Gender Differences in Treatment Outcomes for Eating Disorders: A Case-Matched, Retrospective Pre–Post Comparison

Abstract

Eating disorders (EDs) are increasingly emerging as a health risk in men, yet men remain underrepresented in ED research, including interventional trials. This underrepresentation of men may have facilitated the development of women-centered ED treatments that result in suboptimal outcomes for men. The present study retrospectively compared pre- vs. post-treatment outcomes between age-, diagnosis-, and length-of-treatment-matched samples of n = 200 men and n = 200 women with Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), or Eating Disorder Not Otherwise Specified (EDNOS), treated in the same setting during the same period, and using the same measurements. Compared to women, men with AN showed marked improvements in weight gains during treatment as well as in ED-specific cognitions and general psychopathology. Likewise, men with BED showed marked weight loss during treatment compared to women with BED; ED-specific cognitions and general psychopathology outcomes were comparable in this case. For BN and EDNOS, weight, ED-specific cognitions, and general psychopathology outcomes remained largely comparable between men and women. Implications for treatments are discussed.

Gender differences in individuals with obesity and binge eating disorder: A retrospective comparison of phenotypical features and treatment outcomes

“…Thus far, the reasons for pronounced weight reductions with simultaneous parity in psychopathology outcomes remain elusive, as we cannot exclude that established assessments (like the EDE‐Q) may be less sensitive towards capturing men‐specific psychopathology. As argued elsewhere (Halbeisen, Braks, et al., 2022), men may show pronounced weight reductions due to higher levels of energy expenditure (Redman et al., 2014), but increased weight reductions could also reflect differences in therapy adherence between men and women. Given the paucity of studies on gender differences in EDs, especially for treatment outcomes in BED, further substantiation of these observations and their long‐term consequences is needed.…”

“…Thus far, the reasons for pronounced weight reductions with simultaneous parity in psychopathology outcomes remain elusive, as we cannot exclude that established assessments (like the EDE-Q) may be less sensitive towards capturing menspecific psychopathology. As argued elsewhere (Halbeisen, Braks, et al, 2022), men may show pronounced weight reductions due to higher levels of energy expenditure (Redman et al, 2014), but increased weight reductions could also reflect differences in therapy F I G U R E 1 Participants' percent weight loss trajectories across 50 days of treatment, as a function of gender and diagnostic group. Curved regression lines (with 95% confidence bands) were fitted using function geom_smooth(), method ('gam'), as implemented in R package ggplot2 Version 3.3.5 (Wickham, 2016).…”

“…Participants consisted of a mixed-gender sample of individuals (180 women, 180 men, M age = 33.76, age range: 13-67 years), with men and women matched and selected based on diagnoses (OB vs. OB + BED; Criterion 1), age (Criterion 2), and total treatment duration (Criterion 3). A total of 676 individuals with OB or OB + BED were identified for selection within a larger clinical population that underwent multimodal inpatient treatment at a rehabilitation clinic specialised in the treatment of EDs in Bad Oeynhausen, Germany, between January 2019 and December 2021 (Halbeisen, Braks, et al, 2022). The treatment followed an 'integrative' psychotherapeutic approach (i.e., cognitive-behavioural therapy and psychodynamic therapy), and further included nutritional rehabilitation, occupational therapies, and an exercise programme.…”

“It’s a Touchy Subject”: Service Providers’ Perspectives of Eating Disorders in Men and Boys

“…Historically, men and boys have been overlooked in most approaches to eating disorders in socio-cultural and medical discourses. The focus has predominantly been on women and girls and on Anorexia and Bulimia Nervosa (Andersen, 1990; Wiseman et al, 1992; Weltzin et al, 2005; Greenberg & Schoen, 2008; Halbeisen et al, 2022a). This gender-biased narrative surrounding eating disorders is starting to change, most notably the adjustments made to the DSM-5 criteria to remove amenorrhea as a gendered criteria (Dakanalis et al, 2016).…”

“…Evidence has found that the core features, such as drive for thinness, impulse regulation, and body dissatisfaction remain similar across both genders (Fernandez-Aranda et al, 2004; Hay et al, 2005; Fairburn, 2008; Bunnell, 2010; Nunez-Navarro et al, 2012). Similarly, research has shown that treatment modalities are equally valid when tested with men and boys (Halbeisen et al, 2022a; Woodside & Kaplan, 1994; Fairburn et al, 2008; Dakanalis et al, 2014) and that being a man is not a predictor for poor treatment outcomes (Fairburn, 2008). As a result, there is an emerging field of literature exploring men’s experience of eating disorders (Robinson et al, 2012; Räisänen & Hunt, 2014; Griffiths et al, 2015).…”