At the beginning of this year, Twitter co-founder and CEO Mr Jack Dorsey revealed in a video interview for Wired that he eats only seven meals a week – dinner every night and nothing else, an extreme version of intermittent fasting (restricting your food intake to a small window of the day). This appeared to be an update from an earlier disclosure in which he claimed he ate only ate five meals a week and fasted all weekend.

In 2019, a prominent men’s magazine published a story online about the real-life diet of one of their very fit editors. It’s mostly an inside-joke piece, peppered with suggestions that of all the men on staff, he’s in the best shape, and could take them all in a competition. But there’s a moment, when the interviewer is asking him about his fitness origin story, that he describes going through a period where he saw “food as the enemy” and was “obsessed” with his diet. He then says that he’s found balance through a diet of “pretty much grilled chicken, broccoli, sweet potatoes and rice”. The sentence drips with irony, and the interviewer lets it slide.

These stories, published in glossy mags or their digital counterparts, often have a sheen of humour. They wink at the reader as if to say “we know this is ridiculous, but he’s successful, so hey, why not”. It’s all in good fun, we’re all in on the joke. What’s the harm?

Well, any teenage girl worth her salt might recognise these food diaries as warnings straight out of a high-school health class. One meal a day? Food as the enemy? Hmmm. These sound a lot like the warning signs associated with eating disorders. So, why don’t we call them that for men?

Eating disorders, long considered afflictions suffered only by women, are actually increasingly common among men. The misconception that eating disorders are a women’s issue likely stems from the idea that anorexia and bulimia (the most well-known illnesses under the eating disorder umbrella) only arise out of a desire to be thinner, to look skinny, to fit a particular body type or shape.

As a society we have blamed emaciated models and extreme retouching for encouraging women and girls to pursue unrealistic and unhealthy body ideas. This conversation almost always focuses on women and women’s bodies, and we very rarely address the pressure that is put on men to look a certain way. And so, for this reason (among others), eating disorders have become a “women’s issue” – a dangerous conclusion leading to lack of diagnoses and lack of treatment for men. 

While these things are certainly factors for many people who suffer from eating disorders, one’s appearance is usually only part of the issue. Ms Claire Mysko, CEO of the National Eating Disorder Association (NEDA) in the US, notes that culturally, we’ve moved from obsession over what she calls “appearance ideals” to an obsession with wellness.

“What we’re hearing more and more is that patients are presenting with this obsession with health,” explains Ms Mysko. Clean eating, intermittent fasting and so-called biohacking are to the late 2010s what the South Beach, Atkins and grapefruit diets were to the early 2000s. “Not everyone who goes on a diet is going to develop an eating disorder,” says Ms Mysko, “but pretty much everyone who has an eating disorder started out on a diet.”

Eating disorders are most commonly split into the following main diagnoses: 01. anorexia nervosa, characterised by severe restriction in diet and food intake; 02. bulimia nervosa characterised by cycles of overeating and compensatory behaviour (purging or extreme exercise); 03. binge-eating disorder, characterised by episodes of consuming large quantities of food and associated feelings of shame.

There are many people, Ms Mysko emphasises, who don’t fit neatly into one particular diagnosis. And, importantly, weight loss is not always present – counter to the idea that people with eating disorders are always visibly, and scarily, skinny.

The problem we have today is that while we might have skirted away from the era of fad diets, we’ve moved deeply into a wellness era where any form of eating or exercise habit can be souped up with fancy words to make it sound like it’s good, nay “healing”, for your body. Words such as “biohacking” suggest that certain behaviours around food will simply optimise your wellness or fitness experience much like technology is optimising your music/media/lifestyle experiences.

But eating disorders are deadly: anorexia has the highest mortality rate of all mental health disorders due to the effect that restriction and starvation can have on the heart and bones. The purging of electrolytes that occurs with bulimia can lead to sudden cardiac or respiratory arrest.

Eating disorders are commonly understood to be a coping mechanism. For some, restricting food, or purging after eating is a way to control something in your life when everything else feels chaotic. For others, food is linked to shameful and self-hating feelings that have nothing to do with the food itself. Many people who are dealing with eating disorders are also dealing with depression, substance abuse issues, anxiety, or have experienced past trauma – in other words, issues that can affect anyone, regardless of gender.

During this current pandemic, for example, a period that has exacerbated symptoms of anxiety and depression, and has been traumatic or brought up past traumas for millions of people, behaviours associated with eating disorders have gotten markedly worse. One US survey showed that 62 per cent of people with anorexia reported worsening symptoms and one in three people with a binge-eating disorder reported an increase in episodes after the pandemic began. According to the study: “Respondents noted marked increases in anxiety since 2019 and reported greater concerns about the impact of Covid‐19 on their mental health than physical health.” 

All of this is to say that eating disorders, counter to popular belief, do not exist in a vacuum and can be triggered or exacerbated by factors that may seem to have nothing to do with body image or wellness. “Eating disorders aren’t always visible,” says Ms Mysko. “In some cases there will be extreme weight loss or extreme weight gain but in most cases you won’t be able to tell by looking at them.”

Instead, if you’re concerned that you or someone in your life might have an eating disorder, look for signs of disruption: are they avoiding interaction or engagement with relationships? Are they obsessing over food and exercise? “Really, the level of disruption in a person’s life is the key here.”

Which brings us back to Mr Dorsey. “When you have someone like Jack Dorsey, with such a huge platform and such a huge amount of influence, that’s where it gets really dangerous,” says Ms Mysko. These types of diets, couched in the language of wellness, fitness and biohacking, and which have extraordinary reach because they seem so outlandish, potentially mask deeper issues.

We should be sceptical when someone claims to have discovered the secret to long life, or a perfect body, or endless energy – and on and on and on. Instead, especially in times like these, we should be taking care of one another and ourselves – questioning whether we’re not eating breakfast, going on a long run, or adding an extra leg day at the gym as part of a balanced lifestyle or because we’re trying to fix something that feels broken.

If you or someone you know in the US is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline on 1-800-931-2237, text “NEDA” to 741-741 or click to chat.

If you are in the UK, The National Centre for Eating Disorders provides support through its hotline +44 0845 838 2040 an on their website eating-disorders.org.uk