:00:00. > :00:18.I'm Nigel Owens. I am an international rugby referee. You may
:00:19. > :00:25.know me for my no-nonsense approach on the pitch. I don't know if we've
:00:26. > :00:30.met before, but I am the referee on this field, not you. But you might
:00:31. > :00:35.not know that I have had the eating disorder pulling you for more than
:00:36. > :00:41.20 years. To on Panorama, we reveal the growing number of men and boys
:00:42. > :00:46.battling eating disorders. Is skin goes over the top of my trousers,
:00:47. > :00:52.that's bad. I feel like that should not be there. It's not just girls
:00:53. > :01:00.who suffer from bad body image. In the media, that is what drove me to
:01:01. > :01:03.it. And it claims lives. This 20-year-old died after battling
:01:04. > :01:09.eating disorders for most of his teenage years.
:01:10. > :01:12.I think, with adequate care, Steven would be alive today,
:01:13. > :01:15.and I think he would have been living quite a healthy life.
:01:16. > :01:18.It is time to break the silence on a growing problem
:01:19. > :01:32.I struggled with an eating disorder for over half my life.
:01:33. > :01:38.Men, in particular, find it very difficult to talk about.
:01:39. > :01:40.But thankfully, more and more are coming forward.
:01:41. > :01:44.I have never really understood why this illness has blighted my life
:01:45. > :01:56.It can hit at any time, and it doesn't discriminate.
:01:57. > :02:11.He has anorexia nervosa, a serious mental illness
:02:12. > :02:14.where someone tries to keep their weight as low as possible
:02:15. > :02:19.by restricting the amount of food they eat.
:02:20. > :02:24.Tommy, what is your anorexia like now?
:02:25. > :02:28.Even my body is saying no, stop, my head is saying,
:02:29. > :02:43.A lot of people say that the voice is not real, but it is.
:02:44. > :02:47.You cannot have even ten minutes without it,
:02:48. > :02:50.because it is constant, and you are battling yourself
:02:51. > :02:55.all day, and it is very self-destructive as well.
:02:56. > :03:04.It wants to strip you of everything, and one of the main dark things I am
:03:05. > :03:07.going to say is the actual goal of it is to take everything
:03:08. > :03:22.If skin goes over the top of my trousers, I feel that is fat
:03:23. > :03:26.At home, he checks himself in the mirror constantly.
:03:27. > :03:30.If your face looks sunk in and bony, looking at mine at the moment,
:03:31. > :03:34.it doesn't look sunk in, bony, but if it is, that is the look that
:03:35. > :03:58.As a teenager, James Wade almost 19 stone.
:03:59. > :04:13.Student slimmer sheds seven stone in a year without any
:04:14. > :04:19.help from the diet industry.
:04:20. > :04:21.But his weight-loss got out of control, he had
:04:22. > :04:23.to suspend his studies and return home.
:04:24. > :04:26.It kind of makes me sick, because it makes me feel that
:04:27. > :04:29.what has happened is I have restricted my eating,
:04:30. > :04:31.but the restriction has become an obsession
:04:32. > :04:48.It can lead to depression, brittle bones, and even heart failure.
:04:49. > :04:51.I could not walk up the stairs, I felt weaker.
:04:52. > :04:55.I felt more frail, and I could feel some of my bones sticking out.
:04:56. > :05:00.At first, he got psychiatric treatment, but now he only
:05:01. > :05:03.He is struggling to manage the condition on his own.
:05:04. > :05:07.What is it like to try to deal with anorexia, with this voice
:05:08. > :05:13.James is going to keep a video diary to show us and the reality of life
:05:14. > :05:24.I think this morning I am in the mood for food restriction,
:05:25. > :05:27.my mind is telling me this, and I feel I have to cut back
:05:28. > :05:31.on my food, and probably that is what I will end up doing.
:05:32. > :05:35.It is estimated around 1.6 million people in the UK have under eating
:05:36. > :05:41.disorder, and 400,000 of those are thought to be men.
:05:42. > :05:53.What no-one knew at that time as I was struggling
:05:54. > :05:56.I was also struggling with depression.
:05:57. > :06:02.I started realising that the type of person that I was finding
:06:03. > :06:05.attractive was not finding me attractive, or would not find me
:06:06. > :06:07.attractive because I was fat, obese in my eyes.
:06:08. > :06:10.I started making myself ill, I wanted to lose weight,
:06:11. > :06:13.so I would go to the toilet and make myself sick -
:06:14. > :06:26.not far off every meal nearly, you know.
:06:27. > :06:29.I had bulimia, where someone tries to control the weight
:06:30. > :06:32.by purging after eating, usually by making themselves sick.
:06:33. > :06:35.For nearly 20 years, it became a way of life for me.
:06:36. > :06:38.My mum was diagnosed with terminal cancer.
:06:39. > :06:41.I cried all day thinking about things, and I went
:06:42. > :06:44.to the toilet to make myself sick, and I couldn't.
:06:45. > :06:47.You know, I stuck my fingers down my throat, and nothing
:06:48. > :07:08.I think seeing what my mother went through made me stop.
:07:09. > :07:11.After years of bulimia, it seems like I had finally got control.
:07:12. > :07:14.We do also have good information on the website...
:07:15. > :07:16.The UK's largest eating disorder charity is Beat.
:07:17. > :07:19.It's advice centre in Warrington receives 20,000 calls a year,
:07:20. > :07:23.I have never asked for help for my eating disorder,
:07:24. > :07:26.but more men and boys are now coming forward
:07:27. > :07:45.It is definitely the case that men and boys are not seeking help
:07:46. > :07:48.as readily, many of them don't want to be seen as suffering
:07:49. > :07:50.from what is perceived as a girl' problem.
:07:51. > :07:53.Their parents are not looking for a eating disorder,
:07:54. > :07:56.if they get to the GP, the GP may not be looking
:07:57. > :07:58.for an eating disorder, so it may be diagnosed
:07:59. > :08:02.That allows the eating disorder to get ever more in control,
:08:03. > :08:05.and that makes it much harder for the treatments to work
:08:06. > :08:07.when they finally get into treatment.
:08:08. > :08:10.I encourage you to try that different therapy and see how it
:08:11. > :08:13.goes and let us know if you need further support.
:08:14. > :08:16.Some of the things coming in there, written down, I was thinking,
:08:17. > :08:20.that is exactly how I was, you know, that is what I needed 25 years ago,
:08:21. > :08:25.We wanted to find out the scale of the problem across the UK,
:08:26. > :08:28.so we asked every mental health trust and board how many men
:08:29. > :08:38.were referred to eating disorders services for a first assessment.
:08:39. > :08:40.From those that responded, we discovered that, in 2016,
:08:41. > :08:43.there were 871 referrals, an increase from 2014 of 43%.
:08:44. > :08:46.Our research also revealed that, from those that responded,
:08:47. > :08:48.more than 2500 youngsters, both boys and girls,
:08:49. > :08:55.received help - a rise of 42% over the last two years.
:08:56. > :08:58.This 14-year-old lives with his parents and younger sister
:08:59. > :09:19.He has just come out of hospital, where he was being treated
:09:20. > :09:24.Eating disorders can develop at any age.
:09:25. > :09:31.The risk is highest for young people between 13 and 17.
:09:32. > :09:33.I always had this idea of the body that I wanted,
:09:34. > :09:36.probably because of stuff I saw on social media.
:09:37. > :09:40.When you say the body you wanted, you were looking at sports people?
:09:41. > :09:49.I started exercising, even more than I previously had,
:09:50. > :09:52.so I was doing stuff in the house as well as...
:09:53. > :09:59.I noticed the back of the neck was getting very scrawny.
:10:00. > :10:04.I think he was, and then his behaviour just got more
:10:05. > :10:07.He started doing star jumps, he wouldn't sit down,
:10:08. > :10:12.I probably didn't realise he was just concentrating all day
:10:13. > :10:15.on food, that was all he was thinking about day and night,
:10:16. > :10:30.The night he went into hospital, I can remember a horrible,
:10:31. > :10:33.wet February night, and he was kick jumping into the hospital,
:10:34. > :10:36.he couldn't walk normally, he was kick jumping.
:10:37. > :10:40.As he was being monitored, his heart rate dropped so low
:10:41. > :11:02.He was discharged in February after nearly three weeks in hospital.
:11:03. > :11:04.You get the onions, I'll get the peppers out
:11:05. > :11:09.His family thought he was improving, but a few days later they found
:11:10. > :11:11.chocolate and yoghurt in the bathroom bin.
:11:12. > :11:15.What I was doing was hiding them, and then they found some of the food
:11:16. > :11:20.We thought we were keeping a close eye on him, watching him,
:11:21. > :11:23.after he had eaten his food, but obviously they get very
:11:24. > :11:25.deceptive, and he managed to hide some food.
:11:26. > :11:31.But I felt like people were intruding into my life,
:11:32. > :11:35.I didn't understand why they were sort of...
:11:36. > :11:57.He had to go back to hospital before being admitted to a children
:11:58. > :11:59.and young people's mental health ward, where he stayed
:12:00. > :12:05.He is now receiving weekly therapy through a support worker.
:12:06. > :12:08.But his family say he has yet to see a dietician.
:12:09. > :12:11.According to Nice guidelines, children with anorexia should be
:12:12. > :12:15.offered supplementary dietary advice.
:12:16. > :12:20.14 years of age, to be able to speak about what he has been through,
:12:21. > :12:25.I don't think I could have done that at 14 years of age.
:12:26. > :12:30.So how long do people have to wait for treatment?
:12:31. > :12:33.We asked every mental health trust and board in the UK.
:12:34. > :12:36.We discovered that average waits for treatment for both males
:12:37. > :12:39.and females vary from one week to 28 weeks, with some patients waiting
:12:40. > :12:47.All of that time, the clock is ticking, the illness
:12:48. > :12:50.is getting its claws into the sufferer.
:12:51. > :12:53.The treatments are mostly talking therapies, and in those early days,
:12:54. > :12:55.they are much more likely to work, to be successful,
:12:56. > :13:09.than they are if you leave it a very long time.
:13:10. > :13:12.Back in south Wales, James says he has been asking
:13:13. > :13:14.for talking therapy for more than two years.
:13:15. > :13:19.In the meantime, his anorexia has taken control again.
:13:20. > :13:26.I have just been on my run, I did a lot more than what I was supposed
:13:27. > :13:30.to do, I was thinking of my next meal, what I am planning,
:13:31. > :13:33.and my mind was telling me to restrict, to hold back.
:13:34. > :13:36.But I know what I should be having, a substantial meal.
:13:37. > :13:39.The health board in charge of both James's and the 14-year-old's pair,
:13:40. > :13:42.Cwm Taf, says that while it cannot comment on individuals,
:13:43. > :13:45.its priority is to provide the best possible care for children
:13:46. > :14:11.Many of the young lads I have spoken to with anorexia seem to have been
:14:12. > :14:15.obsessed with exercise, but for me it is my job.
:14:16. > :14:18.Being a rugby ref means I have to keep up on the pitch
:14:19. > :14:22.So I am under huge pressure to maintain my fitness.
:14:23. > :14:25.My eating disorder has been a big part of that.
:14:26. > :14:28.Today I am in Dublin to referee the Pro12 final.
:14:29. > :14:31.I've always spoken about bulimia like it is in my past.
:14:32. > :14:36.It returned as I approached the pinnacle of my career,
:14:37. > :14:44.It started sneaking back probably a little bit before the World Cup.
:14:45. > :14:46.I was under huge pressure to reach certain fitness levels,
:14:47. > :14:48.and the fitness levels are very high.
:14:49. > :14:52.So, I sort of made myself sick a couple of times as well,
:14:53. > :14:54.leading up to the fitness testing and stuff like that.
:14:55. > :14:58.After the World Cup final, the next year, you are just in cloud
:14:59. > :15:03.So I started seeing myself putting some weight on,
:15:04. > :15:06.I was looking in the mirror and I thought, you know,
:15:07. > :15:24.It would be twice a week one week, and then nothing
:15:25. > :15:27.I know it's not the right way to lose weight.
:15:28. > :15:30.I know it makes you more harm than good.
:15:31. > :15:33.But why I still do it from time to time?
:15:34. > :15:38.It's a question I've avoided for most of my life.
:15:39. > :15:41.But I know now I need to face up to it.
:15:42. > :15:43.Could it be the pressure of being a professional sportsman?
:15:44. > :15:47.Research shows that male elite athletes are 16 times more likely
:15:48. > :15:50.to develop an eating disorder in comparison to nonathletes.
:15:51. > :15:52.Boxer Bradley Pryce is a case in point.
:15:53. > :15:57.Like me, he has made himself sick to lose weight.
:15:58. > :16:10.You're hitting that hard, aren't you?
:16:11. > :16:13.Bradley, from Cwmcarn in south Wales, won the Commonwealth light
:16:14. > :16:23.A decade later, he can still pack quite a punch.
:16:24. > :16:32.Eight years ago, he was training to defend his title.
:16:33. > :16:34.I had to get down to the 11 stone mark.
:16:35. > :16:38.I got lazy, I didn't train the way I was supposed to.
:16:39. > :16:40.My weight was kind of not coming down.
:16:41. > :16:45.So I decided to start making myself sick, just to make the weight.
:16:46. > :16:47.Everything I was eating, I was bringing it up.
:16:48. > :16:50.Everybody assumed I was training hard in the gym.
:16:51. > :16:57.When I made the weight, on the weigh-in, I got on the scales
:16:58. > :16:59.and my legs were buckling underneath me.
:17:00. > :17:04.I knew the fight was lost then, pretty much.
:17:05. > :17:10.Bradley was knocked out in round three and lost his
:17:11. > :17:17.Commonwealth title, which he blames on his eating disorder.
:17:18. > :17:19.It kind of ruined my career, losing a fight.
:17:20. > :17:25.If I had won, I would have kept doing it.
:17:26. > :17:29.Bradley is still competing and has to lose three pounds before a fight
:17:30. > :17:43.Not as extreme as I had done it for that fight.
:17:44. > :17:47.But leading up to a fight, when you can't have any fluid
:17:48. > :17:50.or anything, I have had a bottle of pop and drank it,
:17:51. > :18:12.People now still find it hard to believe that I had
:18:13. > :18:15.to put my finger in my throat and make myself sick.
:18:16. > :18:21.That temptation is always there for me, as well.
:18:22. > :18:25.I have had a bulimia for most of my adult life,
:18:26. > :18:28.and in the back of my mind, I am constantly aware
:18:29. > :18:34.But I never thought about the damage it might be doing to my body.
:18:35. > :18:35.Cambridge University student James Downs survived anorexia
:18:36. > :18:37.as a teenager, but then developed severe bulimia,
:18:38. > :18:48.I caught up with 27-year-old James at his parents' home in Cardiff.
:18:49. > :18:52.I would bring all the food up here in the night.
:18:53. > :18:55.I would feel very stressed a lot of the time.
:18:56. > :18:58.It was only when I was eating that I didn't feel that.
:18:59. > :19:04.So I used to eat all of the food, and be sick here, in large buckets,
:19:05. > :19:11.Yes, and then the next day, when somebody was out,
:19:12. > :19:18.James looks healthy to me, and that is the problem
:19:19. > :19:24.Like, I have to take medication for my stomach,
:19:25. > :19:26.because I still get a lot of acid.
:19:27. > :19:37.My front teeth aren't my own, they have to be replaced.
:19:38. > :19:43.I was sick so much that the nerves were hanging out of my teeth.
:19:44. > :19:46.That is because of the acid in your stomach, it eats away
:19:47. > :19:53.James is back at university, and is focusing on his recovery.
:19:54. > :19:56.He has had help in the past, but despite the severe physical
:19:57. > :19:58.symptoms, he is struggling to get more treatment
:19:59. > :20:07.I went to the GP and asked if there was any support available.
:20:08. > :20:10.And they referred me to the Adult Eating Disorder
:20:11. > :20:15.Unfortunately, they didn't even offer me an assessment.
:20:16. > :20:16.The referral was not accepted because James
:20:17. > :20:27.Because, as well as the bulimia, I find it hard to manage how much
:20:28. > :20:32.And those kind of anxieties play a big role in my life.
:20:33. > :20:42.You know, I thought I'd had it pretty bad with bulimia,
:20:43. > :20:44.but nothing compared to what he's been through.
:20:45. > :20:50.I didn't realise people could have it that bad, you know?
:20:51. > :20:52.Cambridgeshire and Peterborough NHS Foundation Trust Eating Disorder
:20:53. > :20:56.Service told us that they cannot comment on individuals,
:20:57. > :20:58.but they are experiencing severe staff shortages,
:20:59. > :21:01.and are only able to accept those with
:21:02. > :21:07.Time and again, when meeting these young men who have battled
:21:08. > :21:09.with eating disorders, I have heard stories
:21:10. > :21:18.Our research has revealed that health trusts and boards
:21:19. > :21:21.across the UK have turned down more than 470 referrals for eating
:21:22. > :21:37.disorders for men and women, for a variety of reasons.
:21:38. > :21:40.Steven Brazier, from Minster, in Kent, was a funloving teenager
:21:41. > :21:42.before his eating disorder took hold.
:21:43. > :21:44.I started to sort of notice that he wasn't eating.
:21:45. > :21:51.And then, when he did eat with us, afterwards, he would disappear
:21:52. > :21:55.into the bathroom for ages afterwards.
:21:56. > :22:03.He just wouldn't eat for days, and then he would binge,
:22:04. > :22:06.where he'd eat all the deserts, or he'd eat a whole
:22:07. > :22:13.Saying, I've got to be sick, I've got to be sick.
:22:14. > :22:17.In the end, he would be pleading with you to let him go and be sick.
:22:18. > :22:21.It was upsetting, because he vanished in front
:22:22. > :22:28.And he just got thinner and thinner, and the spark just went out of him.
:22:29. > :22:31.His GP referred him to the local eating disorders team,
:22:32. > :22:34.His potassium levels became very low, which meant repeated
:22:35. > :22:44.When he was discharged, they said the referral would be
:22:45. > :22:59.and it was just constantly a battle all the time.
:23:00. > :23:03.Steven died ied at home shortly afterwards, in February
:23:04. > :23:13.A postmortem recorded his cause of death as anorexia with bulimia.
:23:14. > :23:18.I think so many opportunities were missed.
:23:19. > :23:20.With adequate care, Steven would be alive today,
:23:21. > :23:26.and I think he would be living quite a healthy life.
:23:27. > :23:29.Melanie took legal action against Kent and Medway NHS
:23:30. > :23:32.and Social Care Partnership and settled out of court
:23:33. > :23:44.They admit that their care was not adequate, and say they have improved
:23:45. > :23:50.it as a result of learning from the failings in Steven's case.
:23:51. > :23:53.We wanted to talk to Secretary of State for Health
:23:54. > :23:55.Jeremy Hunt about waiting times for eating disorder treatments.
:23:56. > :24:02.The Department of Health told us a pathway for adults
:24:03. > :24:05.is being developed, and it is investing ?150 million
:24:06. > :24:06.in children and young people's services,
:24:07. > :24:10.and will expect them to be seen within four weeks, or one
:24:11. > :24:21.For adults and children in Wales, that waiting time standard is four
:24:22. > :24:24.weeks, in Northern Ireland nine weeks, and in Scotland 18 weeks.
:24:25. > :24:27.This is the Maudsley Hospital in London.
:24:28. > :24:30.Its eating disorders unit for children and young people
:24:31. > :24:33.is renowned for its research and treatment.
:24:34. > :24:47.Eating disorders are probably the only condition in mental health
:24:48. > :24:50.where, actually, if you get a diagnosis early, it can lead
:24:51. > :24:51.to a better prognosis, provided you get
:24:52. > :24:54.Delaying treatment can make treatment more difficult.
:24:55. > :24:58.There is also good evidence to show that, the longer an eating disorder
:24:59. > :25:00.goes on, the harder it can be to treat.
:25:01. > :25:03.Eating disorders are renowned for actually having the highest
:25:04. > :25:04.mortality out of any psychiatric condition.
:25:05. > :25:08.So more people will die of eating disorders than any other
:25:09. > :25:12.Over the years, I have spoken openly about my sexuality and depression.
:25:13. > :25:15.But this is the first time I have ever confronted my eating disorder.
:25:16. > :25:19.I've just come back from Argentina two weeks ago, where I was making
:25:20. > :25:22.myself sick three or four times in Argentina, because I was eating
:25:23. > :25:27.And I knew, if I eat all of this food, I will make
:25:28. > :25:35.So I have never sought help about it, because,
:25:36. > :25:38.until speaking to you now, I guess that I have always felt
:25:39. > :25:46.I would say that it is clear that you still have some symptoms,
:25:47. > :25:52.If you haven't really received treatment for an eating disorder,
:25:53. > :25:54.it is that much more likely to re-emerge.
:25:55. > :25:58.So I think it would be really good if, at some point,
:25:59. > :26:03.you could think about maybe getting some help.
:26:04. > :26:11.That was a bit of a reality check, really.
:26:12. > :26:16.You know, speaking to Dr Darren there today,
:26:17. > :26:18.it was sort of an acknowledgement that
:26:19. > :26:21.I need to do something about it, really.
:26:22. > :26:25.I need to sit down and speak to somebody to try and get it out
:26:26. > :26:29.From what I've heard from the people I've met,
:26:30. > :26:32.it's hard to say you've ever fully beaten an eating disorder.
:26:33. > :26:35.But, if you are given the tools to stay one step ahead,
:26:36. > :26:42.This young man is certainly not out of the woods yet,
:26:43. > :26:46.but he is making a phased return to school, where his friends will be
:26:47. > :27:06.Maybe be slightly intrusive, sort of just check that at lunch
:27:07. > :27:07.I'm eating a bit.
:27:08. > :27:13.I guess that is what you guys can do for me.
:27:14. > :27:16.Yes, if we see you getting skinny again in your face.
:27:17. > :27:18.Let you know before it gets to that stage.
:27:19. > :27:24.James also hopes that, with the help of the people
:27:25. > :27:27.around him, he can get back on track with his recovery.
:27:28. > :27:34.But he knows it's not going to be easy.
:27:35. > :27:36.Yeah, it's going to take time, and some battling
:27:37. > :27:41.But then the anorexia is not going to be there forever.
:27:42. > :27:44.There is light at the end of the tunnel, I suppose.
:27:45. > :27:49.I know I can get somewhere where I know I can be happy.
:27:50. > :27:58.Well, it has been an incredible journey.
:27:59. > :28:01.A strange, but an incredible experience, as well.
:28:02. > :28:04.And realising how many different types of people,
:28:05. > :28:08.from all walks of life, men and boys, that an eating
:28:09. > :28:14.To actually accept that you have an eating disorder,
:28:15. > :28:17.or a mental health issue, is actually a sign of
:28:18. > :28:25.But, as I've discovered, is not always easy to get the help
:28:26. > :28:30.So, the sooner you start talking to people, the better.
:28:31. > :28:40.Don't be in my situation, 27 years on, still suffering from it.