds to as big as possible, and as lean as possible, and as much muscle as possible,” he said. “Physique was now a thing for me. It felt like if I had to get there, it had to be through chicken breast, broccoli and brown rice.”
Devenny dreamed of playing in the NFL and felt pressure to look the part of a professional football player at Colorado’s pro day, where athletes walked in a line wearing only compression shorts as scouts examined and measured every muscle. Appearing out of shape could be costly.
“If you show up to the league looking like a gladiator, you literally —no joke — just made a couple hundred thousand dollars just by first impressions,” Devenny said.
“Research and experience typically demonstrate that many athletes underreport symptoms and often consider their habits and behaviors benign, or even a sign of commitment to their training."- Matthew Stranberg, lead nutritionist and exercise science advisor for Walden Behavioral Care’s GOALS program
After going undrafted, Devenny signed a contract with the Seattle Seahawks, but the team released him before the season began. He later ruptured a tendon in his wrist. His playing days were over.
However, his eating disorder continued.
“My three best friends played for the New York Jets, and here I was just a guy now,” Devenny said. “So I felt like I had to at least look better than they did.”
Devenny’s desire to look better is a common problem for male athletes. Stranberg said the rise of the bodybuilding culture and dieting in the 1960s and 1970s created warped ideas of what an athlete should look like and should eat.
“The public started to assume that certain body types meant you were a great athlete,” he said. “A lot of the bodybuilding food and exercise beliefs crossed over into mainstream culture.”
But Stranberg cautioned against assuming that body-image concerns are always the driving component of eating disorders.
“Body image is sometimes a component but is not necessarily the salient component,” Stranberg said. “An eating disorder is part psychiatric illness, part maladaptive coping skill.”
An athlete who is obsessed with performance might hear that losing weight can give them a competitive advantage, leading them down a dangerous path.
“In that instance, they might start restricting and exercising more to drop body fat to deal with anxiety of sports performance,” Stranberg said. “In other instances, an athlete might use eating-disorder behaviors to cope with anxiety or depression. Many factors are often involved, including genetics, personal characteristics and environmental influences, which can ultimately culminate in the perfect storm for an eating disorder.”
Mario Fraioli, a running coach and former collegiate distance runner, developed an unhealthy relationship with eating and exercise after graduating from Stonehill College in 2004. The 5-foot-8 Fraioli, who weighed about 140 pounds and wanted to qualify for the Olympic Trials marathon, felt that he needed to lose weight to compete with elite marathoners.
“I had read bios of guys my height who were running a lot faster than I was, and a lot of them weighed between 115 and 125 pounds,” Fraioli said. “Being the know-it-all 21-year-old that I was at the time, I thought I needed to weigh somewhere around 120 pounds if I would make it to the next level.”
Fraioli lost 16 pounds in a matter of months by limiting himself to 1,000 calories or less per day while running over 100 miles a week, but his hard work to lose weight did not pay off. His race results suffered, and his body broke down. He experienced two sacral stress fractures at the base of his spine and a pelvic stress fracture that his orthopedist told him was common in elderly women and birthing mothers, not healthy men in their 20s.
Like Devenny, Fraioli’s disordered eating affected his social life.
“I definitely shut myself off from social situations,” he said. “I tried to avoid them at whatever cost I could. And anytime I found myself in a social situation I couldn’t avoid for whatever reason, it was really uncomfortable. I thought because nobody had said anything to me, and I was closing myself off and not eating around other people and not really exposing them to my behavior; I didn’t think anyone noticed.”
Fraioli never was clinically diagnosed with an eating disorder, but his eating habits became so bad that he said it wasn’t even about improving performance.
“I was playing these games of how few calories could I eat in a day, how low of a number could I see on the scale, doing the mental math of, ‘If I run 15 miles today; how many calories do I burn?’” Fraioli said.
Fraioli experienced a breakthrough when a female friend who had dealt with her own eating disorders confronted him about his eating habits. He felt ashamed and embarrassed that his secret had been outed.
“Being called out on it and admitting it — it was kind of a shameful thing because it is a taboo topic to begin with,” he said. “And when it is talked about, it’s usually in the context of a female suffering from it, not a male.”
Fraioli slowly improved, stopped counting calories, and now has a healthy relationship with food and exercise.
Devenny hit rock bottom in early 2014. He was living in Mexico with no family support, and his mother had recently died. He felt hopeless and more isolated. Fortunately, he heard a podcast talking about eating disorders that described much of what he was experiencing.
“I had no idea,” he said. “I always saw it as a skinny-white-female problem.”
He emailed the therapist from the podcast and eventually sought therapy for his eating disorders.
Devenny now uses his experience to educate others through public speaking about the perils of eating disorders. He hopes to get more people, especially male athletes, talking about eating disorders.
“The hardest part as an athlete is you feel alone and isolated,” he said. “No one has talked to you about it, so you’re wondering why you care so much (and) why you look a certain way. And that comparison game starts to happen, and things just spiral out of control.”
“The hardest part as an athlete is you feel alone and isolated,” he said. “No one has talked to you about it, so you’re wondering why you care so much (and) why you look a certain way. And that comparison game starts to happen, and things just spiral out of control.” - Patrick Devenny
In addition to coaching, Fraioli is a writer and host of The Morning Shakeout, a popular running podcast. He regularly uses his platform to discuss eating disorders and has written about his struggles. Fraioli said countless people have approached him regarding their own disordered eating.
Fraioli has seen improvements in the running world, where harmful practices, such as weekly weigh-ins of college runners and coaches’ disparaging remarks about athletes’ weight, are disappearing.
“It definitely still goes on,” Fraioli said, “but I think because the public dialog around it now is so much louder and — especially amongst males — there are more folks who have come out with their own stories of disordered eating and body image issues related to performance, that people are just more aware of it. I think that sort of stuff is happening less.”
Even with these improvements, Fraioli said more steps are needed.
“I think more can be done at the scholastic and collegiate level to educate male athletes about disordered eating and what healthy eating looks like, and how to fuel your body properly for hard training and for recovery,” he said.
Rubenking said eating disorders are “a real issue for men.”
“And we need to talk about it more,” she added. “Because there are many men out there who struggle with it and that either feel ashamed to come forward, or they might not even be aware that that’s what it is that they’re struggling with.”
Eating disorders can affect all types of athletes, Stranberg said.
“It's not just wrestlers. It's not just bodybuilders or runners,” he said. “I've worked with basketball players, hockey, rugby, every single sport you can think of. Eating disorders do not discriminate.”
But there is hope for athletes seeking success while maintaining balance.
“You have to be very dedicated and driven to excel at the top, and at the same time, that doesn't mean you have to turn up the suffering to 100% all the time in order to be an elite athlete,” Stranberg said. “You can be flexible. You can enjoy your food. You can enjoy your training and achieve your athletic potential without disordered eating and pathological exercise.
“If you or someone you know is struggling to find balance, do not despair. Reach out and seek help from a qualified provider before it is too late. You can fight this illness and win.”
For more information about eating disorders and to get help, please visit the National Eating Disorders Association.
Editor's Note: For the coming 2019-2020 academic year, the Global Sport Institute’s research theme will be “Sport and the body.” The Institute will conduct and fund research and host events that will explore a myriad of topics related to the body.
Jeff Burtka is a freelance writer based in metro Detroit. You can read more of his work here.