Pandemic leads to 'dramatic increase' in youth needing treatment for eating disorders, Sask. doctors say

Two Saskatchewan doctors who treat children with eating disorders say the pandemic has increased patients — and those they are seeing are younger than a typical year.

"More kids are struggling, more kids are being referred for outpatient clinic visits or outpatient treatment, and more kids are being admitted both for medical complications of their eating difficulties as well as psychiatric admissions," said Dr. Ayisha Kurji, a Saskatoon pediatrician.

Kurji said the onset of an eating disorder is typically in the 14 to 15-year-old age group. She said while the statistics are not yet available, anecdotally, younger children are requiring treatment.

"The biggest issue are [new cases] who started with the onset of the pandemic and they were previously not having any trouble or it wasn't recognized and now have become quite unwell."

She said this often requires medical treatment because the patients are coming in with heart problems due to their condition.

Dr. Madhav Sarda, a child psychiatrist in Saskatoon, is seeing the same trends. He said he has seen a "large increase" in patients.

"Very strikingly, kids who have to be admitted to hospital because they're so underweight and are at medical risk because of their weight loss," Sarda said.

Kurji and Sarda wanted to highlight the issue as Feb. 1 to 7 is Eating Disorder Awareness Week in Canada.

The National Eating Disorder Information Centre, which runs a toll-free helpline, says the number of people reaching out for support doubled from November 2019 to November 2020.

Kurji said the increase in Saskatoon is at least 60 per cent or more in both inpatient and outpatient cases.

She said the Royal University Hospital pediatrics has seen more than double the admissions compared to a year ago.

Sarda said normally on the child psychiatry ward there are one or no children with an eating disorder, but that has not been the case in recent months — there have been three to four children consistently in the unit.

He said that does not include "multiple kids " in the pediatric unit who are not able to be transferred to the psychiatry unit because the 10 beds there are full.

"There are times in Saskatoon when 33 to 50 percent of all the child psychiatry beds are for people with eating disorders who are there for months and months.

"It's a fairly dramatic increase."

The number of new patients is not the only trend emerging. "What's striking is we've seen a lot of new diagnoses of eating disorders," Sarda said.

Sarda, like Kurji, has noted the age of the patients.

"We have had a number of kids who have been admitted in the pre-teen age — 10, 11, 12 — and that's not unheard of in the past. But to have multiple kids in that age at once, this is unusual."

Kurji said the health effects of an eating disorder are severe.

"People think of eating disorders as a mental health issue, and it is actually one of the things that can affect your physical health so, so, so much. Anorexia nervosa has the highest mortality of any psychiatric illness. Part of that is suicide. But part of that is actually also your heart, which can be severely affected," Kurji said.

"I think it's something that we need to take very seriously because it can have irreversible effects on your physical health and it's not as simple as, 'just eat'."

Pandemic as possible catalyst

While Sarda said the exact causes of this trend will need to be investigated but points to the pandemic as being the catalyst.

He said it is "no fluke" that what is happening in Saskatchewan is being reported across Canada and around the world.

"What exactly it is about the pandemic that's causing that increase? I can make guesses. There's a loss of control. There's a loss of control in society. There's more stress that exists."

Kurji said speaking to some of her patients has shown a "lack of routine" as a major factor, specifically the sudden restrictions on in-class learning or alternate day school.

"All of a sudden you don't have that schedule."

She said children need to wake up and have breakfast before school and when that does not happen "it becomes a bit of a slippery slope."

Kurji said the loss of activities for kids has also contribued.

"Whether it's because they don't have sports or any activities that help them cope with their concerns, with their mental health, they don't have that anymore. So that's been an issue."

She said the loss of activities or consistent in-person schooling can lead to a lack of recognition of a problem because there are fewer people around to notice or check-in.

Triggers include diet talk

Kurji said triggers of an eating disorder are complex but one is the actions of family members.

"The more your family members or especially your parents talk about weight loss or dieting, the more likely you are to develop an eating disorder."

She said it is important to also note that eating disorders do not always look the same.

"We think of eating disorders as being someone who is really, really thin. You can have an eating disorder at any weight, any size."

What to watch for

Kurji said eating disorders disproportionately affect girls and women but can also affect boys and men.

She said there are some of the signs to look out for:

• Wanting to eat alone or not eat with people (this can be at home or school).
• All of a sudden restricting food that they used to like.
• Restricting portions. 
• Restricting huge categories of food like dairy or carbohydrates.
• Reading labels.
• Lots of increased exercise.
• Comments like "I shouldn't eat that because I didn't exercise today," or "I ate that, therefore I need to exercise more."
• Becoming moody and crabby.

How to help

Sarda said if you notice some of the warning signs the first thing you should do is talk about it.

"See what's going on from their perspective and see if they'll be willing to open up to you and share what it is they're experiencing."

He said if the situation is worrying then visit their physician.

"They can check their height and weight, and then talk to them also on their own as well to see how things are going and track that over time."

He said the mental health services like counselors and dietitians who work with eating disorders can help to "develop an eating plan, whether that's restricting or bingeing."

Kurji said getting into a routine can help, including regular wake-up and bedtimes, and making time to eat together, whether that be family breakfast or supper.

"Whatever works for everyone's crazy schedule would be a huge piece to try and make sure that we're setting the routines and times for us to be able to check-in regularly with our kids, trying to get them outside."

She said the time together does not have to be just to make sure your child is getting nutrition but time for discussion.

"Time to decompress and talk about your day and make sure you can be aware of what's going on."

More support needed

Kurji and Sarda said Saskatchewan needs to build support for a bridge between inpatient and outpatient care for youth with eating disorders.

"We need is a more robust eating disorder team in the province that includes inpatient and outpatient treatment, includes having a step-down unit," Sarda said.

Kurji said this "in-between" system will help treat people transitioning from full inpatient care to outpatient treatment where they are home. She said this would prevent cases from getting so bad they require long-term hospitalization.

Sarda said the long-term stay is not uncommon.

He said even when the pandemic ends there will be a need for more services to support children diagnosed with an eating disorder.

"We're still going to have a whole bunch of kids who are still recovering and struggling and needing help and support and treatment, that's not going to go away with a few months of more vaccines."