Nathan was a graduate student when he met his girlfriend in 2006. She was concerned about her weight and tracked every meal in a food diary. Nathan, (his name has been changed here), had always been naturally thin, but began cutting out certain sweets from his diet, then processed food. Soon, he was eating only fruits, vegetables and, on occasion, meat.

"It wasn't a vanity thing," he says. Nathan married his girlfriend, had three kids and continued his studies while searching for a job. As the pressures in his life mounted, his diet became increasingly restrictive. At the time, he says he would think to himself, "I can't control how my dissertation is going. I can't control that my kids are crying but I can control what I eat."

Soon Nathan had lost so much weight that he couldn't climb the stairs in his house without getting winded. He was 5'10" and less than 100 pounds, and his weight continued to drop.

"I was looking at myself deteriorating and hating it," he says. At the same time he felt this bizarre sense of accomplishment, almost like a rush. "I was somehow super human. I didn't need to eat."

Nathan is one of a million men in the U.S. who have eating disorders and that number appears to be growing. Boys as young as 8 have been diagnosed with eating disorders, according to the Eating Disorder Hope website.

In a recent study that surveyed 5,500 male teenagers over a decade, one in five subjects was very concerned about his weight and physique. While body image concerns don't automatically qualify someone as ill, because male eating disorders are so often overlooked according to experts, researchers have begun tracking these statistics.

Alison Field, the lead author of the study and an associate professor of Pediatrics and Epidemiology at Boston Children's Hospital Adolescent Medicine Division, said in her report that clinicians often fail to notice male patients who are using "unhealthy methods" to achieve their target weight and shape. "And parents are not aware that they should be as concerned about eating disorders and an excessive focus on weight and shape in their sons as in their daughters, "she added. The study was published by JAMA Pediatrics Nov. 4.

Light as Air

John Nolan, a pseudonym, shared his story in the book "Going Hungry: Writers on Desire, Self-Denial and Overcoming Anorexia,"edited by Kate Taylor, in which he reflected on his teenage battle with anorexia.

Like Nathan, he remembered the high he felt from starving himself-- feeling literally lighter. In this altered mental state a classical concert became a dreamlike experience. "I could hear the whisper of my blood in my ear and see the beat of my heart against my ribs. I was the air and the music," he wrote. More than 20 years later he reflects on that period of his life. "The moments of euphoria were wonderful. I just felt like I connected with the world in some strange way."

But his moods were erratic and the feelings of exhilaration were rare. Mostly, he felt anxious and isolated.

John remembered walking down the street comparing himself and his size to strangers. He also had a brother who was clinically obese. "It was more a fear of fatness than a desire to be thin," he says. He would even picture the food another person had eaten that day. He'd see it in a pile and pride himself on the mental image of his own tiny pile. "Even if I won that competition what was it that I was really winning? It was all about control," he says.

More Than a Woman's Disease

That society looks at men's behavior and women's differently is a given, but it's particularly true of eating disorders. "A woman orders a large pizza and goes for a five-mile run. People notice," says Dr. Mark Warren, medical director of the Cleveland Center for Eating Disorders. When a man does the same thing, he argues, people pay less attention. "The same disorder triggers different pictures for men than for women."

While it's known that one in 10 persons with eating disorders is a man, the link between males and eating disorder still eludes the medical community. Boys with the same symptoms as anorexic girls are less often diagnosed. Warren says check lists tailored to women and girls are often used to diagnose men and boys. Questions like "Do you worry about the size of your buttocks? Do you worry about your thighs?" aren't suited to men.

If a dozen men at a gym, who take supplements, follow fad diets and lift weights for hours, took a screening test with these types of questions, no matter how sick they were, they might still pass, Warren says.

The first reported case of anorexia in a male may have been documented by Dr. Richard Morton in the late 17th century. Morton described the disease in this particular case as "a total want of appetite occasioned by studying too hard and the passion of his mind."

His treatment plan was simple. "I advised him to abandon his studies, to go into the country air and to use riding and a Milk Diet for a long time," John Morgan, author of "The Invisible Man: The Self-Help Guide for Men with Eating Disorders, Compulsive exercise and Bigorexia", quoted Morton as having written.

As Freudian psychoanalysis emerged in the late 19th century, the male anorexic, along with most male psychiatric disorders, disappeared. Freudians held that anorexia was caused by "a fear of oral pregnancy." This, for obvious reasons, prevented any male diagnoses.

"Men weren't even allowed to have anorexia until the 1980s," says Warren of the Cleveland Center for Eating Disorders. In the 1980s, Arnold Anderson, a professor of psychiatry at the University of Iowa, re-introduced the concept of male anorexia. Men with anorexia share many of the same symptoms as women: excessive dieting, distorted body image and compulsive exercise, according to the National Eating Disorder Association.

Today, most people still believe that anorexia is caused by poor parenting or vanity, Warren says. But that isn't true, he notes. "Unless you're born with a vulnerable neurobiology, you can't get an eating disorder," he says. Genes don't definitively predict who gets an eating disorder, they simply predispose a person to developing one. But it's impossible to get one without them, he says.

Dr. Andersen researched and wrote several books on eating disorders in men. Dr. Philip Mehler, a medical director at the ACUTE Center for Eating Disorders in Denver, and Andersen together authored "Eating Disorders A Guide to Medical Care and Complications."

When comparing the impact of the disease in men and women, the balance seems mostly even. "Whatever females develop, males develop," Mehler says. He listed heart problems, digestion problems, neurological problems, changes in blood chemistry and severe problems swallowing that can lead to a certain type of pneumonia. Men sometimes experience decreased libido and testosterone levels and erectile dysfunction. Some men's voices change.

If patients don't die from starvation, from the re-feeding process, from cardiac problems or from suicide,(anorexia is often linked with depression) the greatest long-term risk is osteoporosis.

"Osteoporosis in anorexia is one of the rare complications that may not be reversible," Mehler says.

According to his research, the loss of bone density in men is more severe in anorexic males than in females, and the the consequences are serious. "If you're a 25 year old male who develops anorexia and you get over it, you may have horrible bone disease and lose height and have compression factors and pain in your back for the next 50 years of your adult life."

Mehler also cited evidence of long-term cognitive deficits. "We know that on CAT scans the volume of the brain shrinks during anorexia. It's not clear that that all comes back to where it was." A Harvard math professor, for example, might not operate on the same plane as before his illness, Mehler says, even if he is pronounced fully recovered.

Seeking Help

Corey Meyer, 24, a former employee at Abercrombie & Fitch, was partially hospitalized and underwent five months of treatment for his anorexia. Body image distortions played a role in his illness.

Meyer remains frustrated by the public's lack of awareness of male eating disorders. "There's 100 percent a double standard when it comes to weight and body issues," he says. "If there's a girl whose is having weight issues whether she's too heavy or too thin I think there's a lot of sensitivity and empathy."

When people notice a woman looking frail and thin, they approach a family member or friend discreetly. "My experience was people would just walk straight up to me and tell me."

When Meyer fell ill, he was in an emotionally abusive relationship. He says his girlfriend preferred skinny men and told him she would break up with him if he gained weight. Meyer also had a chiropractor who was continually giving him information about healthy eating. The more foods he learned weren't healthy, the less he ate. His job at Abercrombie & Fitch was also a factor. "It was the kind of cult where you had to look the look and walk the walk."

When Meyer ultimately took hold of his disorder, he entered treatment at The Center for Balanced Living in Columbus, Ohio. He was the only male in a group of about 30 women, but he was relieved to find the double standard evaporated. "There was never any differentiation because I was male," he says.

Unlike Meyer, Nathan resisted getting help for his disease. He says he knew the facts – anorexia kills more people than any other psychiatric disorder – but still he fought treatment.

Part of Nathan's frustration was that people seemed to misunderstand his motivation. "It was so much more than about the food," he says. No one knew how unhappy he was. His sense of self-worth was lost. "Am I worth feeding?" he would ask himself. When he wasn't doing well financially, he would think, "This money could be put to better use."

He says family members threatened not to speak to him unless he got help, but that only isolated him more.

A close friend that Nathan respected told him how worried he was. Even though he'd been told the same thing countless times, there was something different in his friend's delivery. "Knowing that your concern comes from a place of understanding and love is more important than anything else," Nathan says.

Ultimately, "I got tired of wondering if I was going to make it," he says.

His first day at the ACUTE Center, Nathan felt relieved to have outside support. For so long, he had tried to fix his problem on his own. "I was really hard on myself and embarrassed and humiliated with my position – the fact that I wasn't strong enough to get over it."

The ACUTE program accepts only the most severe cases of anorexia from around the country and the world. When Nathan was too sick to receive care at his local hospital, he was referred to the Denver program.

Dr. Jennifer Gaudiani, assistant medical director at ACUTE, took Nathan into her care in November 2011. He was in multi-organ failure. He weighed less than 48 percent of his normal body weight.

Gaudiani fed him the a traditional meal plan of balanced calories, increasing his intake by 400 calories every three days. After two weeks, he left the program and was placed in an inpatient treatment program. Terrified he might not make tenure at the university where he was teaching, he left before he had time to fully recover.

Nathan returned into ACUTE this March. He was given a similar treatment, but this time when he left, Gaudiani was hopeful. Nathan had fully restored his weight.

Hard Lessons

Gaudiani is conscious of the harm society and the media can inflict on young boys. Shopping for Halloween costumes this fall, Gaudiani found one that included a set of muscle padding, a "six-pack and pecs," she says. She was baffled. "If we put boobs and hips in our Halloween costumes, there would be an absolute outcry."

"The greatest problem facing men with eating disorders is that they're under-recognized, under-treated and the severity of the disease is under-appreciated," Dr. Mehler adds.

Meyer left treatment a year ago. He also left his old girlfriend and his job at Abercrombie & Fitch. He's getting married this spring. "I have a lot more to live for now," he says.

John, the writer, has been healthy for more than 20 years, but says he still hears that voice in his head that judges his behavior. "I don't think that has entirely left but I don't feel like I'm in danger. I don't ever want to be that thin again."

Nathan has returned to teaching.