Quick summary: Alcohol and disordered eating often feed the same appetite, so when a man stops drinking the drive commonly shifts onto sugar, restriction, or training that others praise as discipline. Addiction services that treat only the substance miss this shift, and the untreated eating problem frequently pulls him back towards drinking. Clinicians should ask whether he can skip the gym and sit with what comes up, and should explain that hard training on too little food suppresses testosterone in a way that is reversible once fuel and rest return.
A man gets sober. Six weeks in, maybe three months, he is doing everything asked of him. And then something else starts to surface that nobody in the room has a name for.
He is eating enormous quantities of sugar. Or he has stopped eating almost entirely and is at the gym twice a day. Or both, in a cycle he will not describe to anyone. His keyworker sees a man in recovery. His family see a man who has turned his life around. What is actually happening is that an eating disorder, which was there the whole time, has just lost its cover.
I have seen this often enough in over 25 years of practice that I now expect it. Alcohol is liquid sugar. For a great many people the drinking and the eating were never two separate problems. They were one appetite, wearing whichever coat was available. Take the drink away and the appetite does not go anywhere. It simply arrives somewhere else, in a form that is much harder to see and much easier to admire.
And if nobody treats it, it will take him back to drinking.
The evidence is not ambiguous
This is not a fringe clinical observation. Research has consistently found that people with eating disorders misuse substances at substantially higher rates than the general population, and the relationship runs in both directions: each condition raises the risk of the other.
What matters more for anyone working in addiction is the sequencing. Disordered eating often does not fully declare itself until someone is well into recovery, particularly where food has quietly taken over the job the substance was doing: managing distress, flattening feeling, getting through the evening. And the clinical consequence is the one you would predict. Treating one condition while leaving the other alone tends to produce relapse in the untreated one, or in both.
Which means that in a great many addiction services, the eating disorder is not being missed because it is subtle. It is being missed because nobody is looking.
The symptom that gets applauded
There is a second reason men in particular go unrecognised, and it is almost funny if you do not have to live with it.
A man who drinks every night will, sooner or later, be asked about it. A man who trains every night gets respect. Society reads the same underlying compulsion as willpower and discipline. For some men it is neither. It is a jail. It is not a choice made daily; it is a thing that cannot be got out of. The behaviour that would raise concern in any other form is here the one his friends admire him for.
Beat, the UK eating disorder charity, makes the same point from the other end: signs such as over-exercising are easily read as ordinary male behaviour, which is part of why men are not identified.
I have found there is a clarifying question. Could you not go, once, and sit at home with whatever comes up? For some men that is a mildly annoying idea. For others it is unthinkable, and the unthinkability is the diagnosis. The greater act of willpower, for them, would be the evening they stayed in.
What the shame is actually about
Ask a man directly and he will rarely say he is worried about his weight. The shame sits somewhere less reachable: he does not feel like a man, and his body keeps supplying the evidence.
He does not approach the person he is attracted to, or approaches expecting refusal and duly gets it. He needs a drink before he can be naked in front of someone, which is worth pausing on if he has just given up drinking. Desire fades, or his body will not respond, and he treats that as the verdict on him.
Here the physiology is on his side, and telling him so changes things. Sustained hard training on insufficient fuel suppresses testosterone; low libido and erectile difficulty follow directly. Sports medicine describes this as relative energy deficiency in sports, and documented cases show testosterone returning to normal after modest weight gain and reduced training. The discipline he is using to feel like a man is what is removing his masculinity. And it is reversible.
There is usually also a group. Mates, a team, a changing room, where his body long ago became the running joke. So he tells the joke first, about himself, so that nobody else gets to. That is the real reason he never mentions any of this to a professional. Saying it would mean leaving the only role that keeps him safe in that room.
What progress looks like
Not a weight. Not a food diary.
The moment I watch for is quieter: the session where he starts using the room to deal with what he feels, because he needs to, instead of going towards food. When the feeling has somewhere else to go, the eating loosens on its own.
And when men ask me what will work, I try to be honest. I do not know whether therapy, or this kind of therapy, or something else entirely will be the thing. Nobody does, in advance. What I would say to any man reading this is that it comes down to trying. Something that does not work is not a failure; it is information. Only the people who stop trying fail, and there is no single thing that works for everyone.
Dr Philippe Jacquet is a Harley Street and online Jungian analyst and art psychotherapist, registered with the HCPC, UKCP and the British Psychoanalytic Council. He has over 25 years of experience in addiction, eating disorders, trauma and men’s mental health, and holds a doctorate from the University of Essex.
