More teenage boys are suffering from eating disorders. Two experts discuss why.
The medical and scientific understanding of eating disorders is changing and expanding. What happened?
Dr. Smith: Historically, eating disorders have been conceptualized mostly as anorexia, which was portrayed as a disease affecting teenage girls who wanted to lose weight for aesthetic reasons.
Dr. A.S. Nagata: There is increasing recognition, especially in the past decade or so, that some people with body image dissatisfaction don’t try to lose weight at all. Some men and boys try to become big and muscular. In fact, one-third of teenage boys across the United States report that they are trying to bulk up and gain more muscle. A subset of these may develop eating disorders or muscle dysmorphia, which can lead to significant psychological distress and physical health complications.
What is muscle dysmorphia?
Dr. A.S. Nagata: Also known as significant anorexia or reverse anorexia, it is a disorder where someone believes their body is weak or not muscular enough, even if objectively other people consider them fit or athletic.
Dr. Smith: This may be because they want to be fitter to play hockey, or because they want to be more muscular or “cut” from an appearance standpoint. The motivation that may be driving these behaviors may not be consistent with thinness, but we still see very similar behaviors. We see obsessive practice. We see the elimination of certain types of food. We see notable dietary control. Then there are those who choke or vomit, are afraid of it, or have always been picky eaters and fall off their growth curve. Because children and teens grow and develop so quickly, these changes can lead to very serious medical complications.
These complications can lead to a starvation state. What does it mean?
Dr. Smith: It’s a mismatch between someone’s energy or nutrient needs and what they’re actually putting into their body.
Dr. A.S. Nagata: When your body constantly exerts more energy than it takes in, it can lead to a state of starvation where your vital organs begin to stop working because they don’t have enough energy to sustain themselves. I think it is not recognized that starvation can occur among people who exercise excessively without getting enough nutrition.
So, is there an overlap here when it comes to boys and athletics?
Dr. A.S. Nagata: Yes absolutely. I think that athletic boys have a higher risk of developing eating disorders because, to some extent, some of these behaviors are normalized in competitive sports.
Dr. Smith: When it comes to the relationship between over-exercise, under-eating, and physical consequences among athletes with eating disorders, we actually have a term called the “athlete triad.”
What are the components of the feminine triad?
Dr. Smith: Weight loss, changes in bone density, and menopause, which is when females no longer menstruate. It’s another example of our sexism and how we deal with this disease.
Dr. Smith, you have done some of the latest research on eating disorders, including the finding that eating disorders disproportionately affect boys.
Dr. Smith: It looked at more than 11,000 hospital admissions in Ontario for eating disorders in children and adolescents aged 5 to 17 from 2002 to 2019. What it found was that although overall hospital admission rates increased by 139 per cent; The largest relative increase was among males: hospitalizations increased by 416 percent. Common reasons for hospitalization include indications such as very low heart rate, abnormal markers of metals in the blood, or suicidal ideation.
How suggestive is your research in Canada of what is happening in the United States?
Dr. A.S. Nagata: I imagine our trends are very similar. We have a recent study that focused on boys who were hospitalized for eating disorders in the United States. We found that compared to girls who are hospitalized, boys actually experience more serious medical complications. Boys have longer hospital stays, greater heart rate abnormalities, and higher rates of anemia than girls. This may partly reflect that boys are often identified or diagnosed later.