Eating disorder hospitalizations among young men have jumped 416 per cent over 17 years in Ontario, a study released on Monday found.
The study, published in Jama Network Open by Toronto’s Hospital for Sick Children and the Institute for Clinical Evaluative Sciences (ICES), found from 2002 to 2019, there was a disproportionate rise in pediatric eating disorder hospitalizations among males and young adolescents.
“Hospitalization is our most intensive type of care for eating disorders,” explained lead author Dr. Sarah Smith, a child and adolescent psychiatrist who consults for the eating disorder program at SickKids.
“And we reserve it for young people who are too unwell to be treated in other settings. They’re often medically unstable, which could be indicated by a very low heart rate or abnormalities in their blood work related to starvation or to kind of frequent vomiting that puts them at risk.”
In Canada, around one million people have been diagnosed with a type of eating disorder, such as anorexia, bulimia, binge eating or avoidance restrictive food intake disorder, the National Initiatives for Eating Disorders (NIED) stated on its website.
A significant number of eating disorders manifest during childhood or adolescence and are associated with elevated rates of cardiac disease and mental illness. According to NIED, suicide ranks as the second leading cause of death among people with eating disorders.
Though eating disorders have been linked to adolescent females, Smith cautioned that, while this group does face such challenges, there’s a growing trend of eating issues among males.
“One of the reasons that we did this study was because clinically, many of us are seeing more and more males, younger kids, who kind of lived in larger bodies or who had other atypical symptoms. And so that’s what drove me to do this study,” Smith said.
“I think it’s important to say that it doesn’t align with kind of what people expect outside of the eating disorder field, which is an important finding for health-care providers who don’t spend all their time with eating disorders, that we have this increasing diversity of young patients who have symptoms serious enough to require hospitalization.”
To find this data, the authors of the study analyzed Ontario health-care data from 2002 through 2019 and looked at hospitalizations with eating disorder diagnoses.
Across all age groups, the researchers observed significant “absolute increases” in eating disorder hospitalizations, with the largest increases for female patients.
Throughout the study, there were 11,654 pediatric eating disorder hospitalizations, of which 45.2 per cent were for anorexia and 11.8 were for bulimia. Hospitalization rates increased 139 per cent during the 17 years, and the largest relative changes were seen in male patients, (up 416 per cent), the study found.
There was a substantial rise in hospitalizations for eating disorders among individuals aged 12 to 14 years, with a 196 per cent increase. Additionally, there was a 255 per cent increase in hospitalizations for individuals with eating disorders other than anorexia or bulimia.
As the researchers saw an increase in pediatric hospitalizations over time, especially among populations traditionally considered atypical, they recommended that existing eating disorder programs adapt to address this to “ensure effective care.”
“It suggests that (health practitioners) should be more aware. It also suggests that parents or other people involved in the care of children or adolescents should be aware that disordered eating doesn’t always follow the media stereotype from the ’90s,” Smith said.
Several factors may be contributing to the increase, the authors state, including improved detection of illnesses caught by health-care practitioners or an increasing number of affected people seeking medical care.
Another factor may be the introduction of the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders) into clinical practices in 2013, according to the study. This year also coincided with the highest annual pediatric eating disorder rates in the study.
The authors believe this may have contributed to the spike in hospitalizations because, in 2013, the DSM-5 underwent multiple revisions, including removing the percentage body weight criteria from anorexia and broadening diagnostic criteria for anorexia nervosa to include behavioural as well as cognitive symptoms.
This is not the only study to find an increase in eating disorder hospitalizations.
A study published in the Canadian Medical Association Journal (CMAJ) on Oct. 3 found that eating disorders requiring hospital care increased significantly among children and teenagers in Canada during the COVID-19 pandemic.
In all age groups, women required higher rates of hospital care for eating disorders than was expected, according to the CMAJ study.
“A combination of risk factors — including isolation, increased time on social media, extended time spent with family, decreased access to care and fear of infection — may contribute to an increased risk of development or exacerbation of an eating disorder,” the authors said in the study.
Although the authors of the CMAJ study linked it to increased isolation, Smith noted that the SickKids study was done pre-COVID-19.
“And so I can’t speak to how the pandemic kind of might have affected findings,” she said.
While the study does not pinpoint the exact reasons for the increase, she did observe that males often adopt eating disorders for reasons such as a desire to be healthier or to achieve greater fitness.
“And then once they start, it’s very hard to stop for some patients,” Smith said.
If you or a loved one is suffering from disordered eating, the National Eating Disorder Information Centre offers an online chat and toll-free helpline (1-866-633-4220) to help connect people with support.
— with files from Global News’ Saba Aziz
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