More children and teens are suffering from eating disorders than ever before, according to Canada’s largest pediatric hospital, as social isolation caused by school disruptions and limits on extracurricular activities takes a toll.
Children as young as 9 and 10 are being treated for eating disorders. Pediatricians say many of their new patients are sicker and more underweight than those typically seen before the pandemic, while the wait time for outpatient referrals has doubled to six months.
“There are more cases than we ever thought we would see,” said Debra Katzman, a professor of pediatrics at Toronto’s Hospital for Sick Children and the University of Toronto. “We’re seeing kids who are at a significantly lower weight than what we would have normally seen pre-COVID. … Every system of the body is affected. And as a result of that, these kids require an intense amount of observation and treatment and monitoring, and their length of stay tends to be longer than it would be had they been diagnosed earlier.”
Doctors say public-health mitigation strategies to limit the spread of the virus, such as closing schools and curbing activities, are important, but that many children are suffering the effects of being isolated from their peers and having little routine. Further, children on social media are inundated by a pervasive diet culture, and for many children and teens, what may have started as a way to become healthier has changed into dangerous behaviours. Young people with eating disorders often have co-occurring mental-health challenges, such as anxiety and depression, that have also been exacerbated by social restrictions, doctors say.
Specialists across the country, as well as in Britain and the United States, are seeing a “surge” in cases, Dr. Katzman said, and they are even more concerned about increasing numbers and the level of acuity during the second wave of the pandemic. At SickKids, the hospital is projecting that roughly 30 per cent more children with eating disorders will be admitted this fiscal year, which ends March 31. It is also expecting more than 240 outpatient referrals, compared with last fiscal year’s 150.
Christina Bartha, executive director of the Brain and Mental Health program at SickKids, said the hospital saw a significant shift in August, when a number of medically unstable patients began arriving at the emergency department after living with the illness for months, sometimes hesitant to get help over fears of being infected with the virus.
Hospital doctors are treating young people with the greatest needs, she said, while children in more stable conditions are put on a wait-list and are being managed by their family doctors and pediatricians.
“We are working to increase our overall capacity as a system, but this is a major challenge right now,” Ms. Bartha said. A continuing worry, she added, is what happens to children who don’t receive timely interventions, including being able to connect with therapists, social workers and dieticians.
“There isn’t capacity to absorb this many kids this fast, given the degree of the surge.”
Sterling Renzoni, 18, has been in and out of hospitals and treatment centres since he developed anorexia while in Grade 9. The transition to high school was difficult, he said. He had trouble fitting in socially. He started cutting foods from his diet and then became obsessive about exercising.
He was a patient at the Ontario Shores Centre for Mental Health Sciences in Whitby, Ont., in March, when the province shut down. Mr. Renzoni transitioned to virtual care at a difficult time, but he focused on his treatment, determined to start postsecondary studies at Trent University in the fall.
“I can understand and relate to the pain that people with eating disorders are now facing,” he said. “Unfortunately the wait-lists … are long, and it’s really challenging to be on a wait-list and be really struggling and there is nowhere for you to go.”
Jillian Walsh, a registered dietitian and therapist, said she and her private-practice team in London, Ont., went from seeing 10 kids a week prepandemic to now roughly 45 a week. She attributes the increase to social isolation stemming from COVID-19 restrictions, as well as social-media messaging around weight gain.
Many patients are engaging more often in eating-disorder behaviours, such as overexercising, restricting food and purging, she said, and their symptoms are much more severe.
“It breaks my heart, to be honest, to see how sick these kids are. They’re definitely presenting as sicker on average than they may have presented a year ago.”
At North York General Hospital, eating-disorder patients would typically occupy as many as four beds in the 12-bed pediatric unit. Today, it’s around nine. The wait-list for treatment programs for stable patients is anywhere between six and nine months, up from three months prepandemic.
Samantha Martin, an adolescent-medicine specialist and a pediatrician at the hospital, said doctors are seeing children with significant mental-health comorbidities that require a team of specialists. She described the situation as a “shadow pandemic.”
“Parents are doing the best they can,” she said, adding that warning signs to look for include weight loss, excessive exercising, increased rigidity around eating and an avoidance of food.
“Teens are telling me that they have more time to focus on their body image concerns. They find social media very triggering, and what started as a way to become healthy quickly spiralled into disorder eating and unhealthy behaviours.” Families should also contact their doctor early if they have concerns, Dr. Martin said.
“My concern is how are we going to service this volume that I do not see decreasing in the near future?” she asked. “I would say those resources were squeezed before the pandemic and now with this massive unexpected increase in volume, it is much more challenging to meet the need.”
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