Status of Women committee  There are good international standards for treating anorexia and bulimia, and those treatments have reasonable success rates. As I quoted earlier, it's 60% to 65% for anorexia and 75% to 85% for bulimia. These are evidence-based treatments, as much as we can tell. They're described well in the literature, and there are both American and British guidelines to support their use.

Status of Women committee  Sure. I'm involved in reviewing almost all the cases in Ontario. There's a panel of us who have a look at the cases. The most common situation for people applying for out-of-country treatment is that they have never been assessed by an expert in anorexia or bulimia and have never even been offered treatment in Ontario.

Status of Women committee  There is widespread fear among the general public that if a member of the family is diagnosed with a mental illness they will encounter overt discriminatory attitudes or stigmatizing attitudes. I prefer the word “discrimination” to “stigma” because I think this is discrimination, and you can do something about discrimination.

Status of Women committee  My treatment program is voluntary, and that goes for people who have a body mass index of 10. Nobody is forced to come to my treatment program. Nobody is forced to stay; people can exit any time. The program has in it elements that we think are evidence-based and supported by the scientific literature, so we believe we're practising in an evidence-based way.

Status of Women committee  The illnesses are relatively straightforward to diagnose, especially anorexia nervosa. There aren't that many reasons for an 18-year-old to be at a body mass index of 14. That one's pretty obvious. Bulimia is more difficult because it's an invisible condition. Part of the problem is the total lack of exposure to these conditions in medical school curricula and residency training programs.

Status of Women committee  No.

Status of Women committee  It's the truth, unfortunately. There has been no federal attention to this ever in the last 27 years I've been involved in the field.

Status of Women committee  Typically, I submit a grant application to CIHR. I've been involved in two or three grants recently. One was a grant looking at the health costs associated with eating disorders. It was a moderately complex study where data from a variety of sources was going to be obtained, and we were going to look at the lifetime health costs, or the 10-year health costs associated with these conditions, which is something that had never been done before.

Status of Women committee  First of all, the way to think about the societal piece, especially when you think about the genetics of these illnesses, is that anorexia nervosa is one of the most heritable psychiatric conditions. The heritability is about is about 75%. The heritability of schizophrenia, for example, is about 50%.

Status of Women committee  I don't think so. These illnesses continue to be viewed as kind of pseudo-illnesses, that they're not real conditions, in spite of their enormous mortality rates and the rates of suffering that these people endure. The illnesses occur right across the board. The patient we admitted yesterday is homeless and in a shelter.

Status of Women committee  That's an excellent question. In community studies, it's about one in five, for men; in the clinic, it's about one in 30. The answer is that we don't really know. One of the theories is that its genetic, related to something on the X chromosome. Women have two; men have one. Other theories relate to patterns of brain development.

Status of Women committee  I'm an adult psychiatrist. I believe you'll also hear testimony from some of the child psychiatric experts in this area. One who I believe is going to be invited is Dr. Leora Pinhas from Toronto, who sees patients as young as seven and eight, with what she is pretty convinced is full syndrome anorexia nervosa.

Status of Women committee  The treatments actually are somewhat similar. I'll start with bulimia nervosa, which is easier to treat than anorexia nervosa. The binge eating of bulimia nervosa is not food addiction. It's actually a response to starvation in the same way that if you held your breath for a minute or two you would gasp for air because you were starved for oxygen.

Status of Women committee  Thank you, I'm almost done. As I was saying, there is no point in even trying. What do we need? First, we need more attention paid to this situation. The work of the committee will help with that. We need to set some standards for appropriate clinical care for these patients, the type of treatment that works, appropriate wait times, and appropriate levels of access.

Status of Women committee  Public awareness is very important. First of all, these are serious medical conditions. They shouldn't be ignored. They don't generally go away on their own. They're not phases or bad behaviour. I think you're going to have testimony later from Dr. Gail McVey, who is in charge of the Ontario Community Outreach Program for Eating Disorders.