Eating Disorders are a scourge in need of a strategy
By André Picard, The Globe and Mail
December 2, 2014
Eating disorders are the single most deadly mental illness: Between 10 and 15 per cent of young women hospitalized for treatment of anorexia or bulimia will be dead within 10 years.
Somewhere between 600,000 and 990,000 Canadians suffer from eating disorders. Yet they remain among the most neglected and misunderstood of all health conditions.
Those are just two of the shocking findings of the parliamentary standing committee on the status of women. The committee’s new 75-page report, Eating Disorders Among Girls and Women in Canada, was much anticipated by parents and clinicians alike, who know all too well how dire the situation is.
Imagine that your teenaged daughter is starving to death – literally, not figuratively – but the wait for treatment is more than a year.
Imagine that your child is suicidal but deemed “not sick enough” for hospital admission because there is a shortage of beds. The number of girls between 10 and 19 hospitalized for treatment of eating disorders has soared by 42 per cent in the past two years, but the system can’t keep up. Shortages are widespread and chronic.
“There is something inherently wrong with a public health-care system that often only becomes available when someone is on death’s door,” Elaine Stevenson told the committee. Her daughter Alyssa died of anorexia at age 24, like about 1,500 other young Canadian women each year.
The protracted wait times are doubly perverse because it’s well-established that early intervention – counselling for girls (and boys) who have disordered eating, rather than full-blown eating disorders – can be a very effective prevention tool.
The frustration continues once patients are admitted for treatment. The first order of business is refeeding – getting patients with eating disorders to eat three square meals a day, rather than, for example, binging and purging. But the feeding needs to be accompanied with psychiatric or psychological therapy to address the underlying mental-health problem.
Few hospitals have the resources to offer that care. Of the 4,100 psychiatrists practising in Canada, only 12 are specialized in the treatment of eating disorders.
The most effective treatment is a combination of cognitive behaviour therapy (CBT) and family-based therapy (FBT), supplemented with nutritional counselling. Eating tends to be a family-based activity, which is why the involvement of parents and siblings is essential to recovery.
But CBT and FBT are not covered by medicare. Therapy costs anywhere from $80 to $250 an hour. Consider that several hours of therapy a week can be necessary and that treatment for these stubborn conditions routinely lasts two to seven years. Even then, only about half of sufferers fully recover.
While hospital resources are scarce, community-based help for people with eating disorders is virtually non-existent. Consumer groups like the National Initiative for Eating Disorders survive on a wing and a prayer, driven by personal suffering.
Dr. Blake Woodside, medical director of the eating-disorder program at Toronto General Hospital, told the committee that the cause of all this is “egregious discrimination” against a demographic group with no political clout.
“If there were waits like this of four to six months for prostate cancer treatment, there would be a national outcry. There would be marches in the streets,” he said. But because eating disorders affect teenage girls, there is no outrage or political action.
Those called to speak before the committee all had, more or less, the same message: A pan-Canadian strategy is needed to tackle this growing scourge. That includes better prevention, education, treatment and follow-up care. Many stated the starting point should be a national registry, to get a better sense of who is (and isn’t) getting care, and a robust research program to help develop better treatment and support.
What the committee provided, though, was 25 spineless recommendations urging the federal government to “consider,” “encourage” and “recognize” a number of self-evident needs.
Those are do-nothing weasel words – another example of the Conservative government’s obsessive desire to not involve itself in health care regardless of the harm it causes patients. Both the New Democrats and Liberals wrote dissenting opinions, and tried to publicize the report the government wanted buried.
Young women (and men) with eating disorders don’t need indifference and platitudes – they need concrete changes to the health system to, in the words of dissenting Liberal committee member Kirsty Duncan, “steer them through the confusing and overwhelming world in which they are embroiled.”
The Globe and Mail also published a selection of Letters to the Editor in response to this piece.