Alfonso Moretti is a successful personal trainer. He helps his clients stay on a track to get fit. But earlier in his career, he became obsessed with one thing: building big muscles.
"It takes over your life, so every decision you make becomes about the workout and how your body looks," said Moretti. "I used to track and weigh every single ounce of food that went in my body. I used to wake up at 3 o'clock in the morning to drink protein shakes. I never missed a workout, ever, ever, ever."
This all-consuming desire to bulk up is called muscle dysmorphia, also known as "bigorexia," and the number of men susceptible to this disorder is growing.
"About 45 percent of men are dissatisfied with their body image. One in 10 people who are diagnosed with an eating disorder is a man," said Dr. Michele Kerulis, Director of Sports and Health Psychology, Adler School of Professional Psychology.
Kerulis says bigorexia can hit men of all ages, and the emotional fallout can be severe.
"This obsession can start quickly or it can begin over a period of time," said Kerulis. "We see psychological abnormalities, including irritability, angry outbursts, which sometimes people would call a 'roid rage,' we see depression, sometimes mania."
Moretti's desire to "go big" started young.
"I can remember as young as 13, 14 looking at some of these muscle magazines, and I was conditioned to think that's what a man looked like, so big shoulders, big legs, just big muscles with veins everywhere," said Moretti.
Keeping up his meticulous routine of eating and exercising was emotionally exhausting. But the real wake-up call happened one day after his extreme workouts caused a serious injury.
"I finally came to a revelation, only after 11 or 12 years, because I had neck surgery. I had major neck surgery. I had ruptured a disc in my neck, and it basically paralyzed me on the right side of my body," said Moretti.
Physical injuries caused by bigorexia can range from mild-like muscle strains to more serious ones like stress fractures. Carried to the extreme, experts say this obsession could even lead to organ failure.
"So individuals who have bigorexia, a lot of them tend to use supplements, and if you overdose on these supplements without having a balanced diet, you can develop kidney and liver failure, and as that happens you may eventually need a liver or kidney transplant or your could eventually die," said Dr. Selene Parekh, orthopedist professor at Duke University
It took a serious injury, but now, Moretti uses his experience to advocate for a healthy body image and realistic workouts, and he urges other men not to go down the path he did.
"I look back now and I see those pictures and I'm like, 'wow,' like I would never want to look like that guy," said Moretti.