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The medical and scientific understanding of eating disorders is changing and expanding. What happened?
Dr. Smith: Historically, eating disorders have been conceptualized primarily as anorexia, which has been described as an illness of adolescent women who want to lose weight for aesthetic reasons.
Dr. Nagata: There is increasing recognition, especially in the last decade, that some people with body image dissatisfaction do not try to lose weight at all. Some men and boys They are trying to get big and muscular. In fact, one-third of teenagers in the United States report that 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 someone thinks their body is weak or not muscular enough, even if objectively other people would consider them fit or athletic.
Dr. Smith: It may be 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 guide these behaviors may not align with being thinner, but we still see very similar behaviors. We see the obsessive exercise. We see eliminating certain types of foods. We see a marked dietary restriction. And then there are those who choke or vomit, are afraid of it or have always been picky eaters and fall off their growth curve. And because children and teens grow and develop so quickly, those changes can lead to some pretty serious medical complications.
These complications can lead to a state of starvation. What does that mean?
Dr. Smith: It is a mismatch between a person’s energy or nutrient needs and what they are actually putting into their body.
Dr. Nagata: When your body constantly exerts more energy than it absorbs, that 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 there’s not enough recognition that starvation can occur among people who exercise too much without getting enough nutrition.
So is there an overlap between children and athletics?
Dr. Nagata: Yes absolutely. I think kids who are athletes 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 consequences among 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 do not menstruate. It’s another example of our gender bias and how we approach this disease.
Dr. Smith, you have done some of the most up-to-date research on eating disorders, including the finding that eating disorders severely affect children.
Dr. Smith: I looked at more than 11,000 hospitalizations in Ontario for eating disorders among children and adolescents aged 5 to 17 between 2002 and 2019. What I found was that while hospitalization rates increased overall by 139 per cent, the largest relative increase was occurred among men: their rate of hospitalizations increased by 416 percent. Common causes of hospitalization would include indications such as very low heart rate, abnormal blood mineral markers, 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. Have a recent study which focused on children who were hospitalized for eating disorders in the United States. We found that compared to hospitalized girls, boys actually have more serious medical complications. Boys have longer hospital stays, greater heart rhythm abnormalities, and higher rates of anemia than girls. This may partly reflect that children are often identified or diagnosed later.