In the Lancet for June 3 three doctors from Iowa maintain, after a retrospective survey of patients admitted to hospital because of serious eating disorders, that such disorders, notably anorexia nervosa and bulimia nervosa, are as common in men as in women, and may be more severe. Serious behavioural syndromes affecting eating habits are calculated to occur in about 5 per cent of adolescents. A common medical complication in women has been a deficiency of bone minerals, but such a condition in men has been little reported.
The causes of deficient bone mineral density in men suffering eating disorders are speculative, but are probably similar to those in women with anorexia nervosa. Contributory factors are weight loss and restricted dietary intake of calcium. An additional factor in men may be a lowered testosterone level. Testosterone is known to stimulate development of bone mineral density. Men with anorexia are more deficient in bone mineral than women with anorexia and bulimia, while the deficiency in men with bulimia is greater than in anorexia. This last finding is unexpected, and is probably connected with testosterone deficiency. In men with eating disorders, osteopenia and osteoporosis may be looked for as medical complications.
Since many men are involved in contact sports or other activities with a high physical impact risk, there is a need for them to be advised to limit their exercise habits to prevent fractures, until such time as their bone mineral density can be improved by therapy. On the other hand, moderate weight-bearing exercise free from high impact risk is beneficial in aiding bone accretion in conjunction with calcium and vitamin D supplementation.
These findings make an intriguing sequel to a critical attack in the British Medical Journal for June 3 on the advertising media's habit of presenting a slim body image as the ideal to be pursued by women. Abnormal dieting is assumed to be precipitated by excessive concern over the weight or shape of the body. Whether men are subject to the same sort of mental constraints is a tantalising question.