FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

MEN, TOO, CAN SUFFER AND DIE FROM ANOREXIA!

Question: My son recently passed away after a prolonged battle with anorexia nervosa. I don't see many articles about this disorder, and those that I do see usually don't mention that it can be fatal or that it affects men. Would you comment on anorexia nervosa.

Answer: Eating is essential for all of us it provides the nutrients necessary to sustain life. The act of eating generally involves much more that this, however. It is a form of socialization, a form of personal comfort, a response to stress, or a reward, just to name a few of the possible reasons people eat.

The physical need for food is often separated from the emotional needs for eating. The consequence of this is that many of us suffer from health problems that are a consequence of our own eating behavior. Obesity is far and away the most common, in part because of our affluent society. Recent studies estimate that one third of the adult population is overweight, and potential health consequences multiply as the degree of obesity increases.

At greatest risk are those in a category we called "morbidly obese." These are people who are more than twice their ideal weight, or are at least 100 pounds more than their ideal weight. About 0.6 percent of men and 2.5 percent of women are morbidly obese, which will probably be directly responsible for their premature death.

Anorexia nervosa is the opposite end of the eating disorder spectrum. Individuals with this problem view themselves as being overweight even when the obvious evidence shows that they are underweight. At the onset there is often a rapid weight loss as they begin a very restrictive diet. Excessive exercise often accompanies this dietary change. The weight continues to fall until it is well below what is appropriate for that person's height and frame size. Very unusual food preferences and strange eating rituals are also frequently present.

Bulimia nervosa is another eating disorder that often occurs with anorexia or with obesity. Individuals suffering from this disorder typically have binge eating, during which they may consume up to 30,000 calories in a day, and follow this with self-induced vomiting, purging or use of diuretics.

Both anorexia and bulimia occur 20 times more frequently in women than they do in men. This is why most articles about these topics focus on 15- to 30-year-old women. They are "typical" of those with the condition, but as your unfortunate experience demonstrates, males are stricken with these problems, too. And as your experience shows, 5 to 10 percent of those with anorexia die from the complications of this chronic, psychiatric condition.

Treatment of any eating disorder is a long-term process that is about as likely to be successful as it is to fail. Forty to 50 percent of individuals with bulimia are cured after 10 years of cognitive-behavioral counseling when used with medical intervention for the resulting other non-psychiatric problems. Results are similar for anorexia, but there is a lower success rate for treatment of obesity.

Your son, unfortunately, was among those with anorexia that didn't respond to medical and psychiatric help. My "take home" advice for the rest of my readers is to realize that this disorder can often be cured. If you are disturbed because an adolescent or young adult in your family has experienced a significant change in weight - either loss or gain - do all you can to make sure he or she sees a doctor for a physical and psychological evaluation. Their initial reaction to your attempts to help will invariably be that they don't have problem and, therefore, don't need help. Remember that those with eating disorders don't have an accurate assessment of their weight or body shape. That's why you'll need to be persistent!

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.