Letters to the Editor
In Reply
We thank our correspondent for his constructive comments on our review article about eating disorders in men (1). Prof. Gahr provides a succinct overview of the recommendations in the current S3 guidelines (2) as regards the recommendations on pharmacologic (co-)treatment of eating disorders. In view of a planned guideline update and the scope of our article, which was by necessity limited, we welcome the mention of the evidence base, which may be currently weak but is constantly evolving. Furthermore we agree with the correspondent regarding the insufficient research situation into sex/gender-specific aspects of pharmacotherapy for eating disorders, which we wish to further corroborate at this point.
To date, experiences with the pharmacologic (co-)treatment of eating disorders are based almost entirely on studies in women. Only one in five clinical studies of the effects of olanzapine included one male patient with anorexia nervosa; the proportion of women in the meta-analysis cited in the guideline regarding the effects of SSRIs in the treatment of bulimia nervosa is 98.9%.
Only clinical studies of the effects of lisdexamfetamine included men at proportions of 13.5% to 18.5%, but these percentages also notably underrepresent the proportion of men with binge-eating disorder (3).
The strikingly low representation of men in these studies forms a prominent contrast to the otherwise clear and, in recent decades, stable dominance of male participants in pharmacologic studies (4). Possible sex/gender-specific aspects of pharmacotherapies have thus been barely studied, not only in the area of eating disorders, even though the gaps in our insights in this setting affect men to a greater degree. This underlines that continuing sensitization as regards the diversity of patients is of great relevance, not only in the area of eating disorders.
DOI: 10.3238/arztebl.m2024.0097
On behalf of the authors
Prof. Dr. med. Georgios Paslakis, MBA
Universitätsklinik für Psychosomatische Medizin und Psychotherapie
Medizin Campus OWL, Ruhr-Universität Bochum
Lübbecke
Georgios.Paslakis@rub.de
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.
| 1. | Halbeisen G, Laskowski N, Brandt G, Waschescio U, Paslakis G: Eating disorders in men—an underestimated problem, an unseen need. Dtsch Arztebl Int 2024; 121: 86–91 VOLLTEXT |
| 2. | Herpertz S, Fichter M, Herpertz-Dahlmann B, et al. (eds.): S3-Leitlinie Diagnostik und Behandlung der Essstörungen (2nd edition). Berlin: Springer 2018 CrossRef |
| 3. | Flores LE, Muir R, Weeks I, Murray HB, Silver JK: Analysis of age, race, ethnicity, and sex of participants in clinical trials focused on eating disorders. JAMA 2022; 5: e220051 CrossRef MEDLINE PubMed Central |
| 4. | Bøttern J, Stage TB, Dunvald ACD: Sex, racial, and ethnic diversity in clinical trials. Clin Transl Sci 2023; 16: 937–45 CrossRef MEDLINE PubMed Central |
