Adolescent males with anorexia nervosa have higher mortality rates

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. https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230001

"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 behaviors 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.