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Body image and self-esteem

Big Boys Don’t Cry… and Other Myths

Imagine a world where one day a red traffic light meant Stop, then next day red meant Go and green meant Stop! We’d never get anywhere in that world. We’d just be confused. Nonetheless, the conflicting messages and rules around masculine role models are creating just that effect, and in some cases even compromise our health. Do we have to accept these rules or can we decide for ourselves? Read on…

3 min. read
Image is a model and not a real patient

Making of the modern man

It's called gender ideology. Your internalized, cultural belief system telling you how you should feel and act.

Traditional masculine ideology goes something like: Men should never show weakness or engage with feminine things; they should seek out adventure, even if it means violence, strive for success and be “the sturdy oak” with a “give-’em-hell”, “no-sissy-stuff” kind of personality.

I suspect most guys reading this paragraph recognize these attitudes. But to what extent do you believe in and follow these kinds of attitudes? And is it possible that doing so might be more harmful to you than helpful?

I am a psychologist and I believe that understanding behaviour, not judging it, is the foundation for changing it. Understanding behaviour gives us the opportunity to reflect, consider other ways of acting and decide for ourselves which course of action takes us closer to the person we most want to be.
 

Man sitting in a meeting with a HCP holding his hands together in a heart formation.
Image is a model and not a real patient

“I believe that understanding behaviour, not judging it, is the foundation for changing it.”

-Dr. Michael Vallis

Why do we follow societal norms?

So, how should we make sense of our desire to follow societal norms?

We all know that humans have survival instincts. We usually think of this in terms of physical survival. Well, guess what? On top of physical survival, we also have an instinct for social survival.

Humans are social animals. We want to fit in and avoid being rejected. It is no surprise, therefore, that there needs to be a set of rules as to what is OK and not OK.

Is it possible that you have developed beliefs about how you should act that are interfering with your ability to manage your weight?

 

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Impact of masculine ideology on obesity rates and men’s health

So what? What difference does it make? Well, consider this. Men appear to misperceive the extent of their extra weight relative to women. You hardly ever hear a man ask his female partner “Does this make me look fat?”

On the contrary, it is not uncommon to see a man slap his belly, push out his chest and say “I’ve always been a big, strong guy.”

Even when men acknowledge their excess weight, they are less likely to connect it to health problems than women. And men are less likely to consider trying to manage their weight.

So, what’s up with this? Good question! Because obesity is on the rise across the world. Would it surprise you to learn that amongst men born from 1946-1964, there has been a 29% increase in the prevalence of obesity each decade since 1950? A pretty shocking statistic, actually.
 

“Another problem with traditional masculine ideology is that men are less likely to seek help when they need it. Help-seeking is inconsistent with the belief that one must be strong and self-sufficient.”

-Dr. Michael Vallis

Imagine that you are not happy with your weight; it makes you feel bad about yourself. By repressing this emotion nothing changes, which feeds back into your weight problem to make you feel even worse. Our self-image can take quite a beating in this kind of vicious circle.

Some people even develop the so-called “fraud syndrome”. Tough on the outside; damaged goods on the inside.
 

Coping response and stress: the denial trap

OK, so something in men makes them suffer in silence and feel bad that nothing changes.

But now, to add insult to injury, men in developed countries are at a higher risk of developing almost all the chronic diseases: Lung cancer, liver disease, heart disease, stroke and, yes, obesity.

Men’s default response to stress underlies their tendency to not accept that there is a problem and not reach out for help. Here is that survival instinct kicking in again. By instinct, we approach pleasure and avoid pain. The most common coping response is Escape or Avoidance.
 

Man sitting on a bench outside with a wondering look on his face.
Image is a model and not a real patient

“Men’s default response to stress underlies their tendency to not accept that there is a problem and not reach out for help.”

-Dr. Michael Vallis

More than one coping style

So what do we do about this? Fortunately, there are options beyond the default Avoidance.

There are four choices when it comes to stress response:
 

Infographic displaying different coping styles.

 
The emotions associated with stress can be handled by pushing them away (minimizing the emotion - repression) or by focusing on them directly (sensitizing).

These responses form a pattern;

  • Fight/flight goes well with repression and is associated with what we call action focused coping.
  • Tend/befriend goes well with sensitizing and is associated with what we call emotion focused coping.

It is not a good-bad situation. I’d like you to think about these ways of reacting to stress as choices. If your plan A isn’t working consider plan B.

If men tend to be action-focused copers, with a tendency toward repressing feelings and engaging in fight/flight behaviour, then there are choices. Being open to expressing feelings and focusing on caring for self and others can open a world of choices.
 

A father and son standing outside hugging eachother.
Image is a model and not a real patient

“Being open to expressing feelings and focusing on caring for self and others can open a world of choices.”

-Dr. Michael Vallis

Which response to adopt in case of obesity?

Choices are good because obesity is a complex disease; it is not simply a result of poor personal choices and lack of willpower. Rather, it is a reflection of biological, genetic, social and environmental (as well as personal) factors.

It is for this reason we classify it as a chronic disease. As with all chronic diseases, they can’t really be managed on your own.
 

What works for men when it comes to obesity management?

What can you do about this? When we look at research on managing obesity, we see that women outnumber men in most of the studies. This makes it harder to help men.

Many typical obesity programmes are perceived to not recognize the needs of men but to be feminine orientated. There have been successes, though.

Let’s look at two studies of weight management targeted directly at men. One was called the FFIT programme (Football Fans in Training) where participants attended the programme at football (soccer) stadiums.

Another was called HAT TRICK and made use of the locker rooms of a semi-professional hockey stadium to communicate to their male audience.

Research suggests that programmes are more appealing to men if they

  • include group interaction with like-minded men
  • use humour in the delivery of the programme
  • feature some kind of competition and
  • focus on physical activity as well as nutrition

But what if you’re just not naturally inclined to accept a diagnosis of obesity as a chronic medical condition that deserves to be treated as such and may require professional help? Then what?
 

We’re all athletes

I am a fan of metaphors so permit me to leave you with one. Rather than see yourself as sick, or weak and needing help, would you be willing to reframe your situation to the athlete inside of you?

Athletes need coaches. Very few athletes rise to the top without coaches. In fact, elite athletes have a team of coaches. Is that a way you could view your road to improved weight and health?

It’s like you are coming off a long off-season and it is time to get back into training.
 

A group picture of several HCPs.
Image is a model and not a real patient

“Rather than see yourself as sick, or weak and needing help, would you be willing to reframe your situation to the athlete inside of you? Athletes need coaches.”

-Dr. Michael Vallis

  

Managing obesity is a team sport

Like in sport, who should make up your healthcare team really depends on your individual needs and health status, but in general, it may include a doctor specializing in obesity medicine, a nutritionist, an exercise physiologist and a heath psychologist. 

Your doctor can assess the impact of your weight on your health, help to develop your personalized weight management plan, offer medications and/or surgery where appropriate.

Nutritionists can help you achieve a healthy diet and help you find ways to reduce calories to promote healthier weights. Exercise physiologists can help find the tailored physical activity plan. And a psychologist is helpful with behaviour change and promoting healthy self-esteem.

So, in closing, start assembling your healthcare team. And to use an expression common to my native Canada, keep your stick on the ice.

 

References
  • Wirth CK et al. Developing Weight Management Messages and Interventions for Baby Boomer Men. Am J Mens Health. 2014 May 1;8(3):258–66
  • Gavarkovs AG et al (2016). Engaging Men in Chronic Disease Prevention and Management Programs: A Scoping Review. American Journal of Men’s Health10(6), NP145–NP154.
  • Levant, R. F. (2011). Research in the psychology of men and masculinity using the gender role strain paradigm as a framework. American Psychologist66(8), 765–776.
  • Robertson, C., Avenell, A., Stewart, F., Archibald, D., Douglas, F., Hoddinott, P., van Teijlingen, E., & Boyers, D. (2017). Clinical Effectiveness of Weight Loss and Weight Maintenance Interventions for Men: A Systematic Review of Men-Only Randomized Controlled Trials (The ROMEO Project). American Journal of Men’s Health11(4), 1096–1123.
  • Sharp, P., Bottorff, J. L., Hunt, K., Oliffe, J. L., Johnson, S. T., Dudley, L., & Caperchione, C. M. (2018). Men’s Perspectives of a Gender-Sensitized Health Promotion Program Targeting Healthy Eating, Active Living, and Social Connectedness. American Journal of Men’s Health12(6), 2157–2166.
  • Tsai, S. A., Lv, N., Xiao, L., & Ma, J. (2016). Gender Differences in Weight-Related Attitudes and Behaviors Among Overweight and Obese Adults in the United States. American Journal of Men’s Health10(5), 389–398
  • de Vries MFRK. The Impostor Syndrome: Developmental and Societal Issues. Hum Relat. 1990 Jul 1;43(7):667–86
  • Wyke S et al. Football Fans in Training (FFIT): a randomised controlled trial of a gender-sensitised weight loss and healthy living programme for men – end of study report Southampton (UK): NIHR Journals Library; 2015 Jan. (Public Health Research, No. 3.2.)

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