Good afternoon. I would like to thank the members of the House of Commons Standing Committee on the Status of Women for inviting me to speak with you today about girls and women with eating disorders.
My name is Dr. Debra Katzman. I am a professor of pediatrics and an adolescent medicine specialist at the Hospital for Sick Children, University of Toronto. I have worked in the field of eating disorders for the past 28 years. I founded the pediatric eating disorder program at the Hospital for Sick Children and was the medical director for 22 years. My research has focused on young girls with eating disorders, specifically the medical complications of these devastating disorders. I have also been involved in research on early diagnosis in children and adolescents and treatment of these life-threatening disorders.
I have played an educational and advocacy role in eating disorders on a national and international level as a member of the steering committee of the Ontario Community Outreach Program for Eating Disorders, the past president of an international organization, the Academy for Eating Disorders, and now as the current president of the Society for Adolescent Health and Medicine. As you can see, I am passionate about pediatric eating disorders and what we, as health professionals, researchers, and Canadian citizens can do to prevent, identify, and treat these disorders.
I have the daily privilege of working with and caring for very, very sick children and adolescents, and their families, who suffer from the severest forms of eating disorders. Eating disorders, as Dr. Elliott so eloquently said, are biologically based, serious, life-threatening mental illnesses. These disorders warrant the same level of breadth of awareness, identification, treatment, prevention, and research funding as other illnesses. Let me explain to you what I mean by this.
Since I started my medical career some 30 years ago, biomedical research has had an impact on pediatric illnesses and has made some incredible advances on the outcomes of many serious diseases. When I was a medical student, acute lymphoblastic leukemia, the most common cancer of childhood, had a mortality rate of 95%. Today the mortality rate has been reduced by 85%. Six thousand children each year who would have previously died of this disease are now cured.
Another example of important scientific advances is the HIV/AIDS story. For example, a 17-year-old infected boy with HIV 20 years ago would have lived months, only months, and now can live up to 60 or 70 years.
These remarkable changes are due to funded scientific research that has focused on understanding these very tragic major killers. Unfortunately, these types of success stories are not the same when we're talking about eating disorders.
Over the past 20 years we have indeed made some headway with eating disorders, but not to the same extent as what we've seen with cancer, heart disease, or AIDS. Let me share with you, however, what we do know about eating disorders.
Eating disorders are a huge public health issue. Eating disorders are on the rise in children. We've done a study here at Sick Kids, in collaboration with the Canadian pediatric surveillance program, and showed that young people as young as five years of age develop eating disorders. Eating disorders have a relatively high prevalence rate. Approximately 1.5% of women between the ages of 15 to 24 years old suffer from an eating disorder. That means an estimated 525,000 Canadian women will suffer from these disorders. Compare this to 10,000 children and youth living with cancer or 25,000 living with type 1 and type 2 diabetes. Yet, eating disorders do not get the same research funding, nor do they get the same general attention.
Eating disorders start early in life. There are two peak ages of onset, one at 14 years of age and one at 18 years of age. This is very different from other illnesses, such as heart disease and hypertension, that start in adulthood. Most children and adults with eating disorders are girls and women.
Anorexia nervosa is the third most common chronic illness affecting adolescent females. Eating disorders know no bounds when it comes to race, colour, gender, and socio-economic status. No one is immune to an eating disorder.
The cause of eating disorders is, as Dr. Elliott has said, multifactorial, and includes a combination of genetic, biological, and temperamental vulnerabilities that interact with a very toxic environment.
Eating disorders are associated with impairment in emotional and cognitive functioning. We know that girls and women with eating disorders exhibit difficulties with cognitive functioning, specifically, difficulties in their ability to judge things and difficulties with their memory, decision-making ability, and sort of getting the gist of the bigger picture of things.
Studies from our group here at SickKids have shown that young women have pronounced cognitive deficits during the acute phase of the illness that significantly interfere with their cognitive abilities and their ability to make relationships. This type of cognitive impairment is thought to compromise a young woman's ability to engage in psychological treatment, making treatment much less effective. Further, it is unclear whether these cognitive deficits actually return to normal.
We also know that girls and young women have significant comorbid psychiatric problems. The most common comorbid psychiatric conditions in anorexia nervosa include major depression and anxiety disorders. Commonly, comorbid conditions in bulimia nervosa include anxiety disorders, major depression, and substance use disorders. Approximately 80% of individuals with anorexia nervosa and bulimia nervosa are diagnosed with another psychiatric disorder at some time in their life.
Eating disorders limit the life activities of young girls and women suffering from these conditions. Individuals with anorexia and bulimia nervosa rate their quality of life as very low. Social adjustments tend to be impaired; social communication skills are poor; and social networks tend to be very small.
Vocational and educational functioning in individuals with eating disorders is below that expected, with absences from work and from school. In one study, it was shown that girls who suffer from eating disorders spend approximately five and a half months per year in school over a two-year period.
Eating disorders are life-threatening illnesses and are associated with numerous medical complications. Eating disorders have the highest rate of medical complications of any psychiatric disorder.
Eating disorders affect every system in the body. The medical complications represent significant forms of disability. Medical complications include: significant impairment of normal adolescent physical, social, and psychological growth and development; cardiac abnormalities; gastrointestinal problems; and osteoporosis. In fact, our group did the first study in this area and found that young people with anorexia nervosa who only had the illness for three months developed brittle bones, or osteoporosis. In addition to this, these young people also, as I've mentioned, have cognitive impairment. We have shown in studies that they also have changes in the structure of their brain.
These are but a few of the medical complications. Also, from the research we have done, it is not clear that these long-term medical complications are reversible.
These medical complications can and do lead to death in some cases. Death rates for anorexia nervosa are the highest of any psychiatric disorder and are 12 times higher than the annual death rate from all causes in females between the ages of 15 and 24 years. Children with the disorder are 10 times more likely to die than their healthy peers. This inexcusable increased risk of death in eating disorders is frequently due to the numerous medical complications and also to suicide.
Overall, eating disorders are associated with some of the highest levels of medical and social disability of any psychiatric disorder. These conditions carry significant costs to the individuals, to their families, and to society at large.
There is a large cost to eating disorders in young women who suffer from them. Girls and women with anorexia nervosa have higher rates of pregnancy complications than women without eating disorders; they have higher rates of infertility and of spontaneous abortions; and their children seem to have a higher prevalence of emotional and nutritional problems. Parents and carers of individuals with anorexia nervosa and bulimia nervosa have high levels of psychological distress.
Finally, eating disorders result in a significant economic burden and health service use. A recent study on hospital admissions from adult psychiatric illness in England found that eating disorders contributed the highest proportion of admissions of all psychiatric disorders. Most child and adolescent psychiatric beds are occupied by young people with eating disorders, more than any other diagnostic group. In the U.S., individuals with eating disorders have a higher health care utilization rate than individuals with other forms of mental illness.
We have just completed a study—