ORLANDO, FLA. — Anorexia nervosa in males is often accompanied by compulsive exercising, which tends to be driven more by a desire for muscularity than a desire to lose weight, Theodore Weltzin, M.D., said at an international conference sponsored by the Academy for Eating Disorders.
Unlike most anorexic women with an exercise compulsion, very few men say their disease began with weight loss attempts, said Dr. Weltzin, medical director of the eating disorder programs at Rogers Memorial Hospital, Oconomowoc, Wisc.
With male patients, the focus is generally on developing upper body strength, and it often is fueled by an unrealistic desire to achieve the muscular male body type that is increasingly featured in advertisements and elsewhere in the popular media, he said during a workshop at the conference, which was cosponsored by the University of New Mexico.
Chief among the signs that a patient is exercising compulsively are following a rigid daily exercise schedule, exercising while injured, experiencing a negative mood when unable to exercise, harboring unrealistic expectations regarding exercise, and allowing exercise to take the place of other priorities.
Dr. Weltzin described a 19-year-old patient with comorbid obsessive-compulsive disorder who ran 8-10 miles twice each day, and a 45-year-old who had to exercise any time he ate.
“For this (latter) patient, the exercise was more about purging his feelings than about purging calories,” Dr. Weltzin said, explaining that through therapy, the patient pinpointed the start of his disease to high school football camp when his coach called him “fat ass.”
Treatment of male patients with a compulsive exercise component to their disease can be quite challenging.
In Dr. Weltzin's experience, there is a “higher level of intensity” in terms of the psychological withdrawal experienced by men, compared with women, who undergo treatment for eating disorders with such a compulsive exercise component.
Treatment initially requires abstinence from all exercise while eating and weight are normalized.
Noncardiovascular exercise in a controlled environment is gradually added back into the patient's routine as appropriate.
Exercise can continue to be added back to the routine as long as the amount of exercise is reasonable, the patient maintains normal nutritional status, and it is enjoyable rather than compulsive. A “health mentor” or exercise group can be helpful.
Meanwhile, the patient should be encouraged to develop nonexercise interests as well, Dr. Weltzin noted.
In males with anorexia and compulsive exercising, weight maintenance is a sign that treatment is working, he added.
Men Respond Differently to Treatment
Far less is known about eating disorders and their treatment in men than in women, but a recent pilot study looking at outcomes provides some insight.
Data from the follow-up study of 7 men and 26 women who were discharged from a residential treatment program at Rogers Memorial Hospital suggest that men are less concerned about weight loss and that they gain more weight following treatment than do women, Dr. Weltzin reported (J. Addict. Dis. 2004;23:83-94).
Men gained an average of 19 pounds during follow-up; women gained an average of 7 pounds. About 40% more women than men said their weight was too high.
Furthermore, when men were dissatisfied with their bodies, they said they should be more muscular, not thinner, Dr. Weltzin noted.
A finding that patients with a higher weight at follow-up had a higher weight at discharge was consistent with findings from another recent study, which showed that low discharge weight is a critical risk factor in eating disorder relapse, he said.
In this study, higher weight at follow-up was more likely in males than in females.