Men, Boys & Eating Disorders Panorama

I am Nigel Owens. I am an international rugby referee. You

might know me for my no-nonsense approach on the pitch. Christopher?

I don't think we have met before, but I am the referee, not you. What

you might not know is I about the eating disorder bulimia for more

than 20 years. Tonight on Panorama, we revealed the growing number of

men and boys battling eating disorders. Its skin goes over the

top of my trousers, I feel that is fat that should not be there. It is

not just girls affected by body image. Being bombarded by social

media, that is what drove me to it, I guess. And it can claim lives.

This 20-year-old died after battling eating disorders for most of his

teenage years. I think, with adequate care, Stephen 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 for

British men. I struggle with an eating disorder

for over half my life. It is a very secretive illness. Man, 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 flighted my life and the lives of so many others. It can hit

at any time, and it doesn't discriminate. James is 25. 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. How is it going? Are you all right? Not bad, thanks.

Tommy, what is your anorexia like now? Even my body is saying no,

stop, my head is saying, go, keep on going. A lot of people say that the

voice is not real, but it is. To you, it is. It is me. 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. Is

and there now? Yeah. It wants to strip you of everything, and one of

the main dark things I am going to say is the actual goal of eight is

to take everything from you and eventually kill you.

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

shouldn't be there. James lives in Merthyr Tydfil. 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 I would rather be looking for. As a

teenager, James Wade almost 19 stone. At university, he went on a

diet. He ended up in the local paper. Students limit sheds seven

stone in a year without any help from the diet industry. -- student

slimmer. But is way -- 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

and leading to anorexia. Anorexia has serious consequences. It can

lead to depression, brittle bones, and even heart failure. I could not

walk up the stairs, I felt we go. I felt more frail, and I could feel

some of my bones sticking out. James's weight kept plummeting. It

reached dangerously low levels. At first, he got psychiatric treatment,

but now he only sees a dietician. He is struggling to manage the

condition on his own. Calorie amount... What is it like to try to

deal with anorexia, with this voice in your head every day? He is going

to keep a video diary to show us and the reality of life with an eating

disorder. 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. I am one of those statistics. I grew up

in rural Carmarthenshire. Here I am aged 19. What no-one knew at that

time as I was struggling with my own sexuality. I was also struggling

with depression. I started realising that the type of person that I was

finding attractive was not binding 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 after -- by purging after

eating, usually by making themselves sick. For nearly 20 years, it became

a way of life for me. When I was 36, everything changed. 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 would come up. 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, around a fifth from men and boys. I have never asked for help

for my eating disorder, but more men and boys are now coming forward -

albeit slowly. 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 as

something else. 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, something like this. 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 in south Wales. He has just come out of

hospital, where he was being treated for anorexia. Nice to meet you.

Would you like to come in? 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? Yeah. You wanted to look like that? I started

exercising, even more than I previously had, so I was doing stuck

in the house as well as... Obsessed with exercise as well? Yeah. I

noticed the back of the neck was getting very scrawny. Was he hiding

it from you? I think he was, and then his behaviour just got more and

more weird. He started doing star jumps, he wouldn't sit down, he was

standing up all the time. I probably didn't realise he was just

concentrating all day on food, that was all he was thinking about day

and night, I think. She took her son to the doctor's. 11 days later, he

was in hospital. 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 at risk of cardiac

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

hospital. You get the onions, Al get-togethers out of the fridge,

yeah? 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 that I had been

hiding, yeah. 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. Didn't you? Yeah. But I

felt like people were intruding into my life, and it was not of their

business. I didn't understand why they were sort of... I was being

forced to put on weight. Rehab to go back to hospital before being

admitted to a children and young people's mental health ward, where

he stayed for nine weeks. -- he had to go back to hospital. He finally

came home in May. 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. He is brave. 14 years of

age, to be able to speak about what he has been through, that is very,

very brave. 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 ask 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 almost a year. 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. It is telling him to

over exercise. 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 and adults with eating

disorders. 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 with athletes have my age.

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. Thanks, Nigel. I've always spoken

about bulimia like it is in my past. Actually, that is not quite true. It

returned as I approached the pinnacle of my career, refereeing

the World Cup final. 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 cuckoo land, really. So I started seeing myself

putting some weight on, I was looking in the mirror and I thought,

you know, I'll get rid of this quite quickly. And then the bulimia came

back. It would be twice a week one week, and then nothing for months

and months. 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?

I don't know. 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. Is it safe to come in? How is it going?

You're hitting that hard, aren't you? Bradley, from baize in south

Wales, won the Commonwealth light middleweight title in 2006. -- from

Cwmcarn in South Wales. 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. You are hiding it? Yes. When I made the weight, on the

way in, I got on the scales and my legs were buckling underneath me. I

have a job to stand straight. I knew the fight was lost then, pretty

much. I thought, I've got nothing in me. 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 are still competing and has

to lose three pounds before a fight at the weekend. And you haven't done

it since? I have, yes. You have? 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 drum kit, and then brought it

back up. -- a bottle of pop and drank it, and then brought it back

up. People now still really don't believe it, that I make myself sick.

I know how he feels, 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 that it could come back at any time. 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. It has left its scars. I caught up with

27-year-old James at his parents' home in Cardiff. I would bring the

food appear at night, and I would feel stressed a lot of the time. It

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

used to eat all of the food, basic here, in large buckets, and put them

in the wardrobes. You would hide in there? Yes, and then the next day,

when people were out, I would clean it up. They would be overflowing

with sick. My room with smell. James looks healthy to me, and that is the

problem with an illness like bulimia. The damage can remain

hidden. I have to take medication for my stomach, I still get a lot of

acid. Still now? Yes. It has definitely had an impact. My front

teeth aren't my own, they have to be replaced. Because of make yourself

sick? 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 at your teeth?

It does, yes. 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 from his local

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

available. They referred me to the Adult Eating Disorder Service.

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

was not accepted because James was within a normal weight range. I was

very disappointed. As well as the bulimia, I find it hard to manage

how much I exercise. Those anxieties play a big role in my life. It's

unbelievable, really. I thought I had a 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? Cambridge and Peterborough NHS

Foundation Trust's 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 the most urgent needs. Time and

again, when meeting these young men who have battled with eating

disorders, I have heard stories about the struggle to get treatment.

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 fun loving teenager before his eating disorder

took hold. I started to notice that he wasn't eating. He would not eat

with us. When he did eat with us, afterwards, he would disappear into

the bathroom for ages afterwards. He just wouldn't eat the days, and then

he would binge, he would eat all of the deserts, or he would eat a whole

loaf of bread. Afterwards he was full of remorse. He was 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. He had no control over it. It was

upsetting, because he vanished in front of my eyes, basically. He got

thinner and thinner and the spark went out of him. His GP referred him

to the local eating disorders team. But Stephen continued to

deteriorate. His potassium levels became very low, which meant

repeated stays in hospital. He was sectioned for a year. When he was

discharged, they said the referral would be taken by the mental health

team and they would look after him,. None of that materialised. It was a

battle all the time. Nobody wanted to do anything. Died at home,

shortly afterwards, in February 2014, aged 20. A postmortem recorded

his cause of death has anorexia and bulimia. I think so many

opportunities were missed. With adequate care, Steven would be alive

today. 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 earlier this year. They admit that their care was

not adequate and say they have improved as a result of learning

from the failings in bulimia's case. We wanted to talk to the Secretary

of State for Health, Jeremy Hunt, about waiting times for eating

disorder treatments. He declined. The Department of Health told us

that 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 week if it is urgent. For

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

in Northern Ireland it is nine weeks, and in Scotland it is 18

weeks. This is the Maudsley Hospital in London. It 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 if you get it early, it can lead to a better

prognosis, provided you get the right treatment. 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 and of any psychiatric condition. Are they? More people

will die of eating disorders than any other mental health problem.

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 more

food than I needed. I knew if I eat all of this food, I will make myself

ill afterwards. I have never seek to help about it, because, until

speaking to you now, I guess, I have always felt I am in control of it.

But I'm not, am I? I would say that it is clear that you still have some

symptoms. It is still affecting your life. If you haven't really received

treatment for an eating disorder, it is much more likely to re-emerge. 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. Speaking to Dr Darren, it was 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 of my life for ever, I guess. 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, you do have a chance of recovery.

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 keeping a close eye

on him. Maybe be slightly intrusive, check at lunchtime, that I'm eating

a bit. That I'm not skipping it. 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. Make sure you say something.

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.

Yes, it's going to take time and some battling, and some fighting.

But then the anorexia is not going to be there for ever. 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 incredible experience as well. And realising

how many different types of people, from all walks of life, men and

boys, that an eating disorder affects. To actually accept that you

have an eating disorder, or a mental health issue, is actually a sign of

great, great strength. It is not a sign of weakness at all. But, as

I've discovered, is not always easy to get the help that you need, when

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

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

If you have been affected by the issues raised in this programme, you

can find details of organisations which offer advice and support with

eating disorders on the BBC website.