Sex Differences in Refeeding Among Adolescents and Young Adults Hospitalized for Eating Disorders

Full Description: Eating disorders (ED) are illnesses in which people experience severe disturbances in their eating behaviors and emotions. The age group most affected by ED are adolescents and young adults between the ages of 12 and 25 years. If left untreated, mortality rates for ED, such as chronic anorexia nervosa, can be as high as 20%.

The misconception that ED only occur in females contributes to the stigmatization of ED and explains why males wait longer to seek treatment, resulting in the presentation of more severe health conditions. Evidence suggests that ED among males are under-recognized and under-treated, given that less than 1% of body image and ED research has focused specifically on males. Despite sex differences in the medical presentation of ED, there are no sex-specific guidelines for the treatment of ED.

To address sex inequities inherent in the existing female-centric treatment guidelines and to investigate what changes are necessary to create more equitable and tailored treatment of ED in the future, we aimed to assess sex differences in refeeding outcomes among adolescents and young adults hospitalized for ED. We retrospectively reviewed electronic medical records of 601 patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program between May 2012 and August 2020 for medical and nutritional management. Descriptive statistics, crude, and adjusted linear regression models were used to assess the association between sex and nutritional outcomes and predictors of length of stay. Not surprisingly, we found that males require greater kilocalories and time to meet their treatment goal weight, defined as the specific weight needed to achieve physical, emotional and social functioning to be discharged from the hospital. To our knowledge, this is the first study to document the association of male sex with longer hospitalizations, suggesting that current treatment guidelines for the treatment of ED may be inadequate for males.

The involvement of caretakers and stakeholders across the MCH spectrum such as youth with lived experience, policy makers, family leaders, community advocates, and clinicians is needed to raise awareness of and demystify harmful misconceptions about males with ED. This is necessary for research findings, like our own, to inform the guidelines for the treatment of patients with ED.

My poster aligns with the conference theme by reflecting on the past primary focus on females with ED, how that led to the current female-centric treatment guidelines for patients with ED, and what needs to change in the future. This poster will enhance attendees’ MCH knowledge base by: 1) describing the current inpatient refeeding protocol using a storytelling approach, 2) presenting quantitative findings from our study, and 3) providing recommendations for how future treatment of patients with ED, including males and non-binary groups, can be improved.

Abbreviated Description: To address sex inequities inherent in the existing female-centric treatment guidelines for eating disorders (ED), we retrospectively reviewed electronic medical records of 601 patients aged 9-25 years. These patients were admitted to the University of California, San Francisco Eating Disorders Program between May 2012 and August 2020 for medical and nutritional management. Descriptive statistics and adjusted linear regression models were used to assess the association between sex and nutritional outcomes. This poster will enhance attendees’ MCH knowledge base by: 1) describing the current inpatient refeeding protocol, 2) presenting quantitative findings from our study, and 3) providing recommendations for how future treatment of patients with ED can be improved.