Adolescent ER visits in Ontario for eating disorders saw big jump during pandemic: study

The biggest jump in Ontario emergency room visits and hospitalizations for eating disorders during the first 30 months of the pandemic was seen in adolescents aged 10 to 17, according to a new study.

Using provincial health data from two periods -- January 2017 to February 2020 and March 2020 to August 2022 -- researchers calculated and compared the expected and observed rates of eating disorder-related hospital visits for various age groups.

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They found that the rate of ER visits in the 10-to-17 age group was 7.38 per 100,000 in the latter period, up 121 per cent over the expected rate of 3.33, based on pre-pandemic trends.

Hospital admissions for eating disorders also rose among adolescents, by 54 per cent, but dropped for all adult age groups.

The study, published Tuesday in the Canadian Medical Association Journal, also showed that ER visits for eating disorders were 13 per cent higher than expected among young adults between the ages of 18 and 26.

Among those aged 27 to 40, the ER visits were near the rate expected. But they increased by 15 per cent for the oldest age group -- those between 41 and 105.

Lead author Dr. Alene Toulany, a pediatrician and adolescent medicine specialist at Toronto's Hospital for Sick Children, said 90 per cent of the adolescents in the study period after the onset of COVID-19 were female.

It's not known whether the adolescents needing medical care developed an eating disorder during the pandemic or if their pre-existing condition had worsened.

"I think it's really important to understand that, to help with next steps," said Toulany, also an adjunct scientist at the research institute ICES.

What's clear is that the pandemic affected adolescents differently than adults because of their developmental stage "as the world turned upside down" and they became isolated, lost out on structured activities and schooling while being heavily influenced by social media, she said of some of the contributing risk factors.

Similar reasons have been cited for an increase in eating disorders globally among children and adolescents.

"We're seeing a lot of young people with atypical anorexia nervosa," Toulany said of those who appear to have a normal or healthy weight but were much heavier before they started having an eating disorder.

Ambulances sit at the emergency room entrance at the Michael Garron Hospital in Toronto on Thursday, April 29, 2021. THE CANADIAN PRESS/Frank Gunn

"They may have been in potentially the overweight or obese range and lost a significant amount of weight. So now they're not underweight but that still has major implications on their health and their medical stability. And they need medical attention just as much as those that are underweight."

A previous study led by Toulany and published in 2021 in the Journal of Adolescent Health showed that the first 10 months of the pandemic saw an overall 66 per cent increase in ER visits and a 37 per cent hike in hospital admissions for eating disorders among children and adults in Ontario.

The current study looked at triple that time frame and compared the adolescents' data with adults, which Toulany said is important to guide resource allocation as part of pandemic recovery planning.

"While we don't see that much of an increase in our adult population, that doesn't mean that they don't have problems with eating disorders, especially problems that have come out of the pandemic," she said.

Toulany said there aren't enough hospital beds for adults with eating disorders and they sometimes end up on wards for other medical issues so their eating disorder may not be coded as such in health data.

Jennifer Couturier, a child and youth psychiatrist and director of the eating disorder program at McMaster Children's Hospital in Hamilton, said some youth developed an eating disorder during the pandemic. But among those who were already ill, some got worse while others' condition improved slightly because they no longer had to cope with the stress of being in school.

"Parents were home 24/7 to monitor their meals and help them so if they were already in treatment they could discuss any conflict at home and then deal with it. But I think those who weren't in active treatment struggled a lot more," said Couturier, who was not involved in the study.

While girls have higher rates of eating disorders, transgender youth are also more at risk, she said.

"That would be related to increased focus on body image but we don't know really why," said Couturier, adding extensive use of social media has been linked with poor self-esteem among youth.

But general chatter among adults about weight gain during pandemic lockdowns affected some youth in a big way, she said.

"I think adolescents got scared by that and started exercising a lot, and that caused some eating disorders for sure," Couturier said of the multiple factors involved in the condition.

Parents should be talking to young children about accepting their bodies and encouraging them to eat a range of food instead of focusing on restriction and making weight an issue, Couturier said.

Treatment that involves the whole family coming together for sessions with a care provider, typically once a week, is the gold standard for eating disorders, she said.

"It's really about parents being able to help their teenager with eating and interpreting any exercise or binging or purging. And the siblings are there to support their brother or sister as well."

At BC Children's Hospital in Vancouver, a mindfulness program is helping patients and families living with an eating disorder, said Dr. Dzung Vo, who leads groups in the practice.

Vo said more adolescents visited the ER for that condition during the pandemic and over the last two years some kids have experienced anxiety after returning to school in the fall so parents should be aware of suchstressors and have a plan to help them cope.

This report by The Canadian Press was first published Oct. 3, 2023.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.