Clinicians, researchers and activists have stressed the need for better treatment and services of people with eating disorders who don’t fit the stereotypical patient profile — and recent data suggests a growing need.
Researchers analyzed data of more than 11,000 pediatric eating disorder hospitalizations in Ontario between April 2002 and March 2020, according to a new study.
The hospitalizations generally increased over that time, rising by 139% from 2002 to 2019, the data showed.
But the largest changes were among populations often overlooked in the public’s perception of eating disorders. Hospitalizations of young male patients increased by 416%, in patients ages 12 to 14 by 196%, and those with eating disorders other than anorexia or bulimia nervosa by 255%, according to the research published Monday by JAMA Network Open.
“We need to be aware that young people who do not meet this typical image of who has eating disorders are becoming quite unwell — and unwell enough to require hospitalization,” said lead study author Dr. Sarah Smith, an attending physician in the department of psychiatry at The Hospital for Sick Children, known as SickKids, in Toronto.
When many people think of someone with an eating disorder, they imagine an affluent, White teenage girl, said Stuart Murray, an associate professor of psychiatry and behavioral sciences at the University of Southern California’s Keck School of Medicine. Murray, who was not involved in the study, is also director of the Translational Research in Eating Disorders Laboratory at Keck.
Diet culture and disordered eating
“That image unfortunately contributes to mis- and under- diagnosis of eating disorders among individuals who don’t fit that stereotype, as they aren’t seen as being at risk or they experience delays in seeking care or receiving necessary referrals,” said Sara Hofmeier, a licensed clinical mental health counselor and executive director of outpatient services at Veritas Collaborative in North Carolina, in an email. Hofmeier was not involved in the research.
Eating and feeding disorders also expand beyond anorexia and bulimia nervosa.
The other eating disorders in the latest research included pica, rumination and other specified food, feeding and eating disorders.
Pica is a condition in which a person eats substances that are not food for at least a month, according to the Cleveland Clinic. Rumination syndrome is when a person regurgitates undigested food, the clinic said.
Other specified food, feeding and eating disorders, or OSFED, is a diagnosis given when someone is experiencing a significant eating disorder, but the behavior may not align exactly with the diagnostic criteria of the conditions of other disorders, Lauren Smolar, vice president of mission and education for the National Eating Disorders Association, told CNN earlier. She was not involved in the study.
Stigma and screening
Part of the rise may be attributed to an increase in eating disorder prevalence, but a decrease in stigma and improved screening may also affect the numbers, said Smith, who is a trainee at the Institute for Clinical Evaluative Sciences, a research nonprofit. She conducted the research while a research fellow at SickKids.
“I’ve hypothesized that changes in eating might be fueled by reasons others than wanting to lose weight, for example, and people wanting to be healthier or wanting to be fitter,” she said. “And it might also be that health care providers are becoming better at testing … or that parents are becoming better in picking up these red flags in their suffering and helping them access care.”
Historically, screening for eating disorders was not set up for men and boys because they were excluded from diagnostic criteria, Murray told CNN earlier.
Until recently, changes in breasts and loss of menstruation were key to diagnosing eating disorders, Murray said. Although the criteria have changed since then, men and boys are still excluded from most research into eating disorders, he added.
That exclusion can often lead to stigma, with men and boys — as well as those around them — not recognizing their behavior or hesitating to get help because they believe it threatens their masculinity to say they may have a disorder pigeonholed as a women’s disease.
Importantly, the data only captured disorders that rose to the level of hospitalization, which means that the numbers would be even higher if they included other eating disorder services, Smith said.
The data also stopped before the start of the Covid-19 pandemic.
“A fair a bit of recent media attention on eating disorders has focused on the pandemic,” Smith said. She added that further research can look into whether these trends continued — or even worsened — during the height of the pandemic.
Adapting treatment
Diagnostic criteria may be adapting to be more representative, but it’s important that families and clinicians know what to look for, Hofmeier said in an email.
“Accurate and early diagnosis allows for much earlier intervention, and being able to intervene early can help to shorten the overall duration of illness and increase progress toward full recovery,” she added.
Many families and family doctors still aren’t familiar with the signs of eating disorders in boys and men, Murray said, so knowing what to look for is the first place to start.
Speak with your pediatrician if you notice changes in your child’s eating behaviors, rapid changes in weight or growth and development, personality changes or signs of malnutrition.
Those can include “tiredness, poor concentration, irritability, constantly feeling cold, dizziness, menstrual irregularities, hair loss and fluctuations in weight,” according to Nationwide Children’s Hospital in Columbus, Ohio.
Jennifer Rollin, founder of The Eating Disorder Center in Rockville, Maryland, recommended reaching out to therapists who specialize in eating disorders, so they can make evaluations and recommend what other professionals to bring in.