The medical and scientific understanding of eating disorders is evolving and expanding. What happened?

Dr. Smith: Historically, eating disorders have been primarily conceptualized as anorexia, which has been described as a disease of adolescent girls who wish to lose weight for cosmetic reasons.

Dr. Nagata: It is increasingly recognized, especially over the last decade, that some people who are dissatisfied with their body image do not try to lose weight at all. Some men and boys trying to become big and muscular. In fact, a third of teenagers in the United States say they are trying to bulk up and become more muscular. And a subset of them may develop eating disorders or muscle dysmorphia that can lead to significant psychological distress and physical health complications.

What is muscle dysmorphia?

Dr. Nagata: Also known as bigorexia or reverse anorexia, it is a disorder in which a person believes their body is skinny or not muscular enough, even though objectively they would be considered fit or athletic by other people. .

Dr. Smith: Maybe it’s because they want to be in better shape for hockey, or because they want to be more muscular or “cut” from an appearance standpoint. The motivation that might be driving these behaviors may not align with being thinner, but we still see very similar behaviors. We see obsessive exercise. We are seeing the elimination of certain types of foods. We notice a marked dietary restriction. And then there are those who choke or vomit, who are afraid of it, or who have always been picky eaters and lose their growth curve. And because children and adolescents grow and develop so quickly, these changes can lead to some pretty serious medical complications.

These complications can lead to a state of starvation. What does that mean?

Dr. Smith: This is a mismatch between a person’s energy or nutritional needs and what they actually provide to their body.

Dr. Nagata: When your body constantly exerts more energy than it takes in, it can lead to a state of starvation in which your vital organs begin to shut down because they don’t have enough energy to sustain themselves. . And I think it’s underestimated that starvation can occur in people who exercise too much without getting enough nutrition.

So, is there any overlap between boys and athletics?

Dr. Nagata: Yeah, absolutely. I think athletic boys are at higher risk for eating disorders because to some extent some of these behaviors are normalized in competitive sports.

Dr. Smith: When it comes to the relationship between overexercising, undereating, and physical outcomes in athletes with eating disorders, we actually have a term called the “female athlete triad.”

What are the components of the feminine triad?

Dr. Smith: Weight loss, changes in bone density, and amenorrhea, which is when women miss their periods. This is another example of our gender bias and how we have approached this disease.

Dr. Smith, you have done some of the most recent research on eating disorders, including the discovery that eating disorders seriously affect boys.

Dr. Smith: I examined more than 11,000 hospitalizations in Ontario for eating disorders among children and adolescents aged 5 to 17 from 2002 to 2019. I found that although hospitalization rates increased overall by 139 Percent, the largest relative increase was seen among men: their rate of hospitalizations increased by 416 percent. Common causes for hospitalization include indications such as very low heart rate, abnormal mineral markers in the blood, or suicidal ideation.

To what extent does your research in Canada suggest what is happening in the United States?

Dr. Nagata: I imagine our tendencies are quite similar. We have a recent study which focused on boys hospitalized for eating disorders in the United States. We found that compared to hospitalized girls, boys actually suffered more serious medical complications. Boys have longer hospital stays, greater heart rhythm abnormalities and higher rates of anemia than girls. This may partly reflect the fact that boys are often identified or diagnosed later.

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