Downs James, Kelly Clive
King's College London, London, UK.
Department of Rheumatology, James Cook University Hospital, Middlesbrough, UK.
Br J Hosp Med (Lond). 2025 Jun 25;86(6):1-15. doi: 10.12968/hmed.2024.0643. Epub 2025 Jun 5.
Anorexia Nervosa (AN) in males is often overlooked due to the traditional perception of eating disorders as female concerns. Despite this, there has been an increased focus on male presentations. Research evidence, including concerns from people with lived experience, highlights specific risks and unmet clinical needs as a result of delayed help-seeking, inaccessible services, and treatment that does not account for men's needs. Published research and personal narrative from an author with lived experience are combined to assess (1) existing evidence and gaps in knowledge and treatment for males with AN, and (2) solutions which may address challenges across research, policy, and clinical practice. There is an increased prevalence of AN amongst males, with most recent data from National Health Service (NHS) England showing a faster increase in hospitalisations amongst males compared with females. However, the quantity and quality of prevalence data and research into the drivers of this trend are severely lacking. The exclusion of males from clinical research has hindered efforts to assess the efficacy of current AN treatments, despite emerging evidence for males-specific symptoms and health impacts across biopsychosocial domains. These include more frequent use of excessive exercise, feelings of emasculation, neurodivergence, and specific physiological risks occurring at higher weights than females. These factors combine with under-resourced treatment provision which often feels exclusionary to males to create an increased risk of death and significant barriers to recovery. Evidenced solutions for providing more timely recognition and effective treatment for males with AN are limited, emphasising the importance of further research. Present-day clinical practice needs to ensure the safe medical management of males with AN, taking an integrated approach to treatment that accounts for co-occurring conditions and minority status identities. Being more responsive to the needs of males with AN and removing the barriers to effective care can be aided by projects that collaborate with men with lived experience.
由于传统观念认为饮食失调是女性才有的问题，男性神经性厌食症（AN）常常被忽视。尽管如此，男性患者的情况越来越受到关注。包括有实际患病经历者所表达的担忧在内的研究证据表明，由于寻求帮助延迟、服务难以获得以及治疗未考虑男性需求，导致了特定风险和未满足的临床需求。本文结合已发表的研究和一位有实际患病经历的作者的个人叙述，来评估：（1）关于男性神经性厌食症患者现有证据以及知识和治疗方面的差距；（2）可能解决研究、政策和临床实践中各种挑战的方案。男性神经性厌食症的患病率呈上升趋势，英国国家医疗服务体系（NHS）的最新数据显示，男性住院人数的增长速度快于女性。然而，患病率数据的数量和质量以及对这一趋势驱动因素的研究严重不足。尽管有新证据表明男性存在特定症状以及在生物心理社会各领域对健康有影响，但男性被排除在临床研究之外，这阻碍了评估当前神经性厌食症治疗效果的努力。这些影响包括更频繁地过度运动、有 emasculation（该词可能有误，推测是“男性特质缺失感”之类意思，因原词不太准确暂保留）的感觉、神经差异以及在体重高于女性时出现的特定生理风险。这些因素与资源不足的治疗服务相结合，而这些服务往往让男性感觉被排斥，从而增加了死亡风险和康复的重大障碍。为男性神经性厌食症患者提供更及时识别和有效治疗的经证实的解决方案有限，这凸显了进一步研究的重要性。当今的临床实践需要确保对男性神经性厌食症患者进行安全的医疗管理，采用综合治疗方法，考虑到并发疾病和少数群体身份。与有实际患病经历的男性合作的项目有助于更积极地响应男性神经性厌食症患者的需求并消除有效护理的障碍。
