The Sickness in Male Friendship
Men don’t have friends.
Or at least, typically, not the way that women have friends. If they do have friends, they may only talk to one another every few months. Those friendships can take place around a variety of things such as, sports, location, interests, travel, video games, and so on. Men could probably count on one hand the men that they have had heart-to-heart conversations with. But what is the conversation that men have with their friends, colleagues, and acquaintances surrounding health? There is plenty of research that shows who you hang out with influences how you behave, both in and out of the gym and kitchen.[1]
If your friends do not exercise then you are less likely to exercise. If your friends go to the gym and use supplements like pre-workout, then you are more inclined to try them yourself. If your friends focus on weight and body image (positively or negatively), then you are more likely to as well. When your friends joke about getting old and fat, you’re more likely to join in. If you bring salad to your work place and the guys make fun of you, you’re not likely to continue to bring salad to work.
These behaviors aren’t just limited to machismo men. No matter how independent men believe they are, how much freedom they claim is pumping through their veins, men still seek to fit in. The way they fit it can be different.
Women typically define health by thinness and men usually define it by muscles. Take a stroll down the supermarket checkout aisle for an example. Magazines aimed at men show a guy without a shirt on that is ripped on the cover, while those targeted toward women talk about eating right to lose weight. Neither of these is complete. Health is not about being thin or “swole,” it is about the behaviors that treat our body well and allow us to live life to the fullest.
While the culture around men and health is changing, men don’t really have a place to discuss things such as body image, the difficulty of diabetes, or the fear that can occur after having open heart surgery and wondering if they’ll ever be able to provide for their family again. Even with your friends, you may only breach the subject of health with jokes about belly fat, man boobs, and the beer guts. That’s why being a male dietitian and health educator, you’re provided a unique viewpoint of nutrition that you cannot get otherwise.
To demonstrate this point, in every nutrition class I’ve taught I provide the scenario to the students in the room. It is aimed towards the men in the room to gather their reaction, and it goes as like this. Your guy friend shows up to a tailgate party late and says, “Man, I just feel uncomfortable today. Like bloated. I tried on 3 different jerseys before I settled on this one. And even then, it just doesn’t fit right. I’ve been putting on weight and I need to get my health under control. I don’t want to end up having a heart attack like my dad. And on top of that I don’t think my wife is attracted to me anymore.”
Without a doubt, there is laughter in the room. The snickers and jeering are coming from both the men and the women. The overwhelming responses include,
“That boy needs to man up”
“Nope, he is way too sensitive”
“Yeah, you probably do need to lose weight cause you’re fat dude”
“You done? You need a tissue?”
or some other joke about charging them for therapy.
There is the occasional, “Bruh, I’ll go work out with you and we can keep each other accountable”, or “Have you talked to your girl about it”? But those reflective and encouraging comments are few and far between.
It does not help that society’s expectations of men are far below what they are capable of. Men are shown in the media as dumb, heartless, shortsighted individuals. I am confident that we can argue this stereotype is woefully inaccurate.
Part of the overarching problem surrounding men and health can be related to how men are taught about their health, and who is responsible for it. When they are young, typically, a mother is there to watch over their son’s health. Once that young man reaches adolescence there may be new found social pressures to look, or act, a certain way. However, the parent is still likely the one providing healthy foods, feedback on what their health should look like, and the one talking during doctors’ visits. Then it gets handed over to the significant other and the doctor.
There are some years in-between Mom and Partner, but those are likely to be irresponsible years. They make be physically active, but surviving on cheap fast food, microwavable burrito’s, Ramen and the “treat yo self” mentality. During those years no one is taking responsibility, because the man himself probably isn’t. I mean, if he’s not gaining weight he doesn’t have to worry about his health, right?! Yet again, another societal fallacy. Then this young man gets married, has kids, and gets older. Finally, he starts to wonder why his health is not what he wants it to be. Physiotherapist Allison HS Hegdal presented the observation, “I saw very few men owning their own health — it’s not even something they begin to think about until it’s declining. It is not an idea our culture fosters.”
Part of the difficulty in maintaining health as a male is the assumption that freedom is lost.
If I listen to the doctor, that infringes on my freedom to do what I want, when I want, how I want. I have heard people say, “I don’t want to be pushed into something I don’t want to do” and the even more drastic, “I would rather eat what I want and die sooner than eat things I don’t like and live longer”. Put simply, my freedom to choose what I want to eat is more important than whatever could happen during those years.
The reality is that you can choose to adopt healthy behaviors or you can lose freedom and be forced to adopt healthier behaviors after an illness. You can voluntarily change the oil or you can, out of necessity, replace the engine. You cannot sell the car, you cannot trade it in for a new model. The difficult, and ironic, part of this conversation is that treatment and prevention often entail similar behaviors, but one is choice and one is force. And when it is forced, the damage has already happened and you are simply trying to prevent further issues. Why not take the male “fix-it mentality” and take an active role in creating the environment you want to be in and one that will better your health, rather than hinder it? Men should consider what they would need to do in order to build those friendships that will foster their health. Relationships that encourage us to try new foods, outside of social pressure, and to enjoy healthy food items rather than being shamed for trying to be healthy.
Another part of this conversation is men can be under a lot of stress, without an outlet to discuss it, and as a result the items without high priority, and those that are not desired, are put on the back burner. Being the sole-provider of a family with limited income, stopping the cycle of not having a father, being the rock that a family can depend on when the waves of life come all take effort. Sometimes it takes all the effort you have, so thinking about trying to be healthier is a conversation beyond your current vision. Yes, health is a bill I will have to pay but it isn’t due immediately so it can wait.
With men and health, we like to think about muscles, 6-packs (of the beer and the belly), and demonstrating manliness by being stronger than others. But there is another side of health that men may not have discussed or even considered, the downside. Do we consider that men have increased risk in certain areas of health? COVID-19 has shed some light on this as COVID-19 in men is more likely to be severe or fatal.[2] To bring it out of the pandemic conversation, it was reported that heart disease was the leading cause of death for men in the United States in 2017. It killed 347,879 men in 2017 — which equals 1 in every 4 male deaths.[3] In the UK, nearly one in seven men and one in twelve women die from coronary heart disease.[4] Along with that, in the US, 18.6% of men smoke while 14.3% of women smoke.[5] However, in other locations that gap becomes much wider. “In China, for example, 61% of men are reported to be current smokers, compared with only 4.2% of women. Similarly, in Argentina 34% of men are reported to be current smokers, compared with 23% of women.” [6],[7] Along with these facts and figures, men ages 15 to 39, are 55% more likely to die of melanoma than women in that exact same age group.[8],[9] With this increased risk in males, this does not even include the role that ethnicity and the culture you ascribe to can play in increasing your risk even further.
So why does this matter to you?
These are just a few facts that men might want to take into account when talking about what to make for their next Superbowl party, or deciding who is bringing the burgers at their next cookout. Rather than bragging about their new scar from having a quadruple bypass we can start to discuss how to prevent the next one, how to teach our sons to avoid our medical woes, and why eating plants is okay. Again, men have been told, and many have verified, that they like to fix things. They don’t just want to talk about problems, they want to fix them. Use that ingrained “fix-it mentality” to work out how your health can become your desire. It could be setting yearly health goals, playing sports with your kids rather than just watching them, getting your boys together to play more pick-up basketball, or every cook-out or friends get together has a physical challenge (sports, yoga pose, feats of strength, etc.).
In discussing health, you don’t need to become a professional, such as a personal trainer, dietitian, or internet health zealot. You just need to realize you’re invested in the outcome, whether you choose to be or not. Recognizing the social and environmental pressures that are put on you might help you recognize the importance of your crew.
If we build a culture in our friendships where we do not talk about health then we can perpetuate this increased risk of diabetes, strokes, smoking, skin cancer and other illnesses because of our silence. What many men don’t focus on is that those friendships could be a force for good in their journey to health. There are locations around the world where barbershops are becoming hubs for discussing disease risk and health behaviors. The place where men gather, shoot the breeze and razz one another has become the focus for health practitioners to help men have the conversations.
This is not to say that you should shame your buddies for putting on weight, so that they will feel bad and want to lose weight. If being healthy is just what you guys do, then it will show in your behaviors. Go for a hike together, play sports together, and try new foods together. Foster those friendships that are encouraging and supportive in terms of healthy behaviors. From there, invite others along the journey and all while being a man.
(1) Friends, family can influence your weight-for good or bad. News. https://www.hsph.harvard.edu/news/hsph-in-the-news/friends-and-family-can-influence-your-weight/. Published August 11, 2014.
(2) Greenfieldboyce N. The New Coronavirus Appears To Take A Greater Toll On Men Than On Women. NPR. https://www.npr.org/sections/goatsandsoda/2020/04/10/831883664/the-new-coronavirus-appears-to-take-a-greater-toll-on-men-than-on-women. Published April 10, 2020.
(3) Men and Heart Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/men.htm. Published January 31, 2020.
(4) Cardiovascular Disease Statistics 2018. BHF. https://www.bhf.org.uk/research/heart-statistics/heart-statistics-publications/cardiovascular-disease-statistics-2018.
(5) Adults Who Report Smoking by Gender. The Henry J. Kaiser Family Foundation. https://www.kff.org/other/state-indicator/smoking-adults-by-gender/?currentTimeframe=0&selectedRows={"wrapups":{"united-states":{}}}&sortModel={"colId":"Location","sort":"asc"}. Published January 6, 2020.
(6) Gender empowerment and female-to-male smoking prevalence ratios. World Health Organization. http://www.who.int/bulletin/volumes/89/3/10-079905/en/. Published December 16, 2011. Accessed May 1, 2020.
(7) WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva: World Health Organization; 2008.
(8) Skin Cancer Facts & Statistics. The Skin Cancer Foundation. https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/.
(9) Fisher DE, Geller AC. Disproportionate burden of melanoma mortality in young US men. JAMA Dermatol 2013; 149(8): 903. doi:10.1001/jamadermatol.20134437
