Eating disorder may be missed in boys, non-whites

Doctors screening young people for eating disorders must look beyond the stereotype of these patients as being white teenaged girls in order to identify everyone who needs help, two new studies suggest.

"The instruments that we use as clinicians to diagnose eating disorders were all developed for women and tested on women," Dr. Rebecka Peebles, at the Stanford University School of Medicine in California, told Reuters Health. "They really may not be asking quite the right questions in men."

In research presented earlier this month at the International Eating Disorders Conference in Baltimore, Peebles and her team found that the weight of 104 boys with eating disorders treated at their hospital was close to the ideal for their height - within 95%, on average. However, the boys had lost a higher percentage of their initial body weight than the 1,004 girls treated during the same time period, and were "quite ill" when they were hospitalized.

If boys are "quite disordered" at 95% of their ideal body weight, Peebles noted, current cut-offs that require patients to be at 85% or less of their ideal weight to be diagnosed with an eating disorder may be unsuitable for males.

In the second study, Peebles and her colleagues surveyed visitors to eating disorder-related Web sites about their symptoms and experiences. One finding that surprised them, she said, was that the 15 study participants who identified themselves as American Indians or Alaskan Natives seemed to face a much tougher struggle with their eating disorders than their counterparts of other ethnicities.

For example, 47% reported being hospitalized for their condition, compared to 13% of whites. Native Americans also reported higher maximum weights and lower minimum weights than other ethnic groups, suggesting that they experienced more extremes in weight gain and loss.

They also reported having an eating disorder for a longer period than other ethnic groups, and were more likely to use laxatives to control their weight.

The findings must be viewed with caution, Peebles said, given that these participants represented only a tiny fraction of the hundreds of people who responded to the survey, and that while they identified themselves as American Indian or Alaskan Native, there was no way to confirm their ethnicity.

Nevertheless, she added, the findings raise concerns that eating disorders are hitting Native Americans harder than whites, and that current treatment approaches may be less effective for this ethnic group. "We really need to study American Indians more to see how prevalent are these behaviors and is it something that really should be actively screened for more commonly," she added.

"We need to think more broadly about who struggles with these illnesses, and we need to somehow make the screening process more workable for physicians in the community," Peebles continued. This could help "catch people at an earlier state of their illness," she added, when it is much more treatable.