Presenting Signs of Eating Disorders in Adolescent and Young Boys

Vo M, Lau J, Rubinstein M. Eating disorders in adolescent and young adult males: presenting characteristics [published online June 7, 2016]. J Adolesc Health. doi:10.1016/j.jadohealth.2016.04.005.

It is estimated that males make up about 5% to 10% of the cases of bulimia and anorexia nervosa overall, and perhaps up to one fourth of the cases in patients younger than age 13 years. However, there is growing thought that those numbers are a significant underestimate due to the female-centric diagnostic criteria for eating disorders. New diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, were implemented in 2015, and since that time there has been an almost 30% increase in lifetime eating disorders in men.

It is important for health care practitioners to be aware of presenting signs of eating disorders in males. Delays in diagnosis and treatment could lead to cardiovascular sequelae and loss of growth potential in young men. 

With this in mind, Vo and colleagues at the University of California, San Francisco performed a chart review to examine the presenting characteristics, vital signs, past medical and psychiatric history, and family history of men who presented at their outpatient Adolescent and Young Adult Eating Disorder Clinic for a new visit from 2011-2014. 

Thirty-three patients were included in this chart review. The mean percent weight loss was 20% from premorbid weight, and the mean body mass index (BMI) on presentation was 88%. The mean presenting heart rate was 58.7 beats/min. The orthostatic heart rate change was 22 beats/min, and there were minimal changes in systolic and diastolic blood pressure. 

Of the patients included in the study, 51.5% met the Society for Adolescent Health and Medicine hospital admission criteria due to findings such as bradycardia, orthostatic heart rate changes, and/or hypothermia. The mean duration of illness was 5.8 months, but it was noted that patients who presented with a heart rate < 50 beats/min had a slightly longer course of illness than those who did not present in that manner. 

After reviewing information from patients with available laboratory data, the researchers found that 33.3% of patients were anemic, 23.8% were leukopenic, 19.0% were thrombocytopenic, and 10.0% were neutropenic. Potassium levels were found to be abnormal in 25% of patients, and 40% of patients had elevated alanine transaminase levels. 

When relevant factors for disordered eating were reviewed, 41.5% of patients had a past medical history of being overweight or obese. Fifty percent had a comorbid psychiatric disorder such as depression (most likely) or anxiety. Family history was positive for an eating disorder in 12% of cases. 

The most notable take-home message for health care practitioners was that despite the fact that these male patients were only slightly underweight at presentation, a significant portion of them still presented with abnormal vital signs and/or laboratory data. It was also important to note their premorbid weight, because the mean percent of body weight loss was 20%, which qualifies as severe malnutrition despite the relatively high presenting BMI. These findings are consistent with those of other studies, and there is some thought that these factors contribute to the delay of diagnosis in males.

Though the overall study size is small, and the investigators were only looking at those who were actively presenting at a clinic for eating disorders, the potential impact of earlier diagnosis in these patients by recognizing some of these signs could truly change a patient’s life. 

Jessica Tomaszewski, MD, is an assistant clinical professor of pediatrics at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and a hospitalist pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

Charles A. Pohl, MD—Series Editor, is a professor of pediatrics, senior associate dean of student affairs and career counseling, and associate provost for student affairs at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania.