03/10/1997 Panorama

I'm Nigel Owens. I am an international rugby referee. You may

know me for my no-nonsense approach on the pitch. I don't know if we've

met before, but I am the referee on this field, not you. But you might

not know that I have had the eating disorder pulling you for more than

20 years. To on Panorama, we reveal the growing number of men and boys

battling eating disorders. Is skin goes over the top of my trousers,

that's bad. I feel like that should not be there. It's not just girls

who suffer from bad body image. In the media, that is what drove me to

it. And it claims lives. This 20-year-old died after battling

eating disorders for most of his teenage years.

I think, with adequate care, Steven would be alive today,

and I think he would have been living quite a healthy life.

It is time to break the silence on a growing problem

I struggled with an eating disorder for over half my life.

Men, in particular, find it very difficult to talk about.

But thankfully, more and more are coming forward.

I have never really understood why this illness has blighted my life

It can hit at any time, and it doesn't discriminate.

He has anorexia nervosa, a serious mental illness

where someone tries to keep their weight as low as possible

by restricting the amount of food they eat.

Tommy, what is your anorexia like now?

Even my body is saying no, stop, my head is saying,

A lot of people say that the voice is not real, but it is.

You cannot have even ten minutes without it,

because it is constant, and you are battling yourself

all day, and it is very self-destructive as well.

It wants to strip you of everything, and one of the main dark things I am

going to say is the actual goal of it is to take everything

If skin goes over the top of my trousers, I feel that is fat

At home, he checks himself in the mirror constantly.

If your face looks sunk in and bony, looking at mine at the moment,

it doesn't look sunk in, bony, but if it is, that is the look that

As a teenager, James Wade almost 19 stone.

Student slimmer sheds seven stone in a year without any

help from the diet industry.

But his weight-loss got out of control, he had

to suspend his studies and return home.

It kind of makes me sick, because it makes me feel that

what has happened is I have restricted my eating,

but the restriction has become an obsession

It can lead to depression, brittle bones, and even heart failure.

I could not walk up the stairs, I felt weaker.

I felt more frail, and I could feel some of my bones sticking out.

At first, he got psychiatric treatment, but now he only

He is struggling to manage the condition on his own.

What is it like to try to deal with anorexia, with this voice

James is going to keep a video diary to show us and the reality of life

I think this morning I am in the mood for food restriction,

my mind is telling me this, and I feel I have to cut back

on my food, and probably that is what I will end up doing.

It is estimated around 1.6 million people in the UK have under eating

disorder, and 400,000 of those are thought to be men.

What no-one knew at that time as I was struggling

I was also struggling with depression.

I started realising that the type of person that I was finding

attractive was not finding me attractive, or would not find me

attractive because I was fat, obese in my eyes.

I started making myself ill, I wanted to lose weight,

so I would go to the toilet and make myself sick -

not far off every meal nearly, you know.

I had bulimia, where someone tries to control the weight

by purging after eating, usually by making themselves sick.

For nearly 20 years, it became a way of life for me.

My mum was diagnosed with terminal cancer.

I cried all day thinking about things, and I went

to the toilet to make myself sick, and I couldn't.

You know, I stuck my fingers down my throat, and nothing

I think seeing what my mother went through made me stop.

After years of bulimia, it seems like I had finally got control.

We do also have good information on the website...

The UK's largest eating disorder charity is Beat.

It's advice centre in Warrington receives 20,000 calls a year,

I have never asked for help for my eating disorder,

but more men and boys are now coming forward

It is definitely the case that men and boys are not seeking help

as readily, many of them don't want to be seen as suffering

from what is perceived as a girl' problem.

Their parents are not looking for a eating disorder,

if they get to the GP, the GP may not be looking

for an eating disorder, so it may be diagnosed

That allows the eating disorder to get ever more in control,

and that makes it much harder for the treatments to work

when they finally get into treatment.

I encourage you to try that different therapy and see how it

goes and let us know if you need further support.

Some of the things coming in there, written down, I was thinking,

that is exactly how I was, you know, that is what I needed 25 years ago,

We wanted to find out the scale of the problem across the UK,

so we asked every mental health trust and board how many men

were referred to eating disorders services for a first assessment.

From those that responded, we discovered that, in 2016,

there were 871 referrals, an increase from 2014 of 43%.

Our research also revealed that, from those that responded,

more than 2500 youngsters, both boys and girls,

received help - a rise of 42% over the last two years.

This 14-year-old lives with his parents and younger sister

He has just come out of hospital, where he was being treated

Eating disorders can develop at any age.

The risk is highest for young people between 13 and 17.

I always had this idea of the body that I wanted,

probably because of stuff I saw on social media.

When you say the body you wanted, you were looking at sports people?

I started exercising, even more than I previously had,

so I was doing stuff in the house as well as...

I noticed the back of the neck was getting very scrawny.

I think he was, and then his behaviour just got more

He started doing star jumps, he wouldn't sit down,

I probably didn't realise he was just concentrating all day

on food, that was all he was thinking about day and night,

The night he went into hospital, I can remember a horrible,

wet February night, and he was kick jumping into the hospital,

he couldn't walk normally, he was kick jumping.

As he was being monitored, his heart rate dropped so low

He was discharged in February after nearly three weeks in hospital.

You get the onions, I'll get the peppers out

His family thought he was improving, but a few days later they found

chocolate and yoghurt in the bathroom bin.

What I was doing was hiding them, and then they found some of the food

We thought we were keeping a close eye on him, watching him,

after he had eaten his food, but obviously they get very

deceptive, and he managed to hide some food.

But I felt like people were intruding into my life,

I didn't understand why they were sort of...

He had to go back to hospital before being admitted to a children

and young people's mental health ward, where he stayed

He is now receiving weekly therapy through a support worker.

But his family say he has yet to see a dietician.

According to Nice guidelines, children with anorexia should be

offered supplementary dietary advice.

14 years of age, to be able to speak about what he has been through,

I don't think I could have done that at 14 years of age.

So how long do people have to wait for treatment?

We asked every mental health trust and board in the UK.

We discovered that average waits for treatment for both males

and females vary from one week to 28 weeks, with some patients waiting

All of that time, the clock is ticking, the illness

is getting its claws into the sufferer.

The treatments are mostly talking therapies, and in those early days,

they are much more likely to work, to be successful,

than they are if you leave it a very long time.

Back in south Wales, James says he has been asking

for talking therapy for more than two years.

In the meantime, his anorexia has taken control again.

I have just been on my run, I did a lot more than what I was supposed

to do, I was thinking of my next meal, what I am planning,

and my mind was telling me to restrict, to hold back.

But I know what I should be having, a substantial meal.

The health board in charge of both James's and the 14-year-old's pair,

Cwm Taf, says that while it cannot comment on individuals,

its priority is to provide the best possible care for children

Many of the young lads I have spoken to with anorexia seem to have been

obsessed with exercise, but for me it is my job.

Being a rugby ref means I have to keep up on the pitch

So I am under huge pressure to maintain my fitness.

My eating disorder has been a big part of that.

Today I am in Dublin to referee the Pro12 final.

I've always spoken about bulimia like it is in my past.

It returned as I approached the pinnacle of my career,

It started sneaking back probably a little bit before the World Cup.

I was under huge pressure to reach certain fitness levels,

and the fitness levels are very high.

So, I sort of made myself sick a couple of times as well,

leading up to the fitness testing and stuff like that.

After the World Cup final, the next year, you are just in cloud

So I started seeing myself putting some weight on,

I was looking in the mirror and I thought, you know,

It would be twice a week one week, and then nothing

I know it's not the right way to lose weight.

I know it makes you more harm than good.

But why I still do it from time to time?

It's a question I've avoided for most of my life.

But I know now I need to face up to it.

Could it be the pressure of being a professional sportsman?

Research shows that male elite athletes are 16 times more likely

to develop an eating disorder in comparison to nonathletes.

Boxer Bradley Pryce is a case in point.

Like me, he has made himself sick to lose weight.

You're hitting that hard, aren't you?

Bradley, from Cwmcarn in south Wales, won the Commonwealth light

A decade later, he can still pack quite a punch.

Eight years ago, he was training to defend his title.

I had to get down to the 11 stone mark.

I got lazy, I didn't train the way I was supposed to.

My weight was kind of not coming down.

So I decided to start making myself sick, just to make the weight.

Everything I was eating, I was bringing it up.

Everybody assumed I was training hard in the gym.

When I made the weight, on the weigh-in, I got on the scales

and my legs were buckling underneath me.

I knew the fight was lost then, pretty much.

Bradley was knocked out in round three and lost his

Commonwealth title, which he blames on his eating disorder.

It kind of ruined my career, losing a fight.

If I had won, I would have kept doing it.

Bradley is still competing and has to lose three pounds before a fight

Not as extreme as I had done it for that fight.

But leading up to a fight, when you can't have any fluid

or anything, I have had a bottle of pop and drank it,

People now still find it hard to believe that I had

to put my finger in my throat and make myself sick.

That temptation is always there for me, as well.

I have had a bulimia for most of my adult life,

and in the back of my mind, I am constantly aware

But I never thought about the damage it might be doing to my body.

Cambridge University student James Downs survived anorexia

as a teenager, but then developed severe bulimia,

I caught up with 27-year-old James at his parents' home in Cardiff.

I would bring all the food up here in the night.

I would feel very stressed a lot of the time.

It was only when I was eating that I didn't feel that.

So I used to eat all of the food, and be sick here, in large buckets,

Yes, and then the next day, when somebody was out,

James looks healthy to me, and that is the problem

Like, I have to take medication for my stomach,

because I still get a lot of acid.

My front teeth aren't my own, they have to be replaced.

I was sick so much that the nerves were hanging out of my teeth.

That is because of the acid in your stomach, it eats away

James is back at university, and is focusing on his recovery.

He has had help in the past, but despite the severe physical

symptoms, he is struggling to get more treatment

I went to the GP and asked if there was any support available.

And they referred me to the Adult Eating Disorder

Unfortunately, they didn't even offer me an assessment.

The referral was not accepted because James

Because, as well as the bulimia, I find it hard to manage how much

And those kind of anxieties play a big role in my life.

You know, I thought I'd had it pretty bad with bulimia,

but nothing compared to what he's been through.

I didn't realise people could have it that bad, you know?

Cambridgeshire and Peterborough NHS Foundation Trust Eating Disorder

Service told us that they cannot comment on individuals,

but they are experiencing severe staff shortages,

and are only able to accept those with

Time and again, when meeting these young men who have battled

with eating disorders, I have heard stories

Our research has revealed that health trusts and boards

across the UK have turned down more than 470 referrals for eating

disorders for men and women, for a variety of reasons.

Steven Brazier, from Minster, in Kent, was a funloving teenager

before his eating disorder took hold.

I started to sort of notice that he wasn't eating.

And then, when he did eat with us, afterwards, he would disappear

into the bathroom for ages afterwards.

He just wouldn't eat for days, and then he would binge,

where he'd eat all the deserts, or he'd eat a whole

Saying, I've got to be sick, I've got to be sick.

In the end, he would be pleading with you to let him go and be sick.

It was upsetting, because he vanished in front

And he just got thinner and thinner, and the spark just went out of him.

His GP referred him to the local eating disorders team,

His potassium levels became very low, which meant repeated

When he was discharged, they said the referral would be

and it was just constantly a battle all the time.

Steven died ied at home shortly afterwards, in February

A postmortem recorded his cause of death as anorexia with bulimia.

I think so many opportunities were missed.

With adequate care, Steven would be alive today,

and I think he would be living quite a healthy life.

Melanie took legal action against Kent and Medway NHS

and Social Care Partnership and settled out of court

They admit that their care was not adequate, and say they have improved

it as a result of learning from the failings in Steven's case.

We wanted to talk to Secretary of State for Health

Jeremy Hunt about waiting times for eating disorder treatments.

The Department of Health told us a pathway for adults

is being developed, and it is investing ?150 million

in children and young people's services,

and will expect them to be seen within four weeks, or one

For adults and children in Wales, that waiting time standard is four

weeks, in Northern Ireland nine weeks, and in Scotland 18 weeks.

This is the Maudsley Hospital in London.

Its eating disorders unit for children and young people

is renowned for its research and treatment.

Eating disorders are probably the only condition in mental health

where, actually, if you get a diagnosis early, it can lead

to a better prognosis, provided you get

Delaying treatment can make treatment more difficult.

There is also good evidence to show that, the longer an eating disorder

goes on, the harder it can be to treat.

Eating disorders are renowned for actually having the highest

mortality out of any psychiatric condition.

So more people will die of eating disorders than any other

Over the years, I have spoken openly about my sexuality and depression.

But this is the first time I have ever confronted my eating disorder.

I've just come back from Argentina two weeks ago, where I was making

myself sick three or four times in Argentina, because I was eating

And I knew, if I eat all of this food, I will make

So I have never sought help about it, because,

until speaking to you now, I guess that I have always felt

I would say that it is clear that you still have some symptoms,

If you haven't really received treatment for an eating disorder,

it is that much more likely to re-emerge.

So I think it would be really good if, at some point,

you could think about maybe getting some help.

That was a bit of a reality check, really.

You know, speaking to Dr Darren there today,

it was sort of an acknowledgement that

I need to do something about it, really.

I need to sit down and speak to somebody to try and get it out

From what I've heard from the people I've met,

it's hard to say you've ever fully beaten an eating disorder.

But, if you are given the tools to stay one step ahead,

This young man is certainly not out of the woods yet,

but he is making a phased return to school, where his friends will be

Maybe be slightly intrusive, sort of just check that at lunch

I'm eating a bit.

I guess that is what you guys can do for me.

Yes, if we see you getting skinny again in your face.

Let you know before it gets to that stage.

James also hopes that, with the help of the people

around him, he can get back on track with his recovery.

But he knows it's not going to be easy.

Yeah, it's going to take time, and some battling

But then the anorexia is not going to be there forever.

There is light at the end of the tunnel, I suppose.

I know I can get somewhere where I know I can be happy.

Well, it has been an incredible journey.

A strange, but an incredible experience, as well.

And realising how many different types of people,

from all walks of life, men and boys, that an eating

To actually accept that you have an eating disorder,

or a mental health issue, is actually a sign of

But, as I've discovered, is not always easy to get the help

So, the sooner you start talking to people, the better.

Don't be in my situation, 27 years on, still suffering from it.