Anorexia nervosa in adolescent males

Basil Kadoura; Kyle T. Ganson; Debra K. Katzman

doi:10.1503/cmaj.230001

Anorexia nervosa is a potentially life-threatening eating disorder

Up to 0.3% of males will receive a diagnosis of anorexia nervosa in their lifetime.1 Affected males have a 6-times higher mortality rate than those in the general population. 2 Stigma, poor mental health literacy and gendered stereotypes reduce help-seeking behaviours and lead to delayed treatment and worse outcomes. Early identification and prompt treatment are essential.

Specific adolescent male populations are at elevated risk

Athletes involved in body-and strength-focused sports (e.g., cycling, running, wrestling); racially and ethnically diverse males; and gay, bisexual, trangender, and queer people are more susceptible to developing anorexia nervosa.3

Evaluation of adolescent males with possible anorexia nervosa should include screening for muscle-enhancing goals and behaviours

Muscle-enhancing behaviours are driven by body ideals that emphasize muscularity and leanness, and can include diet changes (intermittent fasting, and bulking and cutting diets), purging (vomiting, excessive exercise), supplement use, and anabolic steroid use.3 The Muscularity Oriented Eating Test is an assessment instrument validated to assess for muscularity-oriented disordered eating behaviours.3

Complications can be life threatening

Complications of anorexia nervosa include vital sign instability, bradycardia, abnormal levels of total cholesterol, electrolyte abnormalities, hematologic abnormalities, elevated liver enzymes, impaired gastric emptying, vitamin D deficiency, superior mesenteric artery syndrome, and low bone mineral density.3 A careful evaluation — including a history (exploring symptoms and behaviours), physical examination, and bloodwork — are the first steps in identifying serious medical complications and guiding subsequent treatment.

Clinical guidelines recommend family-based treatment as the first-line outpatient treatment4^,5

Most adolescent males with anorexia nervosa can be treated as outpatients with family-based treatment and ongoing medical monitoring.4^,5 However, some adolescents may require treatment in hospital.

Footnotes

Competing interests: Debra Katzman is an associate editor with the Journal of Adolescent Health and the Journal of Eating Disorders, and editor-in-chief of Neinstein’s Adolescent and Young Adult Health Care. She reports funding from the Canadian Institutes of Health Research and the National Institutes of Health, involvement with the Canadian Pediatric Surveillance Study and institutional travel support. She sits on the data safety monitoring board for the iSTRONG and MAPS studies. She reports board or committee roles with Academy for Eating Disorders, Eating Disorders Ontario, FEAST (Families Empowered And Supporting Treatment for Eating Disorders), Maudsley Parents, National Eating Disorder Association, Sheena’s Place, Ontario Health, Project Health and the Royal College of Physicians and Surgeons of Canada. No other competing interests were declared.
This article has been peer reviewed.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

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