Medical and scientific understanding of eating disorders is changing and expanding. what happened?
Dr. Smith: Historically, eating disorders have been primarily conceptualized as anorexia, a disease of adolescent women who wish to lose weight for aesthetic reasons.
Dr. Nagata: Particularly in the last decade or so, there has been a growing recognition that some people who are dissatisfied with body image never try to lose weight. some men and boys I’m trying to get big and muscular. In fact, one in three teenage boys across the United States report trying to bulk up and gain muscle. And some of them may develop eating disorders or muscle dysmorphia, which can cause significant psychological distress and physical health complications.
What is muscle dysmorphia?
Dr. Nagata: Also known as picky eating disorder or reverse anorexia, this disorder causes people to believe that their body is poor or doesn’t have enough muscles, even if they appear objectively healthy and athletic to others. It’s a disorder that you think doesn’t exist.
Dr. Smith: Maybe it’s because you want to be in shape for hockey, or maybe it’s because you want to be more muscular and “skinny” from an appearance standpoint. Although the motivations guiding these behaviors may not align with losing weight, we still see very similar behaviors. You can see the relentless practice. You may want to eliminate certain types of foods. There are significant dietary restrictions. There are also people who are afraid of choking or vomiting, or who have always been picky eaters and who fall off the growth curve. Also, children and teens grow and develop so quickly that changes can cause very serious medical complications.
These complications can lead to starvation. What does that mean?
Dr. Smith: This is a mismatch between someone’s energy and nutrient needs and what they are actually putting into their body.
Dr. Nagata: If your body is constantly exerting more energy than it takes in, it can lead to starvation, where vital organs begin to shut down because there isn’t enough energy to sustain life. And I don’t think people realize enough that too much exercise without getting enough nutrition can lead to starvation.
So, is there any overlap when it comes to boys and track and field?
Dr. Nagata: Yes, absolutely. I think boys who are athletes are at higher risk for eating disorders. This is because some of these behaviors are somewhat normalized in competitive sports.
Dr. Smith: There is actually a term called the “triad of female athletes” regarding the relationship between over-exercising, under-eating, and the effects on the body of athletes with eating disorders.
What are the components of the female triad?
Dr. Smith: Weight loss, changes in bone density, and amenorrhea, where a woman is not menstruating. This is another example of our gender bias and how we approached this disease.
Dr. Smith, you have conducted the latest research on eating disorders, including the finding that eating disorders have a severe impact on boys.
Dr. Smith: I examined more than 11,000 hospitalizations for eating disorders in children and adolescents ages 5 to 17 in Ontario from 2002 to 2019. What I found was that while hospitalization rates increased by 139 percent overall, the largest relative increase was among men. Hospitalizations increased by 416 percent. Common causes of hospitalization include signs such as a very low heart rate, abnormal mineral markers in the blood, or suicidal thoughts.
To what extent does your research in Canada indicate what is happening in the United States?
Dr. Nagata: I think our tendencies are pretty similar.we have recent research It focused on boys hospitalized for eating disorders in the United States. We found that compared to girls who are hospitalized, boys actually have more severe complications. Boys have longer hospital stays, more heart rate abnormalities, and higher rates of anemia than girls. This may partly reflect that boys are often identified or diagnosed later in life.