Ontario sees 139-per-cent increase in eating disorder hospitalizations

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The number of children who have eating disorders so severe they could be at risk of their hearts stopping has grown significantly, with many boys now needing hospital treatment, challenging traditional perceptions of who are affected by eating disorders, a new Ontario study spanning 17 years shows.

Still, the vast majority of eating disorder hospitalizations were of young women and girls. Between 2002 and 2019, researchers tracked an overall 139-per-cent increase in children and teens hospitalized with an eating disorder. By 2019 boys accounted for nearly 12 per cent of hospitalizations, up from five per cent in 2002.

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Other substantial increases were seen for the youngest teens, aged 12 to 14, and children with eating disorders other than anorexia or bulimia nervosa, such as eating items that aren’t food.

The study paints a sharper portrait of what youth who become unwell enough to need hospitalization look like, one that doesn’t always fit with outdated images of who develops an eating disorder: a white, older teenage girl who wants to be thin.

“Historically we have considered anorexia a disease of older female adolescents and young women,” said Dr. Sarah Smith, an attending physician in the department of psychiatry at SickKids and ICES (Institute for Clinical Evaluative Sciences) trainee.

“This data shows us that there are younger adolescents developing both anorexia and other eating disorders.”

The data span pre-COVID years. Smith said she couldn’t speak to whether the trends have continued. But another study of six children’s hospitals across Canada found the pandemic ushered in a sharp rise in the number of new cases of anorexia, from 25 new diagnoses per month, to 41 during COVID’s first wave. Hospitalizations also increased, and the trends were more pronounced in provinces with higher rates of COVID infections.

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“I think a lot of it had to do with the fact that we took away kids’ daily routines,” Dr. Holly Agostino, director of the eating disorders program at Montreal Children’s Hospital, told HealthDay when her team’s study was published in 2021.

The new study, published today in JAMA Network Open, found that girls still accounted for 91 per cent of hospitalizations for an eating disorder over the study period. Of 11,654 hospitalizations, 10,648 were for female patients.

Among boys, the annual rate of hospitalizations increased 416 percent. Although the absolute increase was modest (from 0.2 hospitalizations per 10,000 population, to 1.1), Smith said treatment programs are seeing more boys than ever before.

“I see young men who are engaged in restrictive eating and often a fair bit of exercise,” Smith said. “Because they want to be healthier, or fitter.”

She sees young males avoiding foods that have fat, “or trying to eat protein, or engaging in conditions exercises like running or sit ups.” Their bodies bear the brunt of dramatic weight loss, particularly their hearts.

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Singer Ed Sheeran revealed in an interview with Rolling Stone earlier this year that he’s had issues with binge eating and purging. “I have a real eating problem,” he told the magazine.

Teens of both genders are growing and developing, Smith said. “So dramatic changes in their eating or exercise can have serious consequences for their growth and development.”

Eating disorders affect between six and 13 per cent of adolescents and have some of the highest death rates of all psychiatric illnesses.

But little has been known about kids with eating disorders who have traditionally been considered “atypical.”

Smith’s team found that while annual hospitalization rates increased for all age groups over time, the largest relative change — 196-per -cent increase — was for teens aged 12 to 24. That age group accounted for 32 per cent of hospitalizations in 2019, up from 26 per cent in 2002.

“It’s meaningful, because 12- to 14-year-olds are kids who could be as young as being in elementary school,” Smith said.

By the time a child needs to be hospitalized for an eating disorder, they’re “quite critically unwell,” she said. “They’re either medically or psychiatrically unstable, meaning they’re at risk of outcomes like having their heart stop or attempting suicide without intensive care in the moment.”

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Those with eating disorders other than anorexia or bulimia also saw a big jump, accounting for 47 per cent of hospitalizations in 2019, up from 30 per cent in 2002.

“Other” eating disorders can include pica (where the child compulsively eats things that aren’t food) or “avoidant and restrictive food intake disorder” — people don’t eat enough for reasons other than body image concerns.

“A young person who chokes and becomes afraid that if they eat solid food, they’ll choke again might really restrict their diet,” Smith said. “Or, there are kids who have a very extreme picky eating who can’t get enough to meet their nutritional needs.

“We consider that an eating disorder. It’s not just picky eating — it’s a very, very limited dietary intake.”

Several factors might account for the findings, her team said: an increase in the sheer prevalence of eating disorders in children, better detection, and a willingness of youth to seek medical care because of less stigma.

Psychiatry’s official catalogue of mental disorders also broadened the criteria for anorexia nervosa and expanded diagnoses for feeding and eating disorders of childhood. The more inclusive criteria could have resulted in more kids being diagnosed with an eating disorder.

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“Parents need to be aware that children and adolescents can engage in disordered eating for a variety of reasons, and that those behaviours have the potential to become medically dangerous quite quickly,” Smith said, especially in younger teens.

Health-care providers need to be aware of the increasing diversity of children and teens needing intensive care earlier in their illnesses, Smith said.

There are signs parents can watch for, before the obvious dramatic weight loss, like kids limiting the variety of foods they’ll eat, or refusing meals or eating in secret, “or perhaps evidence they’ve been vomiting.

“That could be early red flags for families that something is going on.”

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