Thank you.
Good afternoon. I'm really honoured and excited to be able to present to you as you conduct this study on eating disorders in Canada. As mentioned, I am the 2014 president of Eating Disorders Association of Canada and a registered dietitian by profession. I have worked in the area of eating disorders for 25 years.
I have had the opportunity to review the transcripts of the meetings thus far. I'm very excited the Government of Canada wants to hear about the challenges that eating disorder individuals and their families undergo, something that I've known for the past 25 years. There is a lot of heartache and pain and not enough resources.
I currently work in a tertiary centre. I work in the B.C. Children's Hospital eating disorders day treatment program, and I have a private practice that specializes in eating disorders. In my 25-year tenure I have had the opportunity to participate in setting up in-patient programs, working in outpatient clinics, and setting up residential eating disorder programs. I've even had the opportunity to run an eating disorders camp that we have in B.C. Every year I get a couple of hours to lecture to medical and dental students. I talk on adolescent nutrition. Of course, in my view, the big deal around adolescent nutrition in North America is eating disorders and obesity. I have an interest in obesity also. In fact I took a job in the pediatric obesity program at Children's for a couple of years. I think there's a lot of overlap. I know that other people have presented on this same topic.
Now, about EDAC, the Eating Disorders Association of Canada, it is a very young association. It was incorporated in 2009 when a group of eating disorder professionals saw a need for a uniquely Canadian association. Our mandate is to see how we can best serve the needs of those whose lives are impacted by eating disorders. We are exclusively operated by volunteers. Like me, the volunteers are eating disorder health care professionals. Only last year were we able to hire, on a very part-time basis, some support staff for the association. We felt the need to actually pay a few hours for a webmaster and provide a small amount of administrative support for a different staff member. Until this time last year, these individuals were also volunteers.
The board of directors is quite interesting. They span the country. We have people from coast to coast and across disciplines. I'm a dietitian. We have pediatricians. We have psychologists. We have social workers. We have an elections committee, and we try to emulate the fact that the best practices for treating eating disorders are multidisciplinary. EDAC is unique in that we are trying to be truly multidisciplinary.
As an association, we have four specific objectives. We want to: one, educate each other regarding best practices; two, encourage the sharing of information amongst members on the issue of eating disorders care; three, promote a reflective and responsive approach in the provision of care and amongst providers; and four, stimulate and support research in the area of eating disorders.
Our first president was Dr. Leora Pinhas, whom you've heard from. In fact many of the founding fathers and mothers of EDAC-ATAC are the same visionaries and passionate advocates you've already heard from, including Dr. Woodside and Dr. McVey, just to mention two.
To meet our association mandates at this time, we produce three newsletters a year. We host a national conference every other year. Although not ideal, this is all we can do with the rather limited resources we have. This coming year our national conference is in Vancouver, with the theme of innovation and integration in eating disorders.
As the EDAC-ATAC president, I am also the chair of this conference. Our hope is to provide a forum for many of the eating disorder health care providers from across the country to gather and share information and to invigorate each other as we do our work in our situations. We have arranged for keynote speakers who will go from prevention to treatment. In fact one of our plenaries will be totally devoted to looking at national guidelines for the treatment of eating disorders—all things that I know from past presentations have been a passion for many folks.
I am fortunate enough to be in a province, the province of British Columbia, where we do have a goal of the continuum of care for eating disorders.
It's not perfect. We have lots of holes, and the holes in particular have been addressed by previous witnesses. There's no residential program, and there's a need for it, specifically for young people who are suffering from an eating disorder. For example, right now I have a 13-year-old on our in-patient unit who did not manage to stay in our day treatment unit. She's had five admissions in the past two years. She's only 13. She really does not get the care that she could get provided in the in-patient unit but that's all we have. Ideally a residential program with longer-care commitments would be a better fit.
We also have secondary services in B.C. for children and adolescents. It's really based on family-based therapy, the Maudsley model, and has been well-supported by evidence. It's actually reduced the need for tertiary care of more intensive treatment. We've seen that in real life because when we have people working in those communities doing family-based therapy, we don't get the influx of referrals to the intensive treatment centre. But when we hear that there are budget cuts, there's a lack of program, or the wait-list is a year—for a young person that is ridiculous—we suddenly get a huge influx into the referral system into the intensive programs.
Alisa Harrison, who produced a document for the British Columbia government that was a literature review and environmental scan in 2011, actually cites that in the worldwide literature that she was reviewing. This is a really wonderful, very comprehensive document.
The goal that we work towards in B.C. is trying to look at continuing care for eating disorders services. I just want to highlight those two points as I talk about eating disorders and the role that EDAC is perhaps wanting to look at.
For more information on the state of eating disorders in British Columbia—I could spend another 20 minutes on that—I would refer you to Dr. Connie Coniglio, who is one of our directors at the Children's eating disorder program and she's also from the British Columbia mental health and addictions overall sort of management. So, Alisa Harrison's document is available.
A second document that is quite comprehensive is the clinical practice guidelines for the B.C. eating disorders continuum of service. That's a follow-up document from the continuum of service and it's currently in draft form, and its author is Dr. Josie Geller. I believe that Dr. Geller is on your list of witnesses that you may bring forth. Again, we could spend lots of time talking about the clinical practice guidelines that she's put together. I won't take time to do that, but we can provide it or ask for it for you if you need it.
I also want to take a few minutes to talk about one of the most satisfying things I get to do in my private practice that specializes in eating disorders. Because I've been in the British Columbia eating disorder system for so long, I often get referrals. I get calls from desperate moms and dads who are at a loss as to where to go. Because I know many of the systems, I know where their care might be provided free of charge so they don't have to come to me and pay the private practice price. I love getting them into the right care at the right time. Sometimes I support them while they are on the wait-list to get into the care that's in their local programming.
I was at my doctor's office today. I know there's been a lot of talk about GPs getting the right resources and getting them trained correctly, and I think that's really important. My GP said, “You know, when I see an eating disorder patient I book extra time, but the extra time is 10 minutes and the usual time is seven minutes.” It's almost laughable that they have 10 minutes to support an eating disorder patient and family. He told me, “You know, I see them but then I have to spend a half an hour or hours extra on my own time trying to connect people to the resources.” So, the bottom line is that I want to bring out that navigation piece for the country to coordinate. That would be truly wonderful.
The last part I want to talk about, having reviewed all the transcripts so far, is the health care message. One knows that nutrition and physical activity are very important components of the health care message. For our particular population, especially for those with anorexia nervosa, the health messages are taken in and taken to the extreme.
I'll give you an example. I have a 12-year-old young lady who is in my program right now. She came in at 60% of where her goal weight should be. Her heart rate was in the 30s, she was blue, her heart valve was not working properly and yet when we wanted to provide safe nutrition, provide some nutritional supplements, she was fearful because it had fat in it and it was fat juice. She feared it with her life. In the secrecy of her room she was exercising. The messages that she had absorbed were fat is bad and exercise is always good. Those are the health messages she has taken to the extreme. Of course, at this point in her life and her time fat is good for her and she does not need to exercise and those are actually bad for her.
As we look at the messages that are put out there, I want us to actually be cognizant of perhaps a push for the fear of obesity, obesity prevention, and it really clutters up what the general public is seeing or hearing and even our health professionals and GPs.