19 To Change a Culture

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Lim’s essay focuses on eating disorders among adolescent male wrestlers. Lim also compares how eating disorders in males are understood and treated differently from females with eating disorders. In addition to crafting an essay that highlights a nuanced and underexplored topic, Lim employs a wide range of research materials from journal articles to sports websites to Reddit messages to personal interviews from wrestlers in the field. In using both traditional and non-traditional sources in this academic essay, Lim’s research skills provide a unique vantage point into the experiences of male wrestlers. By utilizing existing scientific findings, accounting for a multitude of perspectives, and creating a call to action, Lim’s research works to destigmatize male eating disorders and mental health by educating readers.

Amy Lim

Instructor

ENGLWRIT 112: College Writing

Day Month Year

To Change a Culture

I was friends with a talented varsity wrestler. He was intelligent and kind but often overshared his experiences as a wrestler. I met him at the peak of his season, which prompted him to talk about his weight-cutting practices in great detail. He complained about being hungry even though he had purposefully skipped lunch. He was often dehydrated and dizzy as a result. As a talented wrestler, he attended and won many matches throughout the season, perhaps attributing his success to his aggressive weight-loss tactics. His favorite days of the season were days directly after matches, in which he binge ate to “reward” himself. Even though he was not overly thin, we often joked about his destructive weight-loss practices, dismissing the severity of his issues. His destructive behavior seemed to subside in the spring, as they were only for the purposes of wrestling. What was there to be concerned about? He is lucky never to have experienced life-threatening issues, but many other high school wrestlers have.

It turns out my friend’s experience is not uncommon amongst adolescent male wrestlers. In fact, “numerous studies have reported these practices in [adolescent] wrestlers… eleven percent of wrestlers were found to have an eating disorder… 45%… were found to be at risk of developing one” (“Promotion of healthy weight-control…” 1559). Wrestlers declare weight classes before matches, working hard to “make” the weight range they declared. Weight classes divide competitors based on weight and size, giving athletes on the higher end of each weight class an edge over lighter opponents. As a result, wrestlers often employ weight-loss tactics rather than weight-gain tactics. The inability to “make” a declared weight-class results in disqualification from a match or even suspension for the season (OHSAA 176). Pressure from teammates and coaches to lose weight may result in “unsafe practices leading up to competition… [including] excessive vigorous exercise, fluid restriction, [the implementation of] vapor-impermeable suits, and hot environments (e.g., sauna), in addition to laxatives, emetics, diuretics, and self-induced vomiting” (Gibbs 227). These practices were all too familiar to me as my friend routinely pursued them. Commonly employed rapid weight-loss techniques cause life-threatening conditions such as cardiovascular and renal dysfunction or even death.

The National Collegiate Athletic Association (NCAA) creates strict guidelines to curb college athletes’ dangerous behaviors, but such behaviors still remain prevalent. High school wrestling, on the other hand, is especially poorly regulated. A 1993 clinical survey of 713 male high school wrestlers demonstrates that 1.7% of participants “met all the criteria necessary for the diagnosis of bulimia nervosa,¹ a higher percentage than expected from male athletes in this age group” (228). Regulations have changed in the following decades, but dangerous eating practices in high school wrestling are widespread anyway. The National Federation of State High School Associations (NFHS) creates guidelines for high school wrestling. Official rulebooks are not available free to the public, and current (available) rule changes are more concerned with hair length restrictions than eating disorders (NFHS). However, individual states seem to regulate guidelines a bit better. Ohio High School Athletic Association (OHSAA) appears to be quite vocal about their guidelines, even granting the public free access to rulebooks each year. But how can eating disorders still be so prevalent when “OHSAA does not permit any practice that endangers the health and safety of the participants” (OHSAA 175)? It is evident that unhealthy weight-cutting measures in adolescent wrestling need to be brought to mainstream attention. The cause of modern weight-cutting practices should be explored, as well.

Eating disorders in the general male population are severely under-researched. As of 2017, “the majority of clinical research informing medical management guidelines… [psychological] treatments, and indices of symptom severity, has been conducted in exclusively female samples” (Murray 352). The lack of eating disorder diagnoses in adolescent males is appalling, but perhaps reasonable as diagnostic criteria for all eating disorder sufferers are based on females with anorexia nervosa² (353). In recent years, a large influx of adolescent males seem to suffer from muscularity-oriented disordered eating (MODE), which go unrecognized as such “behaviors are typically oriented toward… the development of greater musculature… [and] muscle leanness” (352). MODE criteria do not include the fear of weight gain found in anorexia or bulimia. However, it does include an “overvaluation for… shape and weight, distorted body image, and attempts to reduce overall dietary energy” (353), which are commonly seen in eating disorders found in female patients. No wonder so many adolescent males go undiagnosed! MODE symptoms are so drastically different from thinness-oriented symptoms found in female patients.

I met fellow UMass student and former high school wrestler “Josh” via Reddit. Even as Josh stated, excessive weight-cutting is a “bad idea in my opinion,” Josh’s wrestling experience paralleled that of my friend’s. Josh purposefully wore warmer clothing and long sleeves to “sweat more” and limited his overall water intake, restricting himself to “one bottle… usually, drink[ing] half [of it] during practice and [saving] the rest for right after practice.” He ate only a banana and sandwich a day to maximize weight loss. He would also treat himself with “chipotle and water” after successfully making weight. Sometimes, Josh resorted to chewing gum and tobacco to lose excess water-weight before matches. Only “more susceptible to bumps and bruises” and a decrease in muscle mass, Josh states, weight-cutting did not majorly impact his health. His eating habits resolved after the wrestling season, and he gained his weight back almost immediately. Josh and those close to him were never concerned about his practices, even as they aligned closely with MODE symptoms.

Unfortunately, other adolescent wrestlers are not as lucky as “Josh” or my high school friend. MODE commonly goes unrecognized, as muscle gain and leanness are often praised, sought after, and normalized in wrestling and other male-dominated sports. As a result, MODE sufferers are oblivious to their praised but unhealthy eating patterns that cause severe medical conditions. Johnny’s experience, a published case report, outlines a 16-year-old wrestler’s MODE case, which explores common symptoms and behaviors observable in adolescent males with eating disorders. The case report emphasizes Johnny’s concerning behaviors. He “[used] dietetic methods to enhance muscularity… [and drank] up to 8 cups of milk each day” (Murray 353). His symptoms were initially considered “normal” within female standards, even praised by teammates and coaches. Eventually, his resulting medical issues, namely low heart rate and normocytic anemia, resulted in a hospital stay of seven days (353). Johnny experienced bradycardia, a slow heart rate, which is a common, life-threatening MODE complication. In the end, Johnny physically recovered but declined psychological treatment (353). Along with the need to destigmatize psychological care in males, Johnny’s case emphasizes the necessity for more extensive research in male eating disorders, especially in adolescents.

Johnny’s case report indicates a strong normalization of MODE eating disorders in adolescent males. The normalization of dangerous weight-cutting measures in male-dominated sports and eating disorder research exclusively in females are a nod toward sexist societal pressures on both men and women. Because MODE symptoms are generally associated with societal body standards for men (strong muscularity and muscle leanness), MODE often goes ignored and even praised. Praise for MODE is similar to the praise and normalization associated with eating disorders of extreme weight-loss commonly found in females, as they are the results of female societal pressures (thinness). It’s apparent that both sexes feel societal pressure to conform to “ideal” body standards, but why is it that eating disorders are more recognized and treated in women? This is likely because mainstream American society regards any ailment (physical or mental) as “feminine” and therefore, “unmanly.” Consequently, seeking out medical treatment for eating disorders as a man is exceptionally stigmatized and condemned because of such regards. As a result, men—adolescent boys especially—are less inclined to seek out and accept treatment for their eating disorders. Even if male patients seek out physical treatment, they may decline psychological treatment, as seeking help for mental ailments is incredibly “feminine” according to our patriarchal society. Johnny’s case outlines this specific issue. Although Johnny accepts treatment for his physical injuries, he declines treatment for his psychological ones. There is less advocacy for mental health awareness in men also, which plays a role in further stigmatization of eating disorders in men.

Though societal pressures play a role in adolescent boys’ adamance to seek help, the problematic nature of wrestling culture as a whole must be addressed for the most meaningful change. As the “coach is the authority figure and responsible for the success of the team” (Stankovich), teenage athletes are sure to please their coach’s demands. Adolescent athletes’ wrongful interpretations of their coach’s suggestions proliferate unhealthy weight-cutting behaviors, resulting in MODE. However, it may be the case that young athletes are not misinterpreting their coach’s suggestions at all. As wrestling is heavily dependent on weight, coaches may actually aggressively push their team to “make weight,” perhaps suggesting unhealthy ways to do so. For example, Johnny’s coach prescribed him to lose “approximately 2.5 kg and reach… [a] lighter-weight class” (Murray 353), leading to Johnny’s health issues. Even in the absence of adult pressure, peer pressure and the desire to conform with peers may reinforce unhealthy weight control practices. Josh states, “my coach honestly did not like us cutting a crazy amount of weight. My family did not want me losing too much weight [either]… [but] my teammates and I would [pressure each other to do so] … [and lost] our weight together,” attributing his issues to the validation he received from his peers. Because Johnny and Josh are merely two people out of hundreds of thousands of high school wrestlers in the United States (Abbott), their experiences alone cannot determine what exactly in wrestling culture contributes to male eating disorders on a whole.

However, it’s clear that the best way to address eating disorders in adolescent male athletes is to destigmatize eating disorders and psychological treatment throughout all wrestling teams in the US. The NFHS could make readily accessible psychological treatment mandatory for all high school wrestling teams. District taxes could fund such treatment in public schools. Perhaps the duties of personal and academic guidance counselors already available in schools could be extended to sports as well. In schools without access to funding or existing counselors, the NFHS itself could fund psychological treatment. Additionally, wrestling should not be the only sport to receive these essential services. However, if mandatory accessible treatment in schools is not feasible, existing public healthcare services should be firmer to assess psychological issues in all children. In my experience, hospital staff does not advocate for the destigmatization of mental health enough at my yearly physical check-ups. At the hospital I attend, staff only require patients to answer a single-page mental health questionnaire without a mention of eating disorders or their symptoms. Perhaps my experience is not universal, but it most definitely indicates that mental health is less important than physical health in mainstream healthcare. Additionally, schools already require a clean bill of physical health to participate in athletics. It only makes sense that schools should require a clean bill of mental health as well. Obviously, children with mental health diagnoses should not be discriminated against in athletics. Still, schools and healthcare systems should implement more significant measures to advocate for children in all aspects of health, especially eating disorder awareness and treatment in male high school wrestlers. As advocacy and awareness increase, research of eating disorders in adolescent males will increase as well, leading to more accurate and efficient diagnoses of MODE in the future.

¹ Also known as bulimia, an eating disorder characterized by bouts of binge eating followed by excessive self-induced purging (vomiting) most commonly diagnosed in females.

² Also known as anorexia, an eating disorder characterized by the refusal to eat most commonly diagnosed in females.

Works Cited

Abbott, Gary. “NFHS Reports High School Wrestling Participation Up for Boys AND Girls in All Categories for 2017-18.” Team USA, United States Olympic & Paralympic Committee, Aug. 2018.

Gibbs, Aimee E. “Weight Management in Amateur Wrestling.” Sports Health: A Multidisciplinary Approach, vol 1, no. 3, Sage Journals, May 2009. pp 227-230.

“Josh.” Message to Amy Lim. Oct. 2020. Private Message via Reddit.

Murray, Stuart B. “Boys, Biceps, and Bradycardia: The Hidden Dangers of Muscularity-Oriented Disordered Eating.” Journal of Adolescent Health, Society for Adolescent Health and Medicine, 2017. pp 352-355.

NFHS. “2020-21 High School Wrestling Rules Changes Address Weigh-In Procedures, Hair Length Restrictions.” NFHS, NFHS, Apr. 2020.

OHSAA. “Wrestling.” Sports Regulations, OHSAA, OHSAA, 2019, pp. 174-179.

“Promotion of healthy weight-control practices in young athletes.” Pediatrics, vol. 116, no. 6, American Academy of Pediatrics, Dec. 2005. pp. 1557-1564, https://doi.org/10.1542/peds.2005-2314.

Stankovich, Chris. “Learn Why Listening to the Coach Helps Athletes Play their Best.”  Advanced Human Performance Systems, 19 June 2017, https://drstankovich.com/learn-why-listening-to-the-coach-helps-athletes-play-their-best/.

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