Healthy Manhattan: Anorexia Is Not Just for Girls

Written by Dr. Cynthia Paulis on . Posted in Healthy Manhattan, Posts.

Mention the word anorexia and the image that comes to mind is a female model sashaying down a runway with toothpicks for arms and legs, size zero body and a scowl on her face because all she eats is a thimble of water and a lettuce leaf. Anorexia was always considered a female eating disorder, but it turns out that an estimated 10 percent of anorexia sufferers are men—and the actual number may be much higher.

Anorexia is an eating disorder where people can literally starve themselves to death, and we are now learning that it is not just a disease of women. People with anorexia eat very little even though they are already thin. They have an intense and overpowering fear of body fat and weight gain. Those with anorexia are often characterized as perfectionists and overachievers who appear to be in control when in reality they suffer from low self-esteem.

Dr. Evelyn Attia, director of the Center for Eating Disorders at Columbia University Medical Center, said: "We are not certain that male anorexia is actually on the rise. We are seeing more men than we have before, but they are still the minority. Eating disorders can affect both men and women. Many doctors out there don’t see a lot of these cases, so they may not have their antennae up for patients who are atypical."

Diagnosing anorexia in males is complicated by the reluctance of men to seek medical help for a disorder that has in the past been considered a woman’s disease, and as a result they suffer in silence.

According to Dr. Attia, most anorexic behavior starts during adolescence, "but we have seen anorexics in our unit ranging in age from 13 to 62."

"We don’t know what causes anorexia but we do have a fair bit of evidence to suggest that genetics plays a part in the story, along with the environment. In cultures where there is no dieting behavior we don’t see anorexia," she said.

She emphasized that in a society like ours, where there is a lot of pressure on thinness, and you take an individual who is biologically and genetically vulnerable, "your environment plus their biology creates the perfect storm, and that person may go on to develop an eating disorder."

For men there is the added pressure to have a six-pack abdomen and a thin, lean body based on all of the media hype.

The most obvious sign of anorexia is weight loss, but men with anorexia tend to keep the weight off with excessive exercise as opposed to women who tend to under eat. Both male and female anorexics share the same traits of low self-esteem and preoccupation with weight.

Without treatment, anorexia can slow the heart rate and lower the blood pressure, thereby increasing the chance of heart failure. Soon the hair and nails of the person will grow brittle and the skin will dry out. Anemia, swollen joints, reduced muscle mass and lightheadedness are a common occurrence among anorexics. Severe cases of anorexia can lead to brittle bones that break easily as a result of loss of calcium.

In males there is a decrease in testosterone. As the disease progresses, electrolyte abnormalities occur, creating abnormal heart rhythms and eventually death.

In addition to physical problems, people with anorexia may also have mental disorders as well, including depression, anxiety disorders, personality disorders, obsessive-compulsive disorders and drug abuse.

Dr. Attia states that with recognition and intervention, most anorexics can recover. The treatment involves not only restoring the weight but behavioral issues as well.

"These treatments aren’t taken care of by popping a pill or checking into a place for a few days or weeks. They are usually months or sometimes longer to really get someone’s behavior moved in a healthier direction," she said.


Dressing in layers to hide weight loss Eating only "safe foods" low in calories and fat Odd rituals of cutting food into small pieces Spending more time playing with food than eating it Cooking meals for others without eating Engaged in compulsive exercising Spending less lime with family andfriends, becoming more isolated, withdrawn and secretive