On the outside, Hayden Winkler appeared to be in top condition: He was lean and muscular, he exercised daily and he led a healthy lifestyle. No one knew his heart wouldn’t beat more than 30 beats per minute, that his hair was falling out or that beneath his clothes, he could see the outline of every bone in his body.

He was diagnosed with anorexia nervosa with bulimic tendencies his sophomore year at UT in 2007.

“I thought that an [eating disorder] was pretty much not eating and being really thin,” Winkler, a UT alumnus, said. “I didn’t think all the other factors, of being afraid of food or gaining weight or all the other physical factors that affect your mental ability would be there.”

Research shows 10 percent of people with eating disorders in the U.S. are male, according to the National Association for Males with Eating Disorders. The association expects the actual numbers to be higher because males are less likely to report a disorder.

In high school, Winkler had always been heavier than some of his peers and self-conscious about his body. He began his journey to lose weight his freshman year of college, intent on taking control of his life and becoming a healthier person, which in his eyes meant skinnier. Winkler began to eat healthier and exercise weekly at Gregory Gym. He had no idea these changes would escalate into something uncontrollable and threaten his life.

Brad Kennington, an Austin therapist specializing in male eating disorders, said most males do not recognize they have an eating disorder because it is widely considered a “female problem,” even though eating disorders in males and females are quite similar. If left untreated, males with eating disorders produce lower levels of testosterone, which can result in a decrease in sexual libido and muscle mass, a change in sleep patterns and conditions such as depression, according to the Mayo Clinic.

“Many disordered males were teased and bullied for [being overweight] when they were children and try to lose weight or shape their body into something they see as more acceptable to get rid of the shame,” Kennington said.

Winkler began dieting excessively, eating an apple a day or at times skipping meals altogether, and running for long hours his sophomore year. He would even load up his backpack with books to burn calories walking to class. When he was alone, Winkler would spend hours on websites such as The Calorie Counter, a free site with nutrition data and food calories.

“It’s almost as if you’re getting some type of high off knowing you have the power to control your body and control what goes into it,” Winkler said. “In college, there are so many variables that you can’t control; this was one thing [I could] control.”

Winkler’s mother, Johanna Winkler, said the family noticed Winkler’s determination to lose weight in high school, although the family did not think the behaviors were disordered.

To hide his increasing weight loss, Winkler wore baggy clothes and told people he was preparing to run the Livestrong Austin Marathon. He would also lie to get out of eating at meal times. At times when the hunger became unbearable, Winkler would end up binge eating and throwing up his food afterward.

Johanna said the family first noticed a serious change in Winkler as it got closer to the Livestrong marathon.

“He seemed irritable, leaner and dressed in layers even though it was warm outside,” Johanna said. “He had pushed himself way too hard to do well in the marathon and in the end, could not get out of training mode.”

After the marathon, Winkler was so skinny he no longer saw a person when he looked in the mirror. The skin on his face was stretched out, making his cheeks and temples appear sunken, he could even wrap a hand around his arm. Winkler said his shoulder blades were the worst because they appeared to shoot out of his body. His friends noticed these drastic changes and urged him to get help, but he waved off their concerns and lashed out at them if they persisted.

The eating disorder grew to affect Winkler’s mind, as well. He walked around campus as if in a haze and sat reading the same sentence in his textbooks for hours. He became a perfectionist, planning out his schedule daily, and became upset if anything happened to interrupt his routine.

“I was really sick of myself,” Winkler said. “I never wanted to be that thin, but something inside my head wouldn’t allow me to want to gain more weight.”

Winkler knew it was time to get help when he was too physically weak to get out of bed one morning. He voluntarily went to see local eating disorders specialist Dr. Edward Tyson in 2008, who immediately sent him to the intensive care unit at a Houston children’s hospital. At the hospital, Winkler was bound to the bed and constantly monitored by cameras.

“I felt like an animal,” Winkler said. “They would watch you while you ate to make sure you ate everything and would not let you go to the bathroom afterward in case you were going to purge or throw it up.”

Winkler stayed at the hospital for three months and returned to UT in the spring of 2008. In addition to visits with Tyson, Winkler saw a dietician after his treatment to plan his meals every week. He graduated from UT in December 2008 with a political science degree. In his spare time, Winkler volunteers at breweries and hopes to become a brewer in the future.

“I’ve learned to be comfortable with myself and to appreciate how I’m made,” Winkler said. “I’ve also learned to take care of myself because if I don’t take care of myself, I’m not going to be here later.”