Long term physical health outcome following in-patient admission in adolescent males with anorexia nervosa—a systematic review

Background: Recent literature has shown that up to one in every four early onset Eating Disorder presentations are male. Males account for 10–25% cases of Eating Disorders. Despite the relatively high prevalence of Eating Disorders in males, the research is limited. Our systematic review focuses on long-term physical health outcomes such as Body Mass Index (BMI)/weight and mortality in males who had undergone psychiatric inpatient admission for Anorexia Nervosa (AN) between the ages of 13 and 17 years. All outcomes were measured at least one year post-discharge. Methods: Articles published in peer reviewed journals between January 2012 and January 2023 in CENTRAL, MEDLINE, Embase and PsycINFO were searched. Following the screening of 1422 abstracts, 63 full text articles were retrieved and assessed for eligibility. Three articles were included in the review, of which, one was a Randomised Control Trial. An updated search completed in May 2025, did not find additional articles for inclusion. Results: In total, 31 males were included across the three studies. Three out of the thirty-one males died at follow-up and all three came from the same study. There was an overall improvement in BMI and BMI percentiles in males across all studies. Conclusions: Due to scarcity in literature focussing on adolescent male AN, it may be difficult to apply our findings within clinical contexts. Our review highlights the importance of addressing this gap in research and issues around providing generic treatments to young people with AN during admission without much consideration to gender differences. The PROSPERO Registration: The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 14 April 2023 (CRD42023407092, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023407092).

Adolescent males; Anorexia nervosa; Physical health; Outcomes; Inpatient admission

[1] Darcy AM, Doyle AC, Lock J, Peebles R, Doyle P, Le Grange D. The eating disorders examination in adolescent males with anorexia nervosa: how does it compare to adolescent females? International Journal of Eating Disorders. 2012; 45: 110–114.

[2] Liu K, Gao R, Kuang H, E R, Zhang C, Guo X. Global, regional, and national burdens of eating disorder in adolescents and young adults aged 10–24 years from 1990 to 2021: a trend analysis. Journal of Affective Disorders. 2025; 388: 119596.

[3] Fombonne E. Anorexia nervosa. No evidence of an increase. British Journal of Psychiatry. 1995; 166: 462–471.

[4] Madden S, Morris A, Zurynski YA, Kohn M, Elliot EJ. Burden of eating disorders in 5–13‐year‐old children in Australia. Medical Journal of Australia. 2009; 190: 410–414.

[5] Wooldridge T, Lytle PP. An overview of anorexia nervosa in males. Eating Disorders. 2012; 20: 368–378.

[6] Weltzin TE, Weisensel N, Franczyk D, Burnett K, Klitz C, Bean P. Eating disorders in men: update. Journal of Men’s Health and Gender. 2005; 2: 186–193.

[7] Jacobsen LM, Haugan G, Dimitropoulous G, Austin A, Sivertsen B, Braaten T, et al. Prevalence of disordered eating and eating disorders among Norwegian university students before and after the COVID-19 pandemic, 2018 and 2022: the SHoT study. Journal of Eating Disorders. 2025; 13: 173.

[8] Gorski M, Polaniak R, Calyniuk B, Garbicz-Kata J, Buczkowska M, Fojcik J, et al. Anorexia nervosa-the frequency of occurrence in Polish youth, the connection with stress, auto-aggressive behaviors and the abuse of psychoactive substances. Frontiers in Psychology. 2025; 16: 1574136.

[9] Satapathy P, Kumar V, Khatib MN, Baldaniya L, Ballal S, Kavitha V, et al. Prevalence of eating disorders in South Asian countries: a systematic analysis of Global Burden of Disease (1990–2021). Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity. 2025; 30: 37.

[10] Gueguen J, Godart N, Chambry J, Brun‐Eberentz A, Foulon C, Divac SM, et al. Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. International Journal of Eating Disorders. 2012; 45: 537–545.

[11] Robinson KJ, Mountford VA, Sperlinger DJ. Being men with eating disorders: perspectives of male eating disorder service-users. Journal of Health Psychology. 2013; 18: 176–186.

[12] Sabel AL, Rosen E, Mehler PS. Severe anorexia nervosa in males: clinical presentations and medical treatment. Eating Disorders. 2014; 22: 209–220.

[13] Mehler PS, Sabel AL, Watson T, Andersen AE. High risk of osteoporosis in male patients with eating disorders. International Journal of Eating Disorders. 2018; 41: 666–672.

[14] Lindblad F, Lindberg L, Hjern A. Anorexia nervosa in young men: a cohort study. International Journal of Eating Disorders. 2006; 39: 662–666.

[15] Strobel C, Quadflieg N, Voderholzer U, Naab S, Fichter MM. Short- and long-term outcome of males treated for anorexia nervosa: a review of the literature. Eating and Weight Disorders—Studies on Anorexia, Bulimia and Obesity. 2018; 23: 541–552.

[16] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. The BMJ. 2021; 372: n71.

[17] Herpertz‐Dahlmann B, Dempfle A, Egberts KM, Kappel V, Konrad K, Vloet JA, et al. Outcome of childhood anorexia nervosa—the results of a five‐ to ten‐year follow‐up study. International Journal of Eating Disorders. 2018; 51: 295–304.

[18] Quadflieg N, Naab S, Voderholzer U, Fichter MM. Long‐term outcome in males with anorexia nervosa: a prospective, sex‐matched study. International Journal of Eating Disorders. 2022; 55: 393–398.

[19] Magill N, Rhind C, Hibbs R, Goddard E, Macdonald P, Arcelus J, et al. Two‐year follow‐up of a pragmatic randomised controlled trial examining the effect of adding a carer’s skill training intervention in inpatients with anorexia nervosa. European Eating Disorders Review. 2016; 24: 122–130.

[20] Sterne J, Mathur MB, Elbers R, Hrobjartsson A, McAleenan A, Reeves B, et al. The risk of bias in non-randomized studies of interventions, version 2 (ROBINS-I V2) assessment tool (for follow-up studies). 2025. Available at: https://www.riskofbias.info/welcome/robins-i-v2 (Accessed: 18 December 2025).

[21] Higgins JPT, Savovic J, Page MJ, Sterne JAC. Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). 2019. Available at: https://www.riskofbias.info/welcome/rob-2-0-tool/current-version-of-rob-2 (Accessed: 18 December 2025).

[22] Goldkuhle M, Kreuzberger N, Neumann I, Brennan S, Meerpohl J, Langendam M, et al. Assessing the certainty of the evidence about effects: principles for assessing the certainty of interventions. 2024. Available at: https://book.gradepro.org/guideline/principles-for-assessing-the-certainty-of-interventions (Accessed: 22 December 2025).

[23] Strobel C, Quadflieg N, Naab S, Voderholzer U, Fichter MM. Long‐term outcomes in treated males with anorexia nervosa and bulimia nervosa—a prospective, gender‐matched study. International Journal of Eating Disorders. 2019; 52: 1353–1364.

[24] Dalle Grave R, Calugi S, Conti M, Doll H, Fairburn CG. Inpatient cognitive behaviour therapy for anorexia nervosa: a randomized controlled trial. Psychotherapy and Psychosomatics. 2013; 82: 390–398.

[25] Halvorsen I, Reas DL, Nilsen JV, Rø Ø. Naturalistic outcome of family‐based inpatient treatment for adolescents with anorexia nervosa. European Eating Disorders Review. 2018; 26: 141–145.

[26] Hergenroeder AC, Wiemann CM, Henges C, Dave A. Outcome of adolescents with eating disorders from an adolescent medicine service at a large children’s hospital. International Journal of Adolescent Medicine and Health. 2015; 27: 49–56.

[27] Calugi S, Franchini C, Pivari S, Conti M, El Ghoch M, Dalle Grave R. Anorexia nervosa and childhood sexual abuse: treatment outcomes of intensive enhanced cognitive behavioural therapy. Psychiatry Research. 2018; 262: 477–481.

[28] Madden S, Miskovic‐Wheatley J, Wallis A, Kohn M, Hay P, Touyz S. Early weight gain in family‐based treatment predicts greater weight gain and remission at the end of treatment and remission at 12‐month follow‐up in adolescent anorexia nervosa. International Journal of Eating Disorders. 2015; 48: 919–922.

[29] Braun DL, Sunday SR, Halmi KA. Psychiatric comorbidity in patients with eating disorders. Psychological Medicine. 1994; 24: 859–867.

[30] Akgül S, Akdemir D, Kara M, Derman O, Çetin FÇ, Kanbur N. The understanding of risk factors for eating disorders in male adolescents. International Journal of Adolescent Medicine and Health. 2016; 28: 97–105.

[31] Murray SB, Nagata JM, Griffiths S, Calzo JP, Brown TA, Mitchison D, et al. The enigma of male eating disorders: a critical review and synthesis. Clinical Psychology Review. 2017; 57: 1–11.

[32] Siegel JH, Hardoff D, Golden NH, Shenker IR. Medical complications in male adolescents with anorexia nervosa. Journal of Adolescent Health. 1995; 16: 448–453.

[33] Vo M, Lau J, Rubinstein M. Eating disorders in adolescent and young adult males: presenting characteristics. Journal of Adolescent Health. 2016; 59: 397–400.

[34] Kask J, Ramklint M, Kolia N, Panagiotakos D, Ekbom A, Ekselius L, et al. Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients. Psychological Medicine. 2017; 47: 1489–1499.

[35] O'Flynn JL, Nowicki GP, Laveway K, Gordon AR, Rodgers RF. Toward inclusivity: a systematic review of the conceptualization of sexual minority status and associated eating disorder outcomes across two decades. International Journal of Eating Disorders. 2023; 56: 350–365.

[36] Guss CE, Williams DN, Reisner SL, Austin SB, Katz-Wise SL. Disordered weight management behaviors, nonprescription steroid use, and weight perception in transgender youth. Journal of Adolescent Health. 2017; 60: 17–22.

[37] Nagata JM, Stuart E, Hur JO, Panchal S, Low P, Chaphekar AV, et al. Eating disorders in sexual and gender minority adolescents. Current Psychiatry Reports. 2024; 26: 340–350.

[38] Mehler PS, Rylander M. Bulimia Nervosa—medical complications. Journal of Eating Disorders. 2015; 3: 12.