Eating Disorders Look Different in Boys and Girls

By Kathryn Doyle

In girls, eating disorders are often linked with a mood disorder, but that's not the case with eating disorders in boys, according to a new study.

And on average, boys develop eating disorders at a slightly younger age than girls do, and they usually don't have anorexia or bulimia, researchers say.

"These results indicate that there are indeed differences in the ways in which child and adolescent males and females present for eating disorder treatment," said lead author Kathryn Kinasz of the Department of Psychiatry and Behavioral Neuroscience at The University of Chicago.

Male and female patients in this study differed in mood disorders and depression, which some studies did not find, she told Reuters Health by email.

The researchers studied 619 youngsters, ages six to 18, whose symptoms qualified for an eating disorder diagnosis. Most of the group - 560 patients - were female.

Males tended to show earlier age of onset for eating disorder symptoms - around age 13, compared to age 14 for girls.

Anorexia nervosa was seen in more than a third of girls but in only 25% of boys. And rates of bulimia were 27% in girls versus 12% in boys.

Almost two-thirds of boys were diagnosed with a disorder in the "other" category, which includes binge eating disorder.

Work still needs to be done to properly assess and diagnose young males who present for eating disorder treatment, Kinasz said.

Males tended to have lower overall eating disorder psychopathology and lower restraint, eating concern, shape concern and weight concern, while females more often had a mood or anxiety disorder along with their eating disorder, according to results online January 28 in the Journal of Adolescent Health.

Researchers should question whether the tools to determine eating disorder pathology are properly capturing the nuances in young males' eating disorders, Kinasz said.

"It is important to remember that our findings (were in patients seeking) eating disorder treatment rather than the general population," she said. "Thus, the earlier age of onset may be more likely an issue of when and how males' eating disorders are being identified."

"We are beginning to understand that males do not hold the same body image ideals as females," she said. "This idea of desiring a thin physique may belong more strictly to females while their male counterparts desire a more 'muscular physique.'"

Purging rates tend to be lower for teen boys and higher for adult men, she said.

"As the authors point out, one of the things that we don't understand is the point at which weight loss in males becomes a clinically significant problem," said Alison Darcy of the Stanford School of Medicine, who was not part of the new study. "Males and females are likely not exactly comparable in this regard because of differential body fat ratios between the sexes."

Low heart rate is one of the key signs of an eating disorder and is frequently mistaken as a sign of fitness, particularly in the context of someone who trains a lot, Darcy told Reuters Health by email.

"Increased focus on time at the gym should be a warning sign, particularly when this begins to take precedent over other activities that the child previously enjoyed," Kinasz said. "Losing weight at a very rapid pace should also be a red flag."

Gym time and weight loss can be healthy, particularly in obese patients, but it should not become an obsession, Kinasz said.

"Similar to females, if a boy begins to focus on his appearance and strictly cutting out major food groups like carbohydrates or dairy, parents or doctors should begin to watch that such dieting does not spiral out of his control," she said.

SOURCE: https://bit.ly/1SLXz1H

J Adolesc Health 2016.

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