Do Only Women Suffer From Eating Disorders? feat. Matt Stranberg

I know him from grad school. Matt and I went to Columbia together. I believe we had the same major, right, you were nutrition and exercise physiology or just exercise physiology as well. You're both as well, right. I transitioned a little bit later, so I think I got to know you with the later part of my girl duate career. Anyway,

Matt is brilliant and has always been. He's always kind of been the person in class who speaks up and says the thing that you know kind of goes against me norder, but also like very confidently will really look at the literature and come up with your own opinions, which can you know, go against the grain, especially in a classroom setting when we're being taught. So I always looked to you for you know, the answers and definitely made the class a little bit more fun. So I'm

excited to be talking to you today. Well, thank you for having me here. So, yeah, I didn't expect you to go in the route that you've gone. Actually, you know, you're really passionate about exercise physiology, and I know you're still passionate about helping people form healthy relationships to exercise, but you ended up going down the eating disorder path professionally, I believe, right, yeah, totally, and so that's my specialty.

And as you pointed out, it wasn't really expected. When when I tell people what I do, oftentimes the assumption is, oh my, like wow, that must be your vocation. You must have like, you know, seen the light. And I wanted to do this for so long, and really it was like, you know, balancing from thing to thing, experimenting with so many different eras and be like, okay, know what interests me? You know, you know, how can I make this work? And really, um, I had always had

an interest in these topics. And at the same time, you know, when I was graduating my dietectic internship, once again faced with that existential crisis of going back out into the real world, like now what. And when I was thinking about my experiences, I had a lot of experience in stranding conditioning with athletes, I had experience in nutrition, had experience in counseling, and I'm like, okay, is there

a way to put this all together? And so when I looked out there, you know, with the research literature as well as like in general, you know, I found that there wasn't really many resources available for athletes or people engaging in physicotivity who maybe we're struggling mental and whether it was disordered eating or inert behaviors or relationship with exercise and so for instance, like you know, growing up as an athlete but also as a coach, you know,

you just hang out with so many different people and everyone's there training, but you know, you begin to realize that people are struggling at times, and there's this always this pressure to put up this image of you know, I'm fully in control, I'm stoic, and you know, I'm dedicated and I have every you know, handle on everything, and so when things are not going as one would expect or someone's struggling, really people will start to feel scared to reach out because they don't want to be

perceived as weak, or they don't want to be perceived as less than or they don't want to be um shot, you know, shadow this image of you know, this athlete and then be considered, well, it looks like you're struggling. So I don't know, if you can maintain your position on the team, you should probably go take some time off. And all of this is just really not conducive to

providing a supportive environment. And to make matters worse, a lot of the environments were pretty toxic in many respects, and that's something that really kind of not talked about in relations to sports, and so, you know, that really inspired me to try to make a change, and that led me to working together with a great researcher. Her

name is Paul Quatrimony. She's at Boston University, and together we came up with the idea of, hey, you know, why don't we actually create a program to help athletes struggling with eating disorders and problematic physical activity. And so

the last five years that's what I did. You know, I pitched a program to all the behavioral care called the Goals Program and helped lots of different athletes in that program and created curriculums and various initiatives and produce some research back into efficacy of the program and its methods with the hopes that it would spur some more interests in the area. And you know, just recently I've opened up my own private practice to help people in other areas as well. So it's been a it's been

an interesting journey, but eventually I ended up here. And it's it's hard because whether you're an athlete or not. You know, I'd say most of our audience, probably probably a handful of people do resonate with being an athlete or athlete in their past. But regardless or not, I think athletes have that extra pressure of eat healthy, you know,

to perform better or whatever. But all of us are really taught that healthy living looks like something we can check off on paper or easily quantify, whether it's that number on the scale or certain food choices or regular exercises. And I think it starts for a lot of people that were doing these things in the name of health, and then all of a sudden, people are hearing, wait a second, your pursuit of healthy eating is actually disordered.

And when we're just looking at this stuff on paper, right, like the behaviors eat more vegetables or move your body every single day, it can be really confusing for somebody to say, well, you told me to do these things to be healthy. How can you be saying that they're dysfunctional? So how how can this happen? And what are we

miss saying when it comes to our healthy behaviors? Yeah, no, this is a really great question and something that I've thought a lot about because in the past I was very much that person where I was being told and congratulated and reinforced for certain types of you know, approaches to exercise and food and body composition, all these different things.

And then you know, it was beginning to wonder why I was struggling, and you know, why why am I struggling so much if people are telling me I'm doing the right thing. So that was very much a point of confusion. And when I went into the work that I've been doing, you know, it actually is very much actually what I would say at the focal point for

most people I talked to. And so as you've mentioned, like, you know, how the heck do we tell the difference and you know, what's going on, and so in relation to answer this question, I think actually it's important to kind of back up a few steps um to really understand kind of what we're talking about, and you know, define you know what we're talking about. So the concepts that you've put forth are healthy and healthy is contrasted

with unhealthy. And then maybe people will say, like what's functional in this contrasted with what is considered dysfunctional order disorder. So when when we look at like, you know, what is this way of categorizing stuff, this is very much an a binary and and kind of like a dualistic

way of thinking. So there's a you know, there's a definition of something, and then the reason why we know it is something is because it's contrasted with what is not and and you know, this is kind of a baseline level thinking for for most individuals when they come into the world, Like we come to the world and people talk about what is safe or unsafe, edible versus inedible.

So just from the start in many instances. You know, culture communicates you know, what is desirable versus what's not desirable, and and that guides us in our day to day. Uh. And so like in the past, you know, this would be like the local elders in the village, or the religion, or the state, or various authorities such as like the father in the household, and they would define, you know, what is a good Christian, what is a good citizen. You know what's a good son, a good daughter, good wife.

This is right, that's wrong. And you know, this has been very much drilled into our day to day that it almost appears natural as if it's a reflection of reality. Now, you know, thinking about you know, how this relates to

our current situation. It's also important to kind of look at the development of these ideas and so, for instance, like science and the post Enlightenment, you know, after the eighteenth century was very much thought to help elucidate the truth about the world and demystify and personal opinion and intuition and religion. These are subjective, kind of touching, feeling things, and they're not based in science. And so if we adhere to scientific principles, then we can really understand what's

going on. So part of this was actually applied to very much like every topic, including humans themselves. So when we think about you know, Darwin and you know, theory of evolution, some people begin to think about this as like fitness in terms of evolution. And some people took that even further and said, well, you know, maybe we could actually improve the human race if we understood what

the ideal human would look like. And and then from there we can now categorize humans based on superior humans versus inferior Now, at the time, this is very popular thinking, and now we would say, you know, this is eugenics. You know, this is very much you know, shady and and and not really something that we want to reinforce. At the time, though the Nazis, the communist but also lots of American scientists and the American establishment very much

adhere to these ideas. And this actually is you know, where we have the origin of dietetics in many respects. Dietects was originally called home economics. How do we view food in a way that is economical so we can help optimize the human and optimize the diet, and then

from there we can create an ideal workforce. And so we have these ideas emerging at the turn of the century that conceptualized humans as machines, and then we also conceptualize them as machines that are imperfect that could be analyzed, reduced into individual components and rebuilt um and restructure through ideal diets, ideal exercise, ideal medications, ideal you know, environments, and we could socially engineer you know, the ideal worker,

the ideal soldier, and then the ideal societal machine. Now you know, Nazism, communism, and eugenics kind of faded out of the picture, but a lot of these ideas regarding fitness have very much for me the basis of how

we conceptualized health. And so when we think about it from a public health standpoint, public health and like the scientific management of the population, examines everyone and then categorize them as such and create these various categories like B m I, blood work, dietary patterns, exercise patterns, and you know, from American psychology, how do we systematize the human psyche

into understanding what is mentally healthy versus mentally ill? And similar to you know what I mentioned before in terms of this has not always been the case. This was

not always the case. And at the same time, because it was very much repeated over time and constantly ingrained into our psyche, these categories that were based in you know, these um conceptions of biology and conceptions of psychology became naturalized to the point where now we think of the world in this way in many respects that you know that these categories that were devised over time are actually

reflections of reality. And you know, another question that I want to ask when we talk about what is defined as healthy or functional, is like, is this actually reflection of reality or is this sign of like what the

society values. So, for instance, is it a sign of health to be well adjusted to a six society that constantly, you know, views the individual as merely in you know, a machine, you know, who is supposed to control themselves, a spouse, you know, rationality and be obsessed with productivity and self governance, trying to obtain a particular body and a perfect way of eating, to check all these various boxes.

And so you know, I'll pause right there, but essentially this is stuff that's talked about that is just naturalized, but in many respects it's missing a lot of different factors that we can really go into on a tuper level to help elucidate, you know, what do we make

of this? These are obviously more intellectual conversations than we've had on this podcast before, and certainly the framework of looking at history, it's very interesting to really see how it came from, what it came from, the cultures that came from, and some of the different ways that that we've come to view what is fit meaning, you know, survival of the fittest, And that first sentence you said really struck me is people were trying to survive and

they qualified or quantified what a body type looks like that would survive. But the truth is the times have changed. We live in much more modern world. You know, we've expanded our lifespan without having to fight off animals to survive, you know, so our idea of what health looks like or be quantified wasn't really updated, even though the way we live and the way we think and the way

we behave has. So I think that's super interesting and definitely allows us to expand out that black and white that you talked about between you know, is this healthy or is this dysfunctional? It's not black and white, it's why are we doing this? What are we thinking about? What is our motivation? What other things are kind of missing there in relation to you know, how can we

relate this to our lives. That the frameworks that have been presented to us as deemed functional and healthy are often reflections of what society values in relation to what is considered acceptable or desirable. And so you know, going back to the fitness category, it actually in many respects reflects what the conception was of creating que unquote you know, a fitter population in terms of you know, ability to

compete on you know, this huge scale. So for instance, like how can we have the deal worker, how can we have the ideal soldier? And and that is constructed in relation to health is primarily you know, a function of one's ability to function within um the framework that society values. Now that being said as m S before, this is often conflated as this is the objective reality.

So when we look at like these values of you know, understandings of research that relate to weight and and biometrics and you know, dietary patterns and exercise patterns, these are archetypal or like patterns that essentially describe predictions or describe observations, and we can relate them to lots of different things. But it would be a mistake to view these maps as the territory. So, you know, these are maps that help us navigate various things and relate them, but that

doesn't mean it's the actual territory itself. So, you know, how do we actually deem what's healthier functional? The way we do this in terms of what works for the person is to sit down with the individual and to actually get to know them and and understand, you know, what their values are, what you know, how do they think about the world, how do they conceptualize, how do they feel, how do they experience, and how do the you know, the multidimensional aspects of their life relate to

each other. So, for instance, something that's talked about a lot is you know, healthy eating, this that, blah blah, exercise, But not many people talk about social connection and the meaning that they have in their life, and you know, how they approach and think about food and how it's

felt and experienced. Most people want to just break it down into simply just numbers, and it's like, you know, what's the lab value how much saturated as opposed to you know, do you sit down and relax and like have a nice conversation with someone when you eat, and like, how does this relate to the other values in your life? And you know, you're thinking about losing weight and at

the same time, how might this affective relationship with food? Like, there's lots of more nuance that can only be really fleshed out if you get to know some on an

individual basis. The problem is this isn't really easy to systematizes across the population if you're looking at it from like a bureaucratic managerial standpoint, right, But when you know, you do work with athletes, or you've worked with athletes in the past, and I think there's such an interesting population just because they quote unquote look like the healthiest, the fittest what we've come to deem as the goal

for every human to become in some way. But when you talk to these individuals, how do they describe their emotional experience despite being quote unquote healthy. I think something and this can also relate to insurers as well, is you know, there's a difference between you know, the behaviors that we're doing versus kind of what we're experiencing on the inside as well, and and how all these various

aspects relate. And so in many respects, the system that you know, the managed healthcare system but also sports as well very much emphasizes, you know, what is called like procedural authenticity, where essentially, how does one's actions essentially relate to like external values or external you know boxes that we can check that signify a particular concept um, and not many people really think about, you know, other aspects such as you know, epistemic authenticity, where you know, you know,

what that means is essentially it's like how this relates to your internal experiences and your intentions and how you're experiencing this. And so a lot of athletes check a lot of quote unquote the boxes in terms of what is considered healthy and desirable and functional, and in many respects, no one sits down and actually asked them, you know, what they're subjective experiences like as well as their intersubjective experience in terms of how they relate to other people.

And that right there opens up a lot of you know, potential avenues for exploration because no one really digs deeper. They look at the image of the representation and never say how does this feel for you? You know, how is this experience? How does this relate to the other spects of your life? And when you have those conversations, you get to see the difference between what someone is doing versus how they're experiencing it and how it relates

to the other aspects of your life. But specifically, tell me what is their emotional experience? How do they describe it? When I'm sitting down with an individual, They're checking all the boxes, you know, they're winning the awards, they're doing all this stuff, and in some respects they feel proud and they feel maybe good about that, and at the same time, the way that they've achieved that is through

these intense repression of their feelings. And similar to like a boogie board, like you know at the pool, like you push the board underneath the water and it just ends up flying you up, you know, and hitting you

back in the face. A lot of the athletes I work with are constantly feeling torn and stuck in these contradictions, and like you can see this in terms of um They're getting padded on the back, uh to win the award and at the same time, they're feeling depressed, anxious, and suicidal because their mental health has been uh you know that they've been anxious and isolated for so long and and they feel like they have to constantly suppress

their feelings. And so there's this deep emptiness or deep sadness that you know, I hear, But like, who am I if if I'm not winning? Am I allowed to

feel sad? Or is this a form of weakness? You have these contradictions when I'm working with like football athletes or mixed martial arts, where in one mode they're supposed to be ultra violent and and hurt the other person as much as possible, and then just like that, they're supposed to stab their fingers and transition out and all of a sudden no longer feel angry, and and now they're supposed to integrate, you know, into the society that is non violent, and so you just you see just

so many internal conflicts across the board, and oftentimes, unfortunately, similar to the military people I work with or people you know in the police force, athletes often conceptualize their emotions as as weaknesses or as barriers to success, and often kind of over emphasized rationality as a means of

guiding them and you know, controlling their emotions. But usually of what this leads to is people suffering for prolonged periods of time and thinking that it is a failure of their personal will, a failure of their rationality, and they shouldn't be feeling this. But eventually, you know, people can only take so much and it really takes its sole you know, we don't get to really hear about men a lot on this podcast, and we get a lot of listeners that do enquire about their significant others

or their sons or their brothers. And you know, the assumption is that eating disorders are way more common in women in the US, and as a male, I assume that you attract male clients who might feel more comfortable with you. Perhaps perhaps not. Do you find that this is really true? Are eating disorders more common in women?

In terms of research, the research is fairly limited in relation to in disorders, and it often asks questions that don't really necessarily capture kind of like you know, what's going on. I mean, this is still a challenge that is very much laden with a lot of stigma. So it's unlike for people to show up and say, oh, by the way, yeah, I know, I'm experiencing all the stigma and I'd love to participate in this research study. This is already present in women, and it's way more

present in men. Who really have you know, in our country in many respects, you know, mental health services and talking about you know, therapy, talking you know, having conversations about your feelings, uh, is not something that is really promoted up until kind of like recently, and really where athletes and people in the military are coming forward, you know and saying, you know, I'm struggling, and so the

research doesn't necessarily capture the full picture. So looking at the research, yes, it shows a higher degree of prevalence in women compared to men. That being said, um, it

really is unknown and it's likely a significant underestimate. And then also, you know, a conversation for another time is the constructs that you know kind of map out what is considered disordered or you know, uh used for etcetera might not fit well within how men or just people in general from a wide variety of backgrounds might experience these areas. And because they quote quote don't fit nicely into a box, they won't be essentially identified by research tools.

So the standard answer would be yes, it's more prevalent in women. And the realistic and you know, probably more real answer is that we don't really know, and that a lot I meet a lot of people and and see a lot of things, and I would say that more people are suffering than the research captures. For sure. That's kind of what we wanted to hear more your

personal experience. Obviously we can't reflect that into a hard fact, but you know, I think all of us in our own experience can kind of see that men can easily silently suffer and oftentimes not know that they're suffering, just like many women here were in pursuit of health and found their way towards orthorexic tendencies or disordered eating in some way and didn't know that could be a cause of suffering until you know, this podcast, for many people

open their eyes to say, you could have disordered eating. It's normal that you feel this internal disarray. Something doesn't

feel right, even though you look right on paper. So I feel like I'm very hopeful that the next wave of conversations around eating disorders and disordered eatings are going to bring men into the picture so that they know that they also don't just have to be you know, tough guys and those those stereotypes that you were talking about, and they too are allowed to have the softness and imperfect diets and they don't need to be the strongest or the you know, the bulkiest at the gym all

that stuff. Yeah, totally, and and so like you know,

similar with the stuff I've been talking about. You know, men have various constructs that have been constructed over time to emphasize certain qualities and to emphasize other qualities, and in many respects that has been really harmful, and you know, for instance, privileging rationality over emotion and privileging stoicism over intimacy and has really left a lot of men with incredibly dysfunctional relationships with themselves and others, and not really

sure why. There are so many times in my life where I've been around men who say things that if those exact words came out of a female's mouth, I would flag it immediately as disordered eating or needing disorder, and when men say it, we just kind of brush it off. Is there a way to help men to see differently without getting them defensive, to get them to start thinking about their relationship to food, without belittling them or making them feel like there's something broken. Yeah, totally.

And I think actually this supplies beyond men and applies to everyone in general. Where first and foremost the first key is to establish trust and report and get to know them as a person. Um, you know. And that's the problem with all these DSM five diagnoses and you know, all different stuff, is it doesn't it removes a lot of the personal elements. And the personal elements are really you know, what is needed for people to explore uncomfortable thoughts, feelings,

emotions and sensations. You know, people want to feel heard, they want to feel witnessed, they want to feel understood, they want to feel safe, they want to feel that

they can trust you. And so I think the first step would be to talk to them as a as a person and get to know them and and and listen and actively listen and and build trust and build reports and then from there, you know, once you have a good relationship with someone, instead of you know, saying oh this is disordered or like that's concerned it whatever you can you can say, like how do you feel

about it. You know, I noticed that you're really upset the other day when this didn't happen, you know, what was going on for you, And and and approaching it in a curious and inquisitive, exploratory manner and and not necessarily seeking an outcome opens the door for people to

start to share. And and because it's you know, so difficult for so many people, and since it's like, you know, behind so many different walls, and also in addition to that, it's it might even be very threatening in many respects to you know, what they perceive as you know, kind of like the things that hold their house up. You know that those supports, if we approach as a problem, is gonna list a lot of defense. And if we approach it with the assumption of pure or false, it's

kind of a matter of perspective. However, if you get to know someone and you start to explore and you notice things, and you're like, hey, you know, and how it relates to other aspects of the life, asking questions and being there's a support without judgment allows them to

start exploring these things. And then when the time is right, you can ask for permission to say, you know, would you be open like it's you know, for instance, I have noticed that you're feeling really upset about your body, or feeling really upset about food or exercise, and you know, I have some thoughts if you'd be open and hearing it, and then you say no, and then you go okay, I hear you, and then you just move on and

maybe bring up another time if if it's warranted. But if they say yes, you could say, well, you know, I actually know some people who might be able to help explore those those areas because it, you know, it makes me sad seeing yourselfer so much, or it makes me sad seeing you struggle with you know, your relationship with food, or feel so stressed about the gym, and and I'm wondering if you'd be open to exploring that with someone who could help you navigate those areas. And

they say no, like, Okay, I hear you. You know, I'm here as a support. But if you say yes, now you have an opportunity to like you know, introduce and explore like would you be open to listen to a podcast like you talked about or would you be

open to reading a book? Would you be open to talking to someone and if you do it very much in a non judgmental, non confrontational manner and coming from a place of empathy and you know, kindness and being gentle, I mean that can really shift the overall experience and allow them to make their own choices that work best

for them. And you could be there as a support that you know, whether they say yes or no, you're always there to support, super helpful, And I think that's kind of the first step we all need to proactively take to let the men in our lives know that

they are heard, seen, invalid, and no better way. I think like even just hearing these tools from you, they feel so implementable, Like I feel like I really could walk into a situation where I'm around either a loved one or not and really handle it differently because rather than see it as a problem that I need to fix right, because that's kind of jumped the gun. Especially those of us who are in our own recovery, we think, oh, we know the answer, let me speed it up and

get them there. We need to bring patience and curiosity and allow for them to go through the stages essentially that we went through, which is often you know, denial not ready, and sooner or later those introspective wheel start turning and things come together. So don't be let down if your first try at speaking to a mail in your life, or if you are a male, if your first try at getting through this stuff is more difficult,

then you imagine that it would be right. Those different constructs of what we need to heal maybe different for different sexes in theory, yeah, totally. And essentially, if if you're there and they know you're non judgmental and you're supportive and you respect their individual autonomy, they'll feel a lot more comfortable likely to come back when they already and say, hey, I thought about what you said, and

I think i'd like to start talking. And that might take days, weeks, months, years, But if they know that you're there, you know, you might be the first person they talked to and they feel that they can trust you and help start that path, and so I think

that's something worth trying. Awesome, I agree, Thanks so much for your time, and the good news is we're going to have you back on for another episode where we talk about exercise addiction, what it looks like and how we can really change that conversation so thanks for today and we'll see you real soon. Mat sounds great.