Sex Differences in Eating Disorder Treatment

Males are receiving treatment for EDs more frequently than in the past. How (if at all) should treatment approaches differ for males and females? Dr. Jason M. Nagata of the University of California, San Francisco, and colleagues concluded that some differences do (and likely should) exist (Int J Eat Disord. 2021. doi: 10.1002/eat.23660. Published online ahead of print.).

In this study, records for 601 people 9 to 25 years of age who were receiving inpatient treatment for eating disorders were reviewed. The authors sought to determine sex differences in refeeding (i.e., short-term nutritional rehabilitation) outcomes among hospitalized adolescents and young adults with eating disorders. The focus was on nutritional and weight-gain-related factors.

A final group of 588 adolescents and young adults (19% male) were included in the study.

Higher energy needs, longer hospital stays

Not surprisingly, the results showed that males had higher estimated energy requirements than females (3694 vs. 2925 kcal, respectively). Males and females were prescribed similar amounts of food at admittance (around 2000 kcal), but by discharge males were prescribed about 800 kcal more than females. The length of hospital stay was also longer for males than females (11 days vs. 9.4 days, respectively), which one might view as relatively short, but it is important to recall that this was inpatient treatment focusing on medical management and refeeding. In unadjusted comparisons, there were no significant sex differences in prescribed kcal per day at admission between males and females (2013 kcal vs. 1980 kcal, respectively; p = .188). However, males also had higher estimated energy requirements (EER, kcal) than females: (3694 kcal vs. 2925 kcal, respectively; p < .001). In linear regression models adjusting for potential confounders, male sex was associated with higher prescribed kcal at discharge (B = 835 kcal; p < .001), greater weight change (B = 0.47 kg; p = .021), and longer length of stay (B = 1.94 days; p = .001) than females. Older age, lower weight on admission, lower prescribed kcal at admission, higher EER, and lower heart rate at admission were all factors associated with longer stays when reviewed in a linear regression model.

These are valuable results. The authors recommend taking an individualized approach to male eating disorder patients. The authors correctly note that existing guidelines are generally not sex-specific, but the results from this study suggest that, at least in regard to refeeding, they should be.