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SAN JOSE, Calif. - Sue Roberts couldn't stop fuming after watching a "Dr. Phil" show on eating disorders. The two-part series featured several girls with bulimia and anorexia.
"What about the boys?" she remembers asking herself, then furiously writing an e-mail to the talk show host.
The Antioch mother knows firsthand the potential danger of the perception that eating disorders are a "girls' issue." Her 16-year-old son, Justin, almost starved himself to death after several doctor's visits missed important warning signs.
Although boys and men make up only about 10 percent of patients with eating disorders, they are more likely to have the condition detected at an advanced stage when treatment is more difficult, health experts say.
The lack of awareness among doctors and parents about the problem means there's little reliable data about boys and eating disorders, said Dr. Pamela Carlton, who helped treat Justin at Lucile Salter Packard Children's Hospital at Stanford. But several doctors say they've seen an uptick in the number of male patients with bulimia and anorexia nervosa.
They attribute the rise to the increasing pressure for boys to look good. And as more parents and doctors become aware of the problem, more boys get diagnosed and treated, including those who have traditionally been at greater risk for developing eating disorders, such as wrestlers, gymnasts, swimmers, runners and boys who question their sexuality. Like girls, boys who have been abused, have low-self esteem or are perfectionists are also at risk.
Lou Rappaport, who is the department head of the master's and doctoral programs in counseling psychology at Argosy University-San Francisco Bay Area, said the number of boys with eating disorders he treats has increased at least twelvefold in the past 20 years. Where it was once rare to get one or two cases per year, he now gets a couple of new cases per month.
"Losing weight isn't a bad idea, but some percentage of them lose weight and keep losing weight, and it becomes an addiction," he said. "Adolescence is a time of flux, and for some kids to latch onto something they can control on a daily basis is very attractive."
Justin, a straight-A student, wanted to be perfect in every way. But in 2001, when he was 13 and beginning the eighth grade, he was starting to feel like a failure. His gym teacher mentioned he might be able to shave a few seconds off his mile time - the basis for his physical education grade - if he lost some weight.
Justin also remembers standing in the hallway one day when a tall, thin boy said he was fat and proceeded to laugh.
"`Maybe I am'" fat, Justin recalled thinking as he walked into class. "I thought about it the rest of the day."
That's when he stopped eating. At lunchtime, the 5-foot-tall, 130-pound teen would walk around the school quad as other kids ate lunch. He would turn down food at home and at most eat two or three bites of the vegetables on his plate.
His parents at first complimented him on his discipline: "I was impressed," Roberts said. "I fought the weight issue all my life."
But along with Justin's new diet came bad moods.
"We were all walking on eggshells because he would blow up about little things," she said. Then she noticed he was dropping weight fast, maybe too fast. She took him to the doctor, who said Justin was fine. After that, if Roberts urged her son to eat, Justin would retort, "The doctor said I'm fine."
She twice again took Justin to the doctor, who advised Justin to eat more. But within a span of four months, Justin dropped to 82 pounds. His lips, fingertips and nails looked bluish. He wore baggy sweatshirts to hide his frail body, but he couldn't conceal the malnourishment evident in his sunken eyes and hollow cheeks.
"If Justin was a girl, the teachers at school would have paid more attention earlier, the doctor would have paid more attention and probably me, too," Roberts said. Justin's doctor declined to comment.
A teacher finally did call the family to say she thought something was the matter with Justin. When Roberts took her son to the doctor a fourth time, the doctor said they had to do something - quickly.
After struggling with her insurance company to prove Justin's condition warranted immediate treatment, Roberts admitted her son into Lucile Salter Packard Children's Hospital.
His condition was worse than she thought. His heart rate was 42 beats per minute. He had zero body fat. His body temperature was 92 degrees Fahrenheit, and there were patches of hair growing on his stomach and neck. It was his body's way of trying to keep him warm.
He was days away from death.
For almost two weeks, he shared a room with another boy with an eating disorder and saw patients who had been hospitalized for months. One day he saw an emaciated girl walking in the hallway talking to herself.
"I really don't want to be like that," he recalled thinking. "I want to get out of here."
That's why he followed the instructions he was given carefully. He spent 13 days in the hospital, less than most patients in similar situations.
Over the next year, Justin's mother, father, brother and grandmother made the three-hour drive to and from the children's hospital every two weeks.
They learned that Justin's former roommate from the children's hospital had returned there. Justin, however, steadily showed signs of recovery. He was eating full meals. He grew four inches in less than a year. At his last follow-up appointment in December, the doctor said he is now just starting to gain back his bone density.
"I'm more outgoing, more confident," he said. "I'm happy now."
His advice to other boys dealing with eating disorders: "Don't listen to what other people say. Do what makes you happy."
Justin is doing just that. He has a girlfriend and is less of a perfectionist these days, getting mostly B's and C's on his report card.
"Now it's: Come home, ride my bike, have dinner, watch TV and go to bed," Justin said, a few days after returning home from a trip with classmates to Hawaii, adding, "And do homework before class starts."
(c) 2004, San Jose Mercury News (San Jose, Calif.). Distributed by Knight Ridder/Tribune News Service.