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Nutritional Considerations for Boys and Men with Eating Disorders

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Eating Disorders in Boys and Men

Abstract

The nutritional management of boys and men diagnosed with eating disorders is likely to be suboptimal. The absence of empirical studies and lack of knowledge about the specific nutritional requirements in males is attributed to the female-centric nature of eating disorders, as well as the under-representation of boys and men diagnosed with eating disorders compared to girls and women, especially in clinical settings. This chapter describes the unique characteristics of males diagnosed with eating disorders and highlights the lack of specific nutritional guidelines for boys and men. In particular, this chapter reviews energy considerations, refeeding syndrome, macronutrients, micronutrients, and diagnosis-specific considerations. The current clinical guidance for refeeding and nutritional support is based on studies undertaken predominantly in girls and women. Thus, the relevance of these guidelines for use in males diagnosed with eating disorders is currently unknown. This chapter describes the current nutritional management in males diagnosed with eating disorders and highlights the lack of evidence for these refeeding practices and nutritional management in boys and men.

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Notes

  1. 1.

    In this chapter, we use the terms males and boys/men interchangeably.

References

  1. Murray SB, Nagata JM, Griffiths S, Calzo JP, Brown TA, Mitchison D, et al. The enigma of male eating disorders: a critical review and synthesis. Clin Psych Rev. 2017;57:1–11.

    Article  Google Scholar 

  2. Limbers CA, Cohen LA, Gray BA. Eating disorders in adolescent and young males: prevalence, diagnosis and treatment strategies. Adolesc Health Med Ther. 2018;9:111–6.

    PubMed  PubMed Central  Google Scholar 

  3. Ganson KT, Murray SB, Nagata JM. Last word: a call to develop specific medical treatment guidelines for adolescent males with eating disorders. Eat Disord. 2019;17:1–7.

    Google Scholar 

  4. Griffiths S, Mond JM, Li Z, Gunatilake S, Murray SB, Sheffield J, Touz S. Self-stigma of seeking help and being male predicts an increased likelihood of having an undiagnosed eating disorder. Int J Eat Disord. 2015;48(6):775–8.

    Article  PubMed  Google Scholar 

  5. Griffiths S, Mond JM, Murray SB, Touz S. Young peoples’s stigmatizing attitudes and beliefs about anorexia nervosa and muscle dysmorphia. Int J Eat Disord. 2014;47:189–95.

    Article  PubMed  Google Scholar 

  6. Strober M, Freeman R, Lampert C, Diamond J, Teplinsky C, DeAntonio M. Are there gender differences in core symptoms, temperament and short-term prospective outcome in anorexia nervosa? Int J Eat Disord. 2006;39:570–5.

    Article  PubMed  Google Scholar 

  7. Darcy AM, Doyle AC, Lock J, Peebles R, Doyle P, Le Grange D. The eating disorders examination in adolescent males with anorexia nervosa: how does it compare to adolescent females? Int J Eat Disord. 2012;45:110–4.

    Article  PubMed  Google Scholar 

  8. Murray SB, Griffiths S, Mond JM. Evolving eating disorder psychopathology: conceptualizing muscularity-oriented disordered eating. Br J Psychiatry. 2016;208:414–5.

    Article  PubMed  Google Scholar 

  9. US Department of Agriculture and Us Department of Health and Human Services. Dietary guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing Office; 2010.

    Google Scholar 

  10. National Health and Medical Research Council (Australia), Commonwealth Department of Health and Ageing (Australia), Ministry of Health (New Zealand). Nutrient and reference values for Australia and New Zealand including recommended dietary intakes. Canberra: Commonwealth of Australia and New Zealand Government; 2006.

    Google Scholar 

  11. Department of Health. Dietary Reference Values for Food and Energy and Nutrients for the United Kingdom. Report of the Panel on Dietary reference values of the committee on Medical Aspects of Food Policy. Report on Health and Social Subjects 41. HSMO: London; 1991.

    Google Scholar 

  12. Schebendach J. The use of indirect calorimetry in the clinical management of adolescents with nutritional disorders. Adolescent Medicine: State of the Art Reviews. 14, 1, 2003. Philadelphia, Hanley & Belfus, Inc.

    Google Scholar 

  13. Nagata JM, Carlson JL, Kao JM, Golden NH, Murray SB, Peebles R. Characterization and correlates of exercise among adolescents with anorexia nervosa and bulimia nervosa. Int J Eat Disord. 2017;50(12):1394–403.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gorrell S, Nagata JM, Hill KB, Carlson JL, Shain AF, Wilson J, Alix Timko C, Hardy KK, Lock J, Peebles R. Eating behavior and reasons for exercise among competitive collegiate male athletes. Eat Weight Disord. 2019:1–9.

    Google Scholar 

  15. Keys A. The biology of human starvation. Minneapolis: University of Minnesota Press; 1950.

    Book  Google Scholar 

  16. Krahn DD, Rock C, Dechert RE, Narin KK, Hasse SA. Changes in resting energy expenditure and body composition in anorexia nervosa patients during refeeding. J Am Diet Assoc. 1993;93(4):434–8.

    Article  CAS  PubMed  Google Scholar 

  17. Obarzanek E, Lesem MD, Jimerson DC. Resting metabolic rate of anorexia nervosa patients during weight gain. Am J Clin Nutr. 1994;60:666–75.

    Article  CAS  PubMed  Google Scholar 

  18. Cuerda C, Ruiz A, Velasco C, Breton I, Camblor M, Garcia-Peris P. How accurate are predictive formulas calculating energy expenditure in adolescent patients with anorexia nervosa? Clin Nutr. 2007;26:100–6.

    Article  CAS  PubMed  Google Scholar 

  19. Schebendach JE, Golden NH, Jacobson MS, Hertz S, Schenker IR. The metabolic responses to starvation and refeeding in adolescents with anorexia nervosa. Ann N Y Acad Sci. 1997;817:110–9.

    Article  CAS  PubMed  Google Scholar 

  20. Position of the American Dietetic Association. Nutrition intervention in the treatment of eating disorders. J Am Diet Assoc. 2011;111:1236–41.

    Article  Google Scholar 

  21. Rosen DS. American Academy of Pediatrics Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2010;126:1240–53.

    Article  PubMed  Google Scholar 

  22. American Psychiatric Association. Treatment of patients with eating disorders, third edition. Am J Psychiatry. 2006;163(7 Suppl):4–54.

    Google Scholar 

  23. Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E. Academy of eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord. 2009;42:97–103.

    Article  PubMed  Google Scholar 

  24. Whitelaw M, Gilbertson H, Lam PY, Sawyer SM. Does aggressive refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia? J Adolesc Health. 2010;46:577–82.

    Article  PubMed  Google Scholar 

  25. Garber AK, Michihata N, Hetnal K, Schafer MA, Moscicki AB. A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health. 2012;50:24–9.

    Article  PubMed  Google Scholar 

  26. Garber AK, Mauldin K, Michihata N, Bucklew SM, Shafer MA, Moscicki AB. Higher calorie diets increase rate of weight gain and shorten hospital stay in hospitalized adolescents with anorexia nervosa. J Adolesc Health. 2013;53:579–84.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Golden NH, Keane-Miller C, Sainani KL, Kapphahn CJ. Higher caloric intake in hospitalized adolescents with anorexia nervosa is associated with reduced length of stay and no increased rate of refeeding syndrome. J Adolesce Health. 2013;53:573–8.

    Article  Google Scholar 

  28. Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, Garber AK, Kohn M, Kreipe RE. Update on the medical management of eating disorders in adolescents. J Adolesc Health. 2015;56:370–5.

    Article  PubMed  Google Scholar 

  29. Garber AK, Sawyer SM, Golden NH, Guarda AS, Katzman DK, Kohn MR, Le Grange D, Madden S, Whitelaw M, Redgrave GW. A systematic review of approaches to refeeding in patients with anorexia nervosa. Int J Eat Disord. 2016;49(3):293–310.

    Article  PubMed  Google Scholar 

  30. Reber E, Friedli N, Vasiloglou MF, Schuetz P, Stanga Z. Management of refeeding syndrome in medical patients. http://www.mdpi.com/journal/jcm. Accessed 18 Dec 2019.

  31. Schwartz BI, Mansbach JM, Marion JG, Katzman DK, Forman SF. Variations in admission practices for adolescents with anorexia nervosa: a North American sample. J Adolesc Health. 2008;43:425–31.

    Article  PubMed  Google Scholar 

  32. Position of the American Dietetic Association. Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders. J Am Diet Assoc. 2006;106:2073–82.

    Article  Google Scholar 

  33. Solomon SM, Kirby DF. The refeeding syndrome. A review. J Parenter Enteral Nutr. 1990;14:90–7.

    Article  CAS  Google Scholar 

  34. Ornstein RM, Golden NH, Jacobson MS, Shenker IR. Hypophosphatemia during rehabilitation in anorexia nervosa: implications for refeeding and monitoring. J Adolesc Health. 2003;32:83–8.

    Article  PubMed  Google Scholar 

  35. Marinella MA. The refeeding syndrome and hypophosphatemia. Nutr Rev. 2003;61:320–3.

    Article  PubMed  Google Scholar 

  36. Lund BC, Hernandez ER, Yates WR, Mitchell JR, McKee PA, Johnson CL. Rate of inpatient weight restoration predicts outcome in anorexia nervosa. Int J Eat Disord. 2009;42:301–5.

    Article  PubMed  Google Scholar 

  37. Mosley PE. Bigorexia: bodybuilding and body dysmorphia. Eur Eat Disord Rev. 2009;17:191–8.

    Article  PubMed  Google Scholar 

  38. Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: The National Academies Press; 2005.

    Google Scholar 

  39. Murray SB, Rieger E, Hildebrand T, Karlov L, Russell J, Boon E, Dawson RT, Touz SW. A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa. Body Image. 2012;9:193–200.

    Article  PubMed  Google Scholar 

  40. Weigle DS, Breen PA, Matthys CC, Callahan HS, Meeuws KE, Burden KE, Burden VR, Purnell JQ. A high-protein diet induces reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. Am J Clin Nutr. 2005;82:41–8.

    Article  CAS  PubMed  Google Scholar 

  41. Griffiths S, Murray SB, Touz S. Disordered eating and the muscular ideal. J Eat Disord. 2013;1:15.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Westerterp KR, Wilson SAJ, Rolland. Diet induced thermogenesis measured over 24h in a respiration chamber: effect of diet composition. Int J Obes Metab Disord. 1999;23:287–92.

    Article  CAS  Google Scholar 

  43. Nagata JM, Peebles R, Bell Hill K, Gorrell S, Carlson JL. Associations between ergogenic supplement use and eating behaviors among university students. Eat Disord. 2020. In Press.

    Google Scholar 

  44. Leclerc A, Turrini T, Sherwood K, Katzman DK. Evaluation of a nutrition rehabilitation protocol in hospitalized adolescents with restrictive eating disorders. J Adolesc Health. 2013;53:585–9.

    Article  PubMed  Google Scholar 

  45. El Goch M, Milanese C, Calugi S, Pelligrini M, Battistini NC, Dalle GR. Body composition, eating disorder psychopathology, and psychological distress in in anorexia nervosa. A longitudinal study. Am J Clin Nutr. 2014;99:771–8.

    Article  CAS  Google Scholar 

  46. Misra M, Golden NH, Katzman DK. State of the art systematic review of bone disease in anorexia nervosa. Int J Eat Disord. 2016;49(3):276–92.

    Article  PubMed  Google Scholar 

  47. Vo M, Lau J, Rubinstein M. Eating disorders in adolescent and young adult males: presenting characteristics. J Adolesc Health. 2016;59(4):397–400.

    Article  PubMed  Google Scholar 

  48. Khosla S, Amin S, Orwoll E. Osteoporosis in men. Endoc Rev. 2008;29(4):441–64.

    Article  CAS  Google Scholar 

  49. Mehler PS, Sabel AL, Watson T, Anderson AE. High risk of osteoporosis in male patients with eating disorders. Int J Eat Disord. 2008;41:666–72.

    Article  PubMed  Google Scholar 

  50. Misra M, Katzman DK, Cord J, Manning SJ, Mendes N, Herzog DB, Miller KK, Klibanski A. Bone metabolism in adolescent boys with anorexia nervosa. J Clin Endocrinol Metab. 2008;93(8):3029–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Nagata JM, Golden NH, Leonard MB, Copelovitch L, Denburg MR. Assessment of sex differences in fracture risk among patients with anorexia nervosa: a population-based cohort study using the health improvement network. J Bone Miner Res. 2017;32(5):1082–9.

    Article  CAS  PubMed  Google Scholar 

  52. Nagata JM, Golden NH, Peebles R, Long J, Leonard MB, Chang AO, Carlson JL. Assessment of sex differences in bone deficits among adolescents with anorexia nervosa. Int J Eat Disord. 2017;50(4):352–8.

    Article  PubMed  Google Scholar 

  53. Mészáros S, Tóth E, Ferencz V, Csupor E, Hosszú É, Horváth C. Calcaneous quantitative ultrasound measurements predicts vertebral fractures in idiopathic male osteoporosis. Joint Bone Spine. 2007;74(1):79–84.

    Article  PubMed  Google Scholar 

  54. Grinspoon S, Thomas L, Miller K, Herzog D, Klibanski A. Effects of recombinant human IGF-1 and oral contraceptive administration on bone density in anorexia nervosa. J Clin Endocrinol Metab. 2002;87:2883–91.

    Article  CAS  PubMed  Google Scholar 

  55. Rigaud D, Boulier A, Tallonneau I, Brindisi MC, Rozen R. Body fluid retention and body weight change in anorexia nervosa patients during refeeding. Clin Nutr. 2010;29:749–55.

    Article  PubMed  Google Scholar 

  56. Stheneur C, Bergeron S, Lapeyraque AL. Renal complications in anorexia nervosa. Eat Weight Disord. 2014;19:455–60.

    Article  PubMed  Google Scholar 

  57. Whitelaw M, Gilbertson H, Lee KJ, Sawyer SM. Restrictive eating disorders among adolescent inpatients. Pediatrics. 2014;134:e758–64.

    Article  PubMed  Google Scholar 

  58. Sawyer SM, Whitelaw M, Le Grange D, Yeo M, Hughes EK. Physical and psychological morbidity in adolescents with atypical anorexia nervosa. Pediatrics. 2016;137:e20154080.

    Article  PubMed  Google Scholar 

  59. Striegel-Moore RH, Rosselli F, Perrin N, DeBar L, Wilson GT, May A, Kraemer HC. Gender difference in the prevalence of eating disorder symptoms. Int J Eat Disord. 2009;42(5):471–4.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Lavender JM, De Young KP, Anderson DA. Eating disorder examination questionnaire (EDE-Q): norms for undergraduate men. Eat Behav. 2010;11(2):119–21.

    Article  PubMed  Google Scholar 

  61. Wansink B, Cheney MM, Chan N. Exploring comfort food preferences across age and gender. Physiol Behav. 2003;79(4–5):739–47.

    Article  CAS  PubMed  Google Scholar 

  62. Murray SB, Griffiths S, Hazery L, Shen T, Wooldridge T, Mond JM. Go big or go home: a thematic content analysis of pro-muscularity websites. Body Image. 2016;16:17–20.

    Article  PubMed  Google Scholar 

  63. Pila E, Mond JM, Griffiths S, Mitchison D, Murray SB. A thematic content analysis of# cheat meal images on social media: characterizing an emerging dietary trend. Int J Eat Disord. 2017;50(6):698–706.

    Article  PubMed  Google Scholar 

  64. McMaster CM, Wade T, Franklin J, Hart S. A review of treatment manuals for adults with an eating disorder: nutrition content and consistency with current dietetic evidence. Eat Weight Disord. 2020; https://doi.org/10.1007/s40519-020-00850-6. [Epub ahead of print].

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Whitelaw, M., Nagata, J.M. (2021). Nutritional Considerations for Boys and Men with Eating Disorders. In: Nagata, J.M., Brown, T.A., Murray, S.B., Lavender, J.M. (eds) Eating Disorders in Boys and Men. Springer, Cham. https://doi.org/10.1007/978-3-030-67127-3_11

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  • DOI: https://doi.org/10.1007/978-3-030-67127-3_11

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