I'd like to thank the committee for conducting its study of eating disorders among girls and women and viewing this as an important health concern in Canada. I'd like to add that eating disorders also affect males, albeit in smaller numbers. Currently, I'm actively seeing four young men struggling with both the disease and a system that they don't fit into.
I'm a pediatrician with a fellowship in adolescent medicine. I've worked in the area of eating disorders for about 14 years. I see patient population generally between the ages of 11 and 23, but unfortunately, I have seen several young people more recently as young as 7.
I reviewed the transcripts of Dr. Blake Woodside. I'm aware he reviewed extensively the epidemiology, including the incidence, prevalence, and characteristics of eating disorders, as well as the statistics of those who die from eating disorders, so I won't repeat this information today.
I want to re-emphasize, though, that the cause of eating disorders is not fully understood. However, for many years socio-cultural influences and environmental risk factors have been thought to be important.
As the research on this subject has progressed, there are now indications that the development of an eating disorder is multifactorial, with socio-cultural, biologic, and genetic influences. Research in the neurobiology of eating disorders has revealed genetic links. Overall, anorexia nervosa and bulimia nervosa appear to be far more common among the biological relatives of anorexic and bulimic probands than in the general population. Eating disorders can be pathological solutions to a developmental challenge, especially in children. Research also suggests that an obsessional, perfectionistic, and anxious personality style may be premorbid traits that contribute to the development of eating disorders.
I ask, then, what are we doing in our schools and early intervention prevention programs to help children learn to self-regulate and learn mindfulness techniques to counter these traits and pressures? The severity of a medical problem associated with eating disorders is significant and should not be underestimated however the patient appears outwardly.
Mortality in anorexia nervosa is the highest of any psychiatric illness. It is the third most common chronic illness among adolescent girls. The medical complications of both bulimia nervosa and anorexia nervosa are multi-system and can have both acute life-threatening and long-term sequelae.
It is again important to note that individuals at normal or above normal body weight who lose an excessive amount of weight may show similar changes in medical status as the individual who starts at a normal body weight. I bring this up as a story related to me by patients many times who are suffering with bulimia nervosa. Their general practitioner looks at them and says they don't look like they have an eating disorder, while potentially these average or possibly overweight individuals may have a serious electrolyte issue that is caused by repetitive bingeing and purging activity.
The primary pathophysiologic response to extensive weight loss is one of metabolism reduction as a physiological adaptation, as we have seen in a very classic study done in...[Technical difficulty—Editor]...Minnesota experiment.
I am a medical consultant at the Calgary Eating Disorder Program. The Calgary Eating Disorder Program uses a multimodal, interdisciplinary team approach to provide service across a continuum of care. We believe it is imperative to work collaboratively as a team and include the patient and the family in this process. In this respect, we strive to have the patient and family in control of their own treatment and give choices and options within the boundaries of responsible care. We utilize a biopsychosocial approach to treatment, including all the necessary team members, to meet the needs of the patient and family. We also work very hard to build community capacity.
I will give you some statistics of our program.
Since 2009 we have gone from 276 referrals a year to, presently, in the 2012-13 fiscal year, 437.
Our diagnoses tend to be divided...[Technical difficulty—Editor]...eating disorder not otherwise specified at about 42%, anorexia nervosa at about 29.4%, and bulimia nervosa at about 22%. A very small percentage is very young patients with an early onset eating disorder.
The age range over the last five years has stayed consistent between the majority being between 18 and 24 years of age and the next large age group being between 14 to 17 years of age.
Our program is a tertiary centre, but I recognize that family physicians are the cornerstone of health care. Their knowledge and ability to screen, support and refer these individuals is essential.
I've always endeavoured to provide continuing medical education for family physicians as this is where we make the most difference in screening, prevention, and promotion. Without a bold standard approach, these physicians often feel at a loss.
There is very little funding to support these types of educational presentations outside of a formal conference. I suggest funding to create a web-based CME program with formal credits, and increasing curriculum in medical schools.
Even in the last 15 years I've watched eating disorder treatment in Calgary go from an orphaned, non-humanistic approach if no one was trained or willing to treat the eating disorders, to some very organized and evidence-based programs.
Generally, I feel we have excellent resources in Alberta, with the exception of a few critical aspects that could both decrease morbidity and mortality. This may be generalized across Canada, but again, there is such a variation in funding and programs.
Number one, there are no specific in-patient eating disorder units for under 14-year-olds or other long-term intensive care. Often, there is nowhere to admit if they are already medically stable, but underweight and failing to thrive. This has significant impact on future growth and development, and other psychiatric comorbidities and chronicity of the illness.
We do not have adequate spaced, very well organized, multidisciplinary in-patients units. The conditions are very concerning. We have six patients in a four-bed room at the Foothills hospital. Often, additional patients are placed in rooms with elderly sick medical patients, often with dementia, and the space for the critical meal support and therapy is a mere 150 square feet. Patients sometimes leave against medical advice because the conditions are so bad and they are ambivalent about getting better.
I will close with a relevant example of a patient I just saw on Monday, ironically, just after I received the invitation to give my testimony.
This is a 19-year-old woman with anorexia nervosa and a BMI of 16, which is far below the third percentile for someone her age. She's medically unstable with a low resting heart rate and dehydration, and she's becoming more cognitively impaired every day. She requires hospitalization, but our allotted beds are over capacity, eight people for an allotted six. The room in which they participate, as I mentioned, is a mere 150 square feet.
I have nowhere to admit this patient who, by the way, wants to be admitted and supported. Therefore, I continue to do intensive out-patient clinic visits biweekly and prepare her for our day program that is more resourced, but is not the best option for her medically at this time.
Her mother's response, through tears, during the appointment, “I'm at a loss of what to do. My daughter has lost so much weight and now hasn't eaten for four days. She is my only priority, and to the program and to the medical resources just a number; hopefully, not a statistic of mortality to be looked upon in 10 years.”
I obviously comforted her and reassured her that she wasn't a number to me and that I would do everything in my advocacy powers to get her the treatment she needed. Unfortunately, this is not a unique presentation in the over-18 population. Hopefully, we can continue to examine the roadblocks and allocation of resources to assure these young women and men, with so much potential, get the adequate care they need to achieve optimum health and well-being.
Thank you.