Anorexia nervosa can be life threatening in males

Anorexia nervosa affects males as well as females, and affected males have a sixfold higher mortality rate than males in the general population. A new article published in CMAJ (Canadian Medical Association Journal) aims to raise awareness of this life-threatening eating disorder. 

"Early identification and prompt treatment are essential," writes Dr. Basil Kadoura, a specialist in adolescent health, British Columbia Children's Hospital and University of British Columbia, Vancouver, BC, with coauthors.

Five things to know about anorexia nervosa in males:

1.Up to 0.3% of males will be diagnosed with anorexia nervosa. Stigma, poor mental health literacy and gendered stereotypes reduce help-seeking behaviours and lead to delayed treatment and worse outcomes.

2. Certain adolescent males are at higher risk. Athletes involved in body- and strength-focused sports like cycling, running, and wrestling, are a higher risk of developing the disorder, as are racially and ethnically diverse males and gay, bisexual, trans, and queer people.

3. Screening for muscle-enhancing goals and behaviours is important to assess for anorexia nervosa. Diet changes, vomiting, over-exercising, and supplement and anabolic steroid use are potential red flags. The Muscularity Oriented Eating Test is a tool used to assess for these eating behaviours.

4. Complications can be life threatening. These include vital sign instability, slower than normal heart rate, electrolyte abnormalities and other conditions. A detailed history, physical examination and bloodwork will help identify serious medical issues and guide treatment.

5. Family-based treatment is recommended for outpatients. In this guideline-recommended approach, parents are considered experts in their adolescent and lead in re-nourishing their child.

"Most adolescent males with anorexia nervosa can be treated as outpatients with family-based treatment and ongoing medical monitoring. However, some adolescents may require treatment in hospital," write the authors.

Reference:

Basil Kadoura, Kyle T. Ganson and Debra K. Katzman, Anorexia nervosa in adolescent males, CMAJ February 20, 2024 196 (6) E191; DOI: https://doi.org/10.1503/cmaj.230001.