Eating disorders may be overlooked in some groups - boys and some ethnicities - by physicians accustomed to diagnosing the condition in white teenage girls, say researchers at Lucile Packard Children's Hospital and the Stanford University School of Medicine.
The problem is compounded when the sufferers don't display the typical symptoms of disordered eating.
"We need to think more broadly about who struggles with eating disorders," said adolescent medicine and eating disorder specialist Rebecka Peebles, MD, instructor in pediatrics (adolescent medicine). Peebles pointed out that diagnostic and even treatment criteria were developed with Caucasian women or girls in mind. "We may not be asking the right questions for these other groups at all."
Peebles is presenting the research as two separate abstracts at the annual meeting of the International Eating Disorders Conference on May 4 and May 5 in Baltimore.
In the gender study, Peebles compared 104 boys aged 8 to 19 who had eating disorders with about 1,004 similarly aged girls who had the condition. She found that boys were less likely than girls to have used purging behaviors, such as vomiting or using laxatives, to control their weight in the month prior to the study (23.5 percent vs. 32.4 percent). They were also more likely to be diagnosed with an "Eating Disorder Not Otherwise Specified," or EDNOS, rather than with anorexia or bulimia, than girls (62.2 percent vs. 49.1 percent), perhaps because they express themselves differently.
"We're taught to be alert for patients who express a desire to be thin," said Peebles. "But clinically, boys often talk about wanting to be more fit and eat healthily, which doesn't set off the same kind of alarm bells."
Fitness is fine, but rigorous exercise coupled with severely restricted food intake can spell trouble just as surely as the more familiar binging and purging cycles seen in girls. Even though the National Eating Disorders Association estimates that approximately 10 percent of people diagnosed with eating disorders are male, alert parents of boys can still sometimes struggle with convincing their health care provider that their son has an eating disorder.
"There is a perception that boys rarely get eating disorders," said Peebles, "and many boys undergo pretty extensive medical workups for other conditions, like gastric problems or brain tumors, before their physicians hit on the right diagnosis."