A recent large-scale
study of adolescents in the US showed that significant numbers of young males
experience unhealthy weight control behaviors. How are eating disorders in
males different than in females? Are there special considerations for this
population? Diane Dermarderosian, medical director of Hasbro Children’s
Hospital Partial Hospital Program and assistant professor (clinical) of
pediatrics, sheds some light.
Males develop eating disorders
more frequently than previously understood. While the prevalence is
controversial, most recent estimates are that 1 in 4 patients with
eating disorders is male. The epidemiology is difficult to characterize,
but we know that in males, there is frequently a more significant delay
between emergence of symptoms and initiation of treatment. Factors
contributing to this include shame about diagnosis, inadequate screening
by providers, and a delay in referral to appropriate treatment even
when the diagnosis has been made.
Males and females share many
risk factors and clinical characteristics. Eating disorders are an
outward expression of and coping mechanism for emotional distress. The
factors causing them include genetic, psychological, biological,
familial, environmental, and social influences. They are associated with
significant morbidity and mortality for both genders.
That said, males are
susceptible to a range of different risks than females. They are often
more concerned with shape than weight, looking to optimize lean
muscularity with minimal body fat. They tend to increase exercise rather
than restrict calories. Risks include a history of being teased for
childhood obesity, a desire to improve sports performance, an attempt to
avoid medical illness, and an effort to improve a gay relationship.
Exercise and athletic competition represent a particular risk. Although
being gay increases the risk due to rigid sociocultural body image
ideals, most men with eating disorders are not gay or bisexual.
While there is limited research about males and eating
disorders, studies suggest that the prognosis is equal to or better than for
females. The key to optimizing prognosis for all patients is prompt and
comprehensive treatment. The core treatment principles for males and females
include nutritional rehabilitation, medical stabilization, and psychological
support to promote behavioral change. Establishing “male-only” support groups
Last fall, biotech company Sequenom began marketing
MaterniT21, a prenatal screening test for trisomy 21, or Down syndrome.
Professor Jacob Canick, PhD, and Associate Professor (Research) Glenn Palomaki,
PhD, in the Division of Medical Screening and Special Testing in the Department
of Pathology and Laboratory Medicine at Women & Infants Hospital, published
their study of the test in the journal Genetics in Medicine. In 1988,
Canick and Palomaki were involved in the development of prenatal triple marker
screening, which is now used throughout the world.
How does the new DNA-based screening test for Down syndrome
work and who might take advantage of it?
The test extracts the small fragments of maternal and fetal
DNA that circulate in the mother’s blood. The DNA is analyzed, looking for a
slight increase in the proportion of DNA fragments derived from chromosome 21,
which signals Down syndrome. In our study, the test identified 98.6 percent
(209/212) of the Down syndrome pregnancies, while only 0.2 percent of the
normal pregnancies were mistakenly called positive. The mothers included in the
study sample were all at high risk for having a child with Down syndrome—they
were older than 38 years of age, had had abnormal ultrasound findings, or
abnormal results for one of the maternal serum screening tests that are
The problem with current prenatal tests for Down syndrome is
the false positive rate of 2 to 5 percent needed to identify about 90 percent
of cases. After a positive screening result, pregnant women are offered either
amniocentesis or chorionic villus sampling. These are diagnostic tests that will
reliably identify any genetic anomalies in the fetus, but both are invasive
procedures that carry about a 1 in 200 risk for fetal loss. With the new
DNA-based test the number of these procedures is dramatically reduced because
it would be unusual to have a woman originally at high risk who also has a
positive DNA test have a normal pregnancy.