Disordered eating in male adolescents: Prevalence and nutritional implications
April McMurray
April 11, 2013
Abstract
Eating disorders have become an increasingly significant issue over the last number of decades, and as the
prevalence increases, so does the interest in the matter. These disorders are caused by a combination of
biological and environmental factors, and can be extremely dangerous, even leading to death. Eating
disorders are more commonly diagnosed in females, particularly in adolescents. However, research is
showing that, although not as prevalent as in females, eating disorders in male adolescents still occur with a
surprising frequency, and the health implications are similar to those of eating disorders in females. The
purpose of this paper is to examine more closely the prevalence of eating disorders among male
adolescents. To find information related to this topic, I searched through the BYU database, medical
databases, such as PubMed, EBSCO, and Google Scholar. In each case, there was limited information on
the subject of eating disorders in male adolescents. I could not target one eating disorder specifically,
because there is not enough information about a specific eating disorder in males. However, from the
literature that does exist, it can be concluded that disordered eating in male adolescents is still an important
issue, even if it is not as prevalent as in females. In order to better help male adolescents suffering from
eating disorders, it is imperative to understand more about it. With further research, medical personnel will
be able to provide appropriate help to young boys dealing with eating disorders.
INTRODUCTION
Eating disorders are defined as “physical conditions that arise from a combination of long-standing
behavioral, biological, emotional, psychological, interpersonal, and social factors.” 1 Some of the main
factors that currently contribute to the incidence of eating disorders include psychological factors, such as
depression, loneliness, or low self-esteem; social factors, such as poor personal relationships, a history of
teasing (based on body size), or the cultural norms that dictate a certain body image; and biological factors,
such as the imbalance of chemicals and hormone regulation or even possible genetic components. 1
There are four types of eating disorders that are generally discussed: Anorexia Nervosa, the most
recognizable eating disorder is characterized by obsessive dieting accompanied by excessive weight loss. 1
Bulimia Nervosa is a condition of compulsive eating followed by purging and is a continuous cycle. 1 Binge
Eating Disorders are similar to Bulimia Nervosa, except that the binge is not followed with purging.1 As the
diagnostic criteria for Anorexia Nervosa and Bulimia Nervosa is so specific, characteristics of disordered
eating that do not meet the criteria are known as Eating Disorders Not Otherwise Specified (EDNOS).2
These eating disorders can arise from various factors, but all can have serious physical effects on the body.
Some of the consequences of Anorexia Nervosa are visible, such as a wasted appearance, with thin limbs
and bony prominences, and a thinning of scalp hair.3 Heart rate, temperature and blood pressure decrease,
as well as a drop of serum levels of important electrolytes. 3 Patients can easily become deficient in several
crucial nutrients, such as zinc, copper, vitamins D, A and K. 3 This lack of these nutrients due to the selfstarvation forces the body to slow down all processes for survival. 1
Bulimia Nervosa has several physical implications as well. While such a physical wasting away is not as
apparent, purging behaviors can be just as dangerous. GI problems are common: inflammation, peptic
ulcers, constipation, and a potential for gastric rupture can cause extreme discomfort. 1 Dehydration and
electrolyte imbalance are caused by purging and can lead to irregular cardiac function and ultimately
death.1 Binge Eating Disorder often leads to risks similar to clinical obesity, such as high blood pressure,
high cholesterol, diabetes type 2, and heart disease.1
These medical implications show an increasing need to address the problem of eating disorders. Due to the
influences of social pressure to maintain a certain body weight, the population that suffers most from eating
disorders is typically female, and the average age range is 15-19 years of age for anorexia nervosa, and 1620 years in bulimia nervosa.3 However, there has recently been an additional focus on eating disorders in
the male population. Males are only estimated to make up 10% of cases involving disordered eating, and
exhibit symptoms clinically similar to females.1 However, the use of symptoms in terms of diagnosing
eating disorders in males needs to be studied further as it has been questioned whether the scales for
examining eating disorders in males can be extrapolated from the studies that have only been conducted on
females.4 Finding appropriate diagnostic criteria for eating disorders in males is an important issue to
address because males who suffer from an eating disorder run the same health risks as females. The
purpose of this paper is to examine more closely the prevalence of eating disorders among male adolescents
as well as the implications of eating disorders on the nutritional and medical well-being of this population.
METHODS
To find relevant information, my search through the BYU database, looking for articles that may provide
insight on male adolescents with eating disorders. Medical databases, such as PubMed and EBSCO, were
also searched and finally, due to a lack of relevant information, Google Scholar was included in the search.
Key included: “male,” “adolescents,” “eating disorders,” “disordered eating,” “nutrition,” “prevalence,”
“implications.” The topic of eating disorders related to the male population is intriguing because it is not as
well known or studied as is the prevalence of eating disorders in females. It was surprising to find how little
information there is about the subject. Although there were several search results from each database, most
of the results did not include information specific to disordered eating patterns in male adolescents, and
many did not even address the topic at all. In order to find enough literature, the search could not target one
eating disorder specifically; instead, this paper gives a broader look at several eating disorders, simply
because there is not enough information about any one disorder in particular.
RESULTS/DISCUSSION
There simply has not been much research done on the male adolescent population regarding eating
disorders. Health professionals have questioned whether information about eating disorders in male
adolescents can be extrapolated from the studies that have only been conducted on females. 4 Darcy et al. 5
sought to verify whether or not males and females were similar enough to combine populations. The
examination used in this particular study proved to be less accurate for males than for females, as some of
the questions did not apply to males. 5 Males were also found to be less likely to report accurately. 5 Present
data may serve as a present spring-board of information, but in order to understand more fully eating
disorders in male adolescent populations, more research will eventually need to be done.
It is important to note the increasing prevalence of eating disorders among male adolescents. It has
generally been accepted that male eating disorders account for approximately 10% of all cases of eating
disorders.1 Results from one study comparing females to males6, however, showed that the ratio increases
to 2:1 when considering EDNOS, or signs of disordered eating that do not meet the full criteria to be
diagnosed as anorexia or bulimia. Further studies also showed much smaller ratios for the diagnosable
eating disorders, such as 3.5:1 of males to females diagnosed with anorexia nervosa. 7 Additionally, the
hypotheses that there is a “community reservoir of undiagnosed men”7 suggests that the ratio could
possibly be even higher.
Adolescent males with eating disorders are similar to females in dissatisfaction for their body image, but
there is a different type of preoccupation with food and the relationship to body size. 6 Females are generally
driven by a desire to be thin, evidence of the social norms of today. In the case of adolescent males, some
wish they could be thinner while others wish they could bulk up more to match the idyllic masculine
shape6. Sadly, as obesity becomes more prevalent, particularly in adolescents, some young males are
beginning to develop an unhealthy obsession with weight loss and dieting. 2 15.9% of young adolescents
who were surveyed7 considered themselves to be obese, while in reality only 5.1% were even classified as
overweight or obese. Pressure and bullying can be the trigger for many adolescents' spiral into disordered
eating.8 For some young boys, what begins as an attempt to follow a doctor's guidelines for a healthier
weight leads to excessive behavior.2 While some males want to lose weight, similar to females, other young
males express the desire to gain more weight—in effort to attain the “idealized masculine shape.”6 Norris et
al.9 found in that seven of ten adolescents reported over-exercising. The influence of mass media, movies,
and even toys appear to have a reinforcing impact on society's perception of a the masculine look. 7,8
Similar to the nutritional implications of eating disorders in females, the consequences of eating disorders
in male adolescents can be dangerous. One study looked at the bone density loss in 20 young males ages
12-17 who had been diagnosed with anorexia nervosa.10 Bone density was measured at baseline then
followed with several medical interventions for anorexia nervosa. Six to 24 months after the medical
interventions began, bone density was measured again.6 The subjects who made a total weight recovery
saw an increase in bone density after the medical interventions, while subjects who only made a partial
weight recovery actually had decreased bone mineral density. 10 Another study had shocking results as well:
of 38 participants, the average at the time of the first physical assessment BMI was 17.6, and stunted
growth and failure to thrive was evident.9 Two-thirds of the subjects had cardiac rhythmic abnormalities
and ”marked brakycardia.”9 Two patients already were diagnosed with osteoporosis, and eight more with
osteopenia.9 27 of the subjects were already admits to the hospital and 15 were later admitted due to the
findings from the assessment.9 It shows how serious these consequences of eating disorders can become.
was also concluded that the changes in bone mineral density in males with anorexia nervosa is similar to
the changes in females.10 Rajendra and Barathi2 were able to illustrate that some of the medical
complications in males due to eating disorders were similar to ones previously reported among females,
including bradycardia, hypothermia, cardiac arrhythmias due to nutrient deficiencies, postural hypotension,
electrolyte derangements due to purging (by vomit or laxative use), and bone mineral loss or osteoporosis.
CONCLUSION
It appears that while eating disorders in males are not as prevalent as in females, it is still becoming a
greater problem, due to social values on physical appearance. Additionally, the medical implications of
eating disorders are similar in males and females. This is of particular importance in adolescents, because
they are in a crucial time of physical development and need to get adequate nutrition for a healthy life.
However, information on eating disorders in males is still limited because male subjects have not been
researched as much as females. In order to help male adolescents dealing with eating disorders, it is
imperative to understand more about it. With further research, medical personnel will be able to provide
appropriate interventions to adolescent males diagnosed with eating disorders.
References
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