Anorexia Nervosa in Adolescent Males

The article “Anorexia Nervosa in Adolescent Males” by Basil Kadoura, Kyle T. Ganson, and Debra K. Katzman, published in the CMAJ in February 2024, provides valuable insights into anorexia nervosa among adolescent males, a demographic often overlooked in discussions about eating disorders. The authors emphasize that anorexia nervosa, while less commonly diagnosed in males compared to females, presents a significant risk to affected individuals, including a mortality rate six times higher than the general population. This elevated risk underscores the importance of early identification and intervention. Here are the key points discussed in the article:

1. Prevalence and Impact: Anorexia nervosa is a potentially life-threatening condition affecting up to 0.3% of males over their lifetime. The disorder is characterized by an intense fear of gaining weight and a distorted body image, leading to severe dietary restrictions and weight loss. The high mortality rate among affected males highlights the critical need for awareness and timely treatment. Stigma, poor mental health literacy, and gender stereotypes contribute to reduced help-seeking behavior, further exacerbating the condition.
2. Risk Factors: Specific groups of adolescent males are at an increased risk of developing anorexia nervosa. These include athletes engaged in sports focusing on body image and strength, such as cycling and wrestling, as well as individuals from diverse racial and ethnic backgrounds, and members of the LGBTQ community. Awareness of these risk factors can aid in early detection and prevention.
3. Muscle-enhancing Behaviors and Screening: A unique aspect of anorexia nervosa in males is the pursuit of muscle-enhancing goals, driven by ideals of muscularity and leanness. Behaviors may include dietary changes, purging through excessive exercise, and the use of supplements or anabolic steroids. The Muscularity Oriented Eating Test is recommended for assessing disordered eating behaviors related to muscularity.
4. Complications: Anorexia nervosa can lead to severe complications, including vital sign instability, bradycardia, electrolyte imbalances, hematologic abnormalities, elevated liver enzymes, impaired gastric emptying, vitamin D deficiency, superior mesenteric artery syndrome, and low bone mineral density. A comprehensive evaluation, including history, physical examination, and bloodwork, is crucial for identifying and managing these complications.
5. Treatment Recommendations: Family-based treatment (FBT) is advocated as the first-line outpatient treatment for adolescent males with anorexia nervosa. This approach involves the family in the treatment process, emphasizing their role in supporting the adolescent’s recovery. Continuous medical monitoring is necessary, and hospitalization may be required for severe cases.

The article calls attention to the need for increased awareness and understanding of anorexia nervosa in adolescent males, highlighting the necessity of targeted interventions and support systems. It stresses the importance of recognizing the unique presentation of the disorder in males, including the focus on muscle-enhancing behaviors, and the need for specialized assessment tools. By addressing these key points, the authors hope to improve outcomes for adolescent males affected by anorexia nervosa through early detection, appropriate treatment, and ongoing support.

Kadoura, B., M.D., Ganson, K. T.,PhD.M.S.W., & Katzman, D. K., M.D. (2024). Anorexia nervosa in adolescent males: CMAJ. Canadian Medical Association.Journal, 196(6) doi:https://doi.org/10.1503/cmaj.230001