Boys and men get eating disorders too - Trends in Urology ...
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MEN’S HEALTH
9
Boys and men
get eating
disorders too
DOMINIQUE THOMPSON
Much attention has Bullying and negative comments by a sports coach are risk factors for developing an eating
disorder in boys and young men (© Gustoimages/Science Photo Library)
been focused on eating
disorders in young girls and
women. Eating disorders E ating disorders matter. It is well
publicised that anorexia nervosa has the
highest mortality of all the mental health
in boys and men are not conditions, with 20% of sufferers dying
often discussed, yet rates prematurely from their illness, either by
are increasing and it is suicide or from physical complications.1 BLOG
Eating disorders also take their toll on the Caring for eating disorders in
thought that a significant individual over many years, both on their males: a marathon not a sprint
number of sufferers remain health and on their ability to function, Read the accompanying blog and
unidentified. In this article study and work. This in turn impacts on have your say at:
their families, friends and society as a www.trendsinmenshealth.com/blog
the author provides guidance whole; a cost which has been estimated at
on how disorders can be about £15bn a year.2
identified and managed, Dominique Thompson, Director of
It is not just a problem in young girls Service, Student Health Service, University
and what sources of support and women. Between 2005 and 2014 the of Bristol
are available. number of hospital admissions for eating
TRENDS IN UROLOGY & MEN’S HEALTH MARCH/APRIL 2017 www.trendsinmenshealth.com
MEN’S HEALTH
10
disorders in males aged 10–24 years rose need to be aware of the diagnostic
Box 1. Risk factors for eating
by 20%, and the most common age for possibility, of risk factors that increase
disorders in boys and men
admission was just 13 years (in girls it was likelihood of eating disorders in men and
15).3 It is becoming increasingly necessary boys, and of resources that are available to ● Being gay/bisexual/asexual/trans
for primary and secondary care teams to support them, and their carers and families. male/questioning
recognise and manage eating disorders ● Previous obesity
in males, as although 2004 NICE figures RISK FACTORS ● Previous dieting
suggest 11% of sufferers are male, it is Risk factors for males who develop eating ● Professional focus on fitness/body
likely that the real figure is higher.4 Even disorders include non-heterosexuality, shape/thinness/sport/training
in 2007 it was estimated that 6.4% of all previous dieting, previous obesity, and ● Body builders
adults (over 16) showed signs of an eating participation in a sport that emphasises ● Bullying/childhood abuse/trauma
disorder, up to 25% of whom were male.5 thinness, eg jockeys.7 Professions with an ● Prisoners
emphasis on fitness are at risk, eg personal ● Comorbidity, eg cancer, alcohol
Bulimia nervosa is more common in men trainers, athletes and dancers, as are ● Bereavement and loss
than anorexia nervosa, and the remainder young men subjected to bullying/negative ● Work or exam pressure
fall into the less specific ‘other specified comments from a sports or athletics coach. ● Getting older
feeding or eating disorder’ (OSFED), which In an increasingly visual society, with 24/7
replaces EDNOS (eating disorder not social media, it is important to note that You cannot tell if someone has an eating
otherwise specified) in the latest DSM-5 even brief exposure to media images of disorder simply by looking at them,
categorisation. This diagnosis applies to muscular men in adverts may negatively although if a person has a low BMI you
those who do not fit with the exact criteria affect men’s views of their own bodies might be prompted to ask a little more
for bulimia or anorexia.6 (‘muscle dysmorphia’).8 about their eating habits and body image.
In non-mental health specialist settings,
The figures imply that about 720 000 Other reported triggers include where a person may have presented
males over 16 years of age in the UK are bereavement or diagnosis with a major with quite different issues, it can be
struggling with a clinically significant level illness. The prison population may be challenging to bring up such a topic.
of eating disorder, with the majority hidden at particular risk, as their eating may However, simply introducing the idea that
to healthcare professionals. We therefore be the only aspect of their life they can their eating/weight may be an issue may
control, and there is much emphasis on be all you wish to do at this stage. I usually
body building and exercise for some. use a phrase such as: ‘You look quite slim.
Comorbidity with other psychological Does that worry you at all?’ or ‘Do you
conditions is common, especially spend a lot of time thinking about what
depression, substance misuse and you eat/your weight?’
personality disorder.9 Abuse in childhood
has been clearly defined in both males and Alternatively, the following two questions
females as a risk factor, and even more so have been shown to reliably rule out an
in males if they are gay or bisexual.10 Very eating disorder:
stressful jobs or exam pressure can also • ‘Does your weight affect the way you feel
trigger symptoms (Box 1). about yourself?’
• ‘Are you satisfied with your eating
SPOTTING EATING DISORDERS. patterns?’
Many clinicians tell me they ‘never
see eating disorders’. As healthcare A no and yes respectively would make an
professionals, we probably are not asking eating disorder unlikely.
enough or the right questions, or perhaps
we are avoiding what may become a tricky Once you have introduced the topic,
consultation. However, it is absolutely you can either plan to discuss it again
key to remember that, as with so many in future consultations or signpost and
The problem of eating disorders in boys and conditions, the earlier treatment is started refer to appropriate support. You will not
men is increasingly recognised. Resources the better the prognosis, and in the case of make things worse by mentioning it in a
and support are available eating disorders, the lower the mortality.4 gentle and non-judgmental way; you will
www.trendsinmenshealth.com TRENDS IN UROLOGY & MEN’S HEALTH MARCH/APRIL 2017MEN’S HEALTH
11
Box 2. Investigation for suspected Box 3. Useful resources, CPD and meetings
eating disorders
● Men Get Eating Disorders Too: http://mengetedstoo.co.uk
● Bloods: FBC (low Hb, or WCC),
● Anorexia and Bulimia Care: http://www.anorexiabulimiacare.org.uk
UE/CREAT (low K with vomiting
● B-eat: https://www.b-eat.co.uk
or laxative overuse), creatinine
● Network ED website for resources (professional/patients/carers): http://www.
kinase, GLUC, LFT, Ca, Mg (low
network-ed.org.uk
with diarrhoea), PO4 (low with
● National Centre for Eating Disorders: http://eating-disorders.org.uk/information/
malnourishment), BICARB (low
eating-disorders-in-males
with laxative overuse, high with
● National Collaborating Centre for Mental Health. Eating disorders: core
vomiting) (plus TFT first visit to
interventions in the treatment and management of anorexia nervosa,
rule out other causes of symptoms)
bulimia nervosa, and related eating disorders. National Clinical Practice
● ECG if BMIMEN’S HEALTH
12
Search?q=eating+disorders&go=Go&area=
KEY POINTS both; accessed 25 January 2017)
• Eating disorders in males are on the increase 4. National Collaborating Centre for Mental
Health. Eating disorders: core interventions
• Commonest age of admission is 13 in boys (younger than girls) in the treatment and management
• Certain groups are at higher risk of anorexia nervosa, bulimia nervosa,
and related eating disorders. National
• Bulimia is more common than anorexia Clinical Practice Guideline number
• Referral should not be delayed CG9, 2004 (https://www.nice.org.uk/
guidance/cg9/evidence/full-guideline-
• Red flags are clearly defined, in particular rapid weight loss and blood 243824221;accessed 25 January 2017).
discrepancies 5. NHS Information Centre for Health and
• Treatments are well evidenced and mainly psychological Social Care. Adult psychiatric morbidity in
England, 2007: results of a household survey
• Excellent resources are available for additional patient support and (http://content.digital.nhs.uk/catalogue/
professional training PUB02931/adul-psyc-morb-res-hou-sur-eng-
2007-rep.pdf; accessed 25 January 2017).
have a significant mortality rate, and disorders remain very concerning, it is 6. American Psychiatric Association.
are associated with many physical and important to give patients hope and refer Diagnostic and statistical manual of mental
mental health complications, ranging them for the many treatments that are disorders (DSM-5) (http://www.dsm5.org/
from self-harm to osteoporosis. There now available. psychiatrists/practice/dsm; accessed 25
is no one type of male who will develop January 2017).
an eating disorder, of course, but it has Declaration of interests: none declared. 7. King MB, Mezey G. Eating behaviour of male
been shown to be more likely in certain racing jockeys. Psychol Med 1987;17:249–53.
population groups and so we should be REFERENCES 8. Leit RA1, Gray JJ, Pope HG Jr. The media’s
aware of this. These populations include 1. Herzog DB, Greenwood DN, Dorer DJ, et al. representation of the ideal male body: a
non-heterosexual men and those who Mortality in eating disorders: a descriptive cause for muscle dysmorphia? Int J Eat
participate in certain sports, or athletic/ study. Int J Eat Disord 2000;28:20–6. Disord 2002;31:334–8.
body-conscious types. Muscle dysmorphia 2. PWC. The costs of eating disorders: social, 9. Carlat DJ, Camargo CA Jr, Herzog DB. Eating
is a symptom particular to males and health and economic impacts. Assessing the disorders in males: a report on 135 patients.
should be asked about. It is important to impact of eating disorders across the UK Am J Psychiatry 1997;154:1127–32.
be proactive and direct in our enquiries, on behalf of BEAT. February 2015 (https:// 10. Feldman MB, Meyer IH. Childhood abuse and
as most patients do not present with an www.b-eat.co.uk/assets/000/000/302/The_ eating disorders in gay and bisexual men. Int
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