Over the past decade, studies in Australia and the United States have highlighted that eating disorders affect a significant percentage, between 6 and 13%, of adolescents. A recent study conducted in Ontario further illuminated a worrying trend: a notable increase in pediatric hospitalizations due to eating disorders.
However, the health service use of these patients in Canada has yet to undergo a formal evaluation. Health service use refers to the utilization of healthcare resources by individuals to address their medical needs, such as inpatient hospitalizations. Analyzing health service usage aids in identifying disparities in care access, facilitating the development of strategies to address them, and ultimately leading to better healthcare outcomes for individuals and populations.
Dr. Sarah Smith, affiliated with the Dalla Lana School of Public Health at the University of Toronto, the Institute for Clinical Evaluative Sciences, and the Department of Psychiatry at The Hospital for Sick Children, recently spearheaded a study that investigated trends in service use among children and adolescents diagnosed with eating disorders in Ontario. This study was published in the journal JAMA.
The study encompassed all children and adolescents admitted as inpatients at Ontario hospitals and diagnosed with an eating disorder between 2002 and 2019. Its primary focus was on determining the annual hospitalization rate per 10,000 individuals aged 5 to 17 years. Specific rates were calculated based on sex, age group, and eating disorder diagnosis.
The study documented over 11,500 pediatric hospitalizations due to an eating disorder during the investigated period. The majority of hospitalizations were reported for groups commonly associated with eating disorders: predominantly females (91%), anorexia diagnoses (42%), urban dwellers (90%), adolescents aged 15-17 years (65%), and those in the highest neighbourhood income quintile (30%).
Notably, however, there was a staggering 139% increase in pediatric eating disorder hospitalizations over the 17 years in Ontario. The most substantial increases were observed among groups uncommonly associated with eating disorders: male patients (416%), younger adolescents (aged 12-14 years; 196%), and patients with eating disorders other than anorexia or bulimia nervosa (225%).
The observed shifts in eating disorder diagnoses among atypical patient subgroups were partially attributed to demographic and clinical characteristic modifications in the latest Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria. For example, in the new DSM, amenorrhea — the absence of one or more menstrual cycles — was removed as a diagnostic criterion for anorexia nervosa since this criteria does not apply to all patients (specifically male or premenarche female).
Nonetheless, these findings can not be entirely attributed to the new DSM modifications. It is clear from this study that improved practitioner education around eating disorders is necessary, such as a better understanding of the different eating disorder types and their distinct diagnostic criteria.
All in all, addressing these issues is vital in ensuring improved healthcare outcomes and meeting the evolving healthcare needs of all youth battling eating disorders in Ontario.
