Recently, I had the opportunity to discuss topics in eating disorders with Dr. Arnold Andersen, not only a world renowed eating disorders specialist, author of several books including Making Weight: A Men's Guide to Problems with Food, Weight and Shape; Eating Disorders: Guide to Medical Care and Complications and Males with Eating Disorders, but a fellow University of Iowa colleague and mentor.
LM: In the past few years, there have been more men coming forward to discuss their battles with eating disorders. Do you feel that stigma among men has decreased?
AA: Unfortunately, not. Stigma is still high at this time.
LM: Can you estimate the prevalence of eating disorders in boys and men?
AA: At this time, the community based estimate is three female sufferers for every male sufferer. Clinical studies also underestimate males.
LM: How do you explain the lack of self care in men?
AA: This is an assumption, probably founded, based on the lower percentage of males who go to doctor for any reason. The answer is probably sociological and perhaps neurobiological.
LM: I have noticed that eating disorders, mainly anorexia in young boys generally develops for different reasons and is treated differently than older boys. Can you speak about treatment prognosis for different disorders at various ages?
AA: Prognosis is as good or better for males. I conducted a study a Johns Hopkins and others have conducted studies with similar results. Old ideas about being sicker or harder to treat or worse prognosis are out of date.
LM: What can parents do to bolster the self-esteem of their sons to help prevent eating disorders?
AA: Individualize parent-child interaction so each has a sense of competence within their biological endowment—the skinny, slow to development boy needs more patient encouragement than the early mesomorph with natural athletic skills. Talk over issues of body image at home. Learn media skepticism.
LM: How should a parent address an overweight child?
AA: Complex issue—the key is to nip it in the bud by understanding family history creates a vulnerability to genetic obesity where present. No tv/video games until an hour of daily physical activity and serve healthy balanced meals without concentrated sweets or fats at homes.
LM: Would it be your recommendation that the entire family change their eating habits to incorporate more healthy choices, not just the identified patient?
AA: The whole family of an obese child, unless the obesity is driven by medication, will benefit from a life-long approach to high volume, low-density meals, with fast food once a week maximum, lots of fruits and vegetables done in tasty manner. It’s not that hard to make the changes gradually. Families need to know that it takes about 6 weeks for a change to taste good, for example, decreasing salt. What is not recommended is different meals for different family members, or any focus on weight or calories. Eating as a family is a nurturing experience. There is a good study that showed that there is a direct inverse correlation between the number of meals a family eats together and the probability of developing an eating disorder or drug abuse.
LM: What do you recommend to parents of boys who aren't naturally athletically inclined, yet strive to do well in sports?
AA: The U.S. needs to stop the divide that occurs around 7th grade into elite athletes and bench warmers. It is a major mistake to stop taking P.E. seriously. Studies have shown that aerobic activity improved academics, especially ADHD. By having all children involved in sports at their peer level at every grade, as is done in Scandinavia, each kid can develop enjoyment and competence about their bodies. The key is to emphasize enjoyment and lifetime carry through skills. The kiss of death is when one sibling is compared to another negatively or parents are critical of the boy’s best efforts (like the out of control dads and moms you see at some soccer games). In Norway, each town has sports clubs for people of every ability. Each poor child in Oslo who receives state support must receive a pair of cross country skis—it’s considered basic, not an extra for elites. Also, tailoring the boy’s body type, stage of development, height, weight, fast-twitch vs. slow-twitch muscle balance to different types of sports is important. Not everyone needs to be a quarterback.
LM: Thank you, Dr. Andersen
AA: Best Wishes.
Dr. Andersen is especially interested in the integration of biomedical and psychosocial therapies, the gender factor in behavioral disorders, the neurobiology of eating disorders, medical complications of eating disorders, and cross-cultural studies. He and colleagues have published numerous peer-reviewed research studies, clinical teaching chapters in books, and presented outcome and other research studies at local, national, and international meetings. His background includes Cornell Medical College, a medical internship, board certification in psychiatry, 15 years on the faculty of Johns Hopkins Medical Institutions, and participation in numerous scientific groups.
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