Status of Women Committee on Feb. 24th, 2014

[Terence Young, Conservative, Oakville, ON]

Thank you very much.

Dr. Spettigue, is cognitive behavioural therapy the most effective therapy for girls and women with eating disorders?

[Dr. Wendy Spettigue]

There's a difference between treatment for girls versus that for women, so for adults, yes, but for young people we recommend family-based therapy.

[Terence Young, Conservative, Oakville, ON]

Thank you.

What are the challenges facing individuals? For a young woman who realizes or has been told by people who love her or by a doctor that she has an eating disorder, what are the challenges in seeking treatment?

[Dr. Wendy Spettigue]

The number one challenge—and again, I'm only talking about pediatric eating disorders—is that she won't seek treatment because she's terrified that it will mean that she'll have to gain weight. So no matter how much she is suffering, she will not choose to go and get help, because she's terrified. It's usually distraught parents who drag their teenagers to the doctor.

[Terence Young, Conservative, Oakville, ON]

Thank you.

What seems to be the greatest contributing factor to the development of eating disorders? We've heard a lot about the different factors. What are the greatest contributing factors?

[Dr. Wendy Spettigue]

That's a very difficult one, because I don't have enough research to answer that question. We desperately need more research into the causes of eating disorders. I might have some opinions, but I don't have facts.

[Terence Young, Conservative, Oakville, ON]

Okay. That's very helpful. That leads to my next question.

Could you please comment on what gaps there are in research into eating disorders in order to meet the needs of patients? If you had a blank slate and you could commission research, in what areas would you want to see research results?

[Dr. Wendy Spettigue]

Wow. There are so many gaps that it's hard to know where to begin. There's a huge lack of research. We don't understand the causes of eating disorders. We don't understand how to prevent eating disorders. We don't know how to disseminate the most effective treatments. We don't know how to treat the ones who don't respond to the family-based therapy, which is about 30% of youths. There are huge gaps.

[Terence Young, Conservative, Oakville, ON]

Would you characterize the treatment that girls and women with eating disorders receive as discriminatory compared to patients with other diseases?

[Dr. Wendy Spettigue]

Yes, in many ways. Would you like me to elaborate?

[Terence Young, Conservative, Oakville, ON]

Yes, please. Thanks.

[Dr. Wendy Spettigue]

For example, in medical school and residency training, there's a definite lack of training and a lack of understanding of eating disorders. Like Ms. Phoenix said for the NPs, for the doctors there would be a mandatory lecture on the symptoms of anorexia nervosa and that kind of thing, but never enough time or depth to really understand and appreciate these patients, what they're going through, and the kind of help they need. Certainly, the poor family doctors are so overwhelmed that they don't have the time to really learn about these illnesses.

[Terence Young, Conservative, Oakville, ON]

Dr. Blake Woodside talked to us about the fact that virtually every hospital in Canada has a prostate clinic for middle-aged white males, but the services for girls are much sketchier or are unavailable in many locations.

[Dr. Wendy Spettigue]

There's not one single specialized multidisciplinary pediatric eating disorder program in Saskatchewan, P.E.I., New Brunswick, or the Canadian north. There's one only in all of B.C., Nova Scotia, Quebec, and Newfoundland.

[Terence Young, Conservative, Oakville, ON]

Thank you.

We heard about how the media affects the way girls view their own body image, etc. Could you please comment on whether there's anything we could do about it, about how the media, movies, and television affect the way young women think about themselves?

[Dr. Wendy Spettigue]

Yes, but it will take me some time. That's a tough one.

[Terence Young, Conservative, Oakville, ON]

One minute...you can do it in one minute.

[Dr. Wendy Spettigue]

I think we need to have a huge campaign to change the huge anxiety around eating and nutrition and helping youth, especially young children. The increase in eating disorders in young children is coming out of the fact that there are a lot of very compliant, self-conscious, perfectionistic, anxious little girls who are trying to be very, very good, and avoiding all the bad foods.

Many of them get to the point where they're hospitalized for medical instability because they're only eating vegetables because they've heard so many messages about the bad foods: the fats, the sodium, and the sugar.

We somehow need to create an atmosphere that's more about moderation and balance that applies to everybody. We also need to figure out how to treat obesity without causing eating disorders because for all of the patients who are getting the messages about the need to diet and watch your eating and all of that, they're creating a whole bunch of young patients who are coming into our hospital terrified of eating, terrified of gaining weight.

Another huge issue is the toxic atmosphere in our high schools across Canada and the emphasis on appearance. I cut some things out of my long talk but one of them was regarding the “hot or not” app that you can get for your iPhone where you post photos of girls and rate them, or the Kate Moss pillow that you can order for $16 on the Internet that has embroidered on it the words “Nothing tastes as good as skinny feels”. There are all sorts of things on the Internet—

[The Chair, NDP, Hélène LeBlanc]

Those messages are very....

[Dr. Wendy Spettigue]

—that are causing eating disorders.

[The Chair, NDP, Hélène LeBlanc]

Thank you very much once again, Dr. Spettigue.

Ms. Duncan, you have seven minutes.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair, and thank you to all. We appreciate your expertise, and your time and effort today.

I'm going to begin with Dr. Spettigue, and I think this should be an important case study in this report. Could describe as tightly as you can—because I want to ask you all about recommendations for this report—what happened to your clinic, how many people did you treat, the lack of funding, no community resources, the one-year waiting list. What happened, please?

[Dr. Wendy Spettigue]

That was nice of you, thank you.

For 14 years I served as the psychiatric director of the program at CHEO. Two years ago we were faced with a one-year waiting list, which is completely unacceptable, given the severe medical and psychological complications of eating disorders in young people.

Out of desperation, given that you can't have a one-year waiting list for such sick kids, we just decided to close the program and all those one-year referrals on the waiting list were all sent back to their poor family doctors.

We went through what's called a “lean review” to try to figure out what we were going to cut in order to be more efficient. We're not going to take mild or moderate referrals to our program anymore, even though there's nobody out in the community who will do it. Even though it takes two years for these kids to recover, we're only going to offer them nine months of therapy.

We had to cut all of the therapy groups from our in-patient program in order to try to move some of our in-patient therapists to be able to provide the outpatient family therapy because we didn't have an outpatient team.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Dr. Spettigue, how many children did that impact in terms of the closure and in terms of the one-year waiting list, and moving the children and their families around?

[Dr. Wendy Spettigue]

It's hard to know since I didn't have to see them, but I'm going to say about 200 or so.