Eating disorders are about more than just body image and food. They are also about self-worth, personal effectiveness, and feelings of control. Early detection, preliminary evaluation, and appropriate treatment are critical. They can help you progress to recovery quicker, and prevent the disorder from advancing to a more acute or incurable state.
Canadian Facts and Statistics
Eating disorders are consistently gaining more recognition as severe mental illnesses. With more awareness, patients with eating disorders may access help before the effects of their conditions become irreversible. Here are a few facts and figures about eating disorders in Canada, from reports published between 2013 and 2016.
1. Eating disorder prevalence is higher than what is documented
- At any particular time, between 600,000 and 990,000 Canadians fit diagnostic criteria for eating disorders.
- About 80% of eating disorder patients are women
- Anorexia occurs in 0.5% of the population while bulimia is at 1%
2. Anorexia and bulimia affect women more, while Binge Eating Disorder affects both genders equally
- About 25% of women with healthy weight view themselves as obese
- Women who are dieting are approximately 56%
- Bulimia occurrence in women is between 1% and 4% while anorexia is at 0.5% to 4%. Binge eating for all people is at 2%.
3. Eating disorders are potentially fatal
- Between 15% and 20% of anorexics progress to its chronic form
- Between 10% and 15% of anorexics will die in under ten years
- The estimated mortality rate in bulimia is 5%
- Females aged between 15 and 24 years are 12 times more likely to die from anorexia than from other causes combined
- On average, bulimia lasts at least eight years
4. Adolescents and young adults are at a higher risk of developing eating disorders
- The onset of anorexia peaks between ages 19 and 20, bulimia peaks from age 16 to 20 while binge eating peaks between ages 18 and 20.
- About 40% of girls have at age nine dieted for weight loss, even with a healthy weight
- Up to 27% of 12 to 18-year old girls engage in disordered eating behaviour
- At least 4.5% of adolescents have bulimia, while at least 1.5% have anorexia
- Disordered eating among high school students is about 17% for females and 8% for males
5. Eating disorders often co-occur with other mental illnesses.
- At least 50% of patients have a dual diagnosis with substance abuse or other addiction
Diagnosing Eating Disorders
Eating disorder diagnosis can be done by medical physicians, psychologists, psychiatrists, social workers or dieticians. Sometimes, a family practice doctor or a pediatrician will suspect an eating disorder when:
- They observe symptoms during a regular checkup.
- You or your family ask questions.
- You or your family have concerns, and you schedule a mental assessment.
Eating disorder diagnoses depend on eating habits, signs, and symptoms. If the doctor suspects an eating disorder, they may perform further evaluations to identify a diagnosis. The following are the recommended assessments and tests to diagnose eating disorders and to help determine the appropriate level of care.
Your clinician will ask you, and possibly your family, questions to confirm an eating disorder and to determine the best action to take. The focus will be:
- Your history and other screening questions about your eating patterns
- Your social, psychological, nutritional, and medical health. If possible, have an eating disorder expert assess your mental health.
- Your attitudes towards appearance, eating, and exercise
- Your family history of food or other psychiatric disorders including alcohol or substance abuse
- Your family history relating to obesity
- Assessing other mental conditions like anxiety and depression
Your doctor will first conduct an exam to rule out medical reasons for your eating disorder. In the absence of such causes, your doctor will focus on identifying your exact condition. Eating disorders almost always have accompanying medical issues as a result of self-starvation, binge eating, excessive exercise, and purging. A typical evaluation involves:
- Physical examination of your weight, height, body mass index (BMI), peripheral vascular and cardiovascular function. It also includes hair dryness or loss, skin health, evidence of self-harming behavior and a growth chart assessment for adolescents and children
- Checking your orthostatic blood pressure
- Measuring your pulse and body temperature
- Checking your abdomen for intestinal issues
- Dental and throat examination if the doctor suspects self-induced vomiting
- Establishing a diagnosis and recommending the necessary level of care and treatment plan
Eating disorders are severe illnesses that cause adverse physical complications. However, there are no specific laboratory tests that screen for these diseases. Your doctor will request bloodwork and other laboratory tests to establish the physical complications arising from your eating disorders. The doctor will combine your laboratory test results with your physical examination and psychological evaluation reports to correctly diagnose your eating disorder.
The tests will assess the following elements:
- Kidney and liver functioning
- Electrolyte levels, to establish dehydration levels, especially if you are purging
- Blood sugar levels
- Your heart’s rhythm
- Chemicals in your urine
The detailed laboratory tests are:
- A Comprehensive Metabolic Profile (CMP) to determine your overall health. It will check
- Electrolytes (chloride, potassium, and sodium)
- Blood glucose
- Carbon dioxide
- Thyroid function
- Creatinine and its clearance to assess kidney function
- Blood urea nitrogen, an indicator of kidney function
- Total bilirubin, a measure of liver performance
- Liver enzymes to establish liver health. They include
- Alanine aminotransferase (ALT)
- Alkaline phosphatase (ALP)
- Aspartate transaminase (AST)
- Electrocardiogram (ECG) to measure your heart’s rhythm and check for any abnormalities or irregularities
- Phosphate and serum magnesium tests. The two chemicals help in regulating your heartbeat and metabolism
- Urinalysis to:
- Assess urine specific gravity, to determine fluid intake and dehydration
- Check for ketones. Ketones are by-products of fat metabolism, a process that occurs when your body has inadequate fuel
- X-rays to check for broken bones, an indicator of low bone density from bulimia or anorexia
In addition to physical examination and laboratory tests, a mental health doctor must evaluate you psychologically to ensure an accurate diagnosis. The mental health practitioner will interview you about your experience and ask you about your feelings, thoughts, and eating habits. The topics of interest will typically include:
- Your current eating habits
- Your exercise routine
- How much you weigh
- Whether you have recently lost weight
- Your physical signs such as bruising easily or feeling cold often
- Your views on body image and weight
The objective is to gain insight into your perception and attitudes towards body image, eating, and food. While the questions may be personal, providing honest answers is critical to getting an accurate diagnosis and for the doctor to recommend an appropriate treatment plan.
The mental health doctor may also use a variety of assessment tools and questionnaires to assess your symptoms. Examples are:
- A psychological self-assessment questionnaire
- Self-report instruments like the Eating Disorder Inventory
- The Eating Attitudes Test
- The SCOFF Questionnaire
- The Eating Disorder Examination Questionnaire (EDE-Q)
Your doctor will use reports from the three forms of evaluation to diagnose your eating disorder. They will also ensure that you fit the diagnostic criteria for eating disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines the diagnostic criteria for each eating disorder.
Hurdles of Diagnosis
There is no accurate record of the number of people suffering from eating disorders. It is difficult to document the cases because not all people with eating disorders seek diagnosis and treatment. The challenges in diagnosis are:
- Lack of awareness: Despite an improvement in understanding mental health issues, eating disorders do not receive the same amount of attention given to other mental health conditions. There is still significant exclusion from mental health agendas, campaigns, and programs.
- Stigma and stereotypes: The greatest challenge in eating disorder diagnosis is the stigma, stereotypes, and misinformation about the diseases. The society misunderstands these patients and their families and views the conditions as pseudo-illnesses or taboos. The stereotypes increase stigma and shame in the suffering persons. The shame prevents patients from acknowledging the problem, seeking diagnosis and accepting treatment.
- Community-based support: There is a scarcity of information and resources for eating disorder patients and their families. Local support and resource centers cannot keep up with demand. Community-level assistance for siblings, parents, and partners of individuals with eating disorders is minimal. Parents whose very young children suffer feel the lack of support more because of children’s specific meal support and refeeding needs.
- Biased healthcare: Some patients and their families feel that the healthcare system generally discriminates against them. The disorders are not a priority. The patients have limited access to treatment and long wait times before admission into treatment programs.
- Financial constraints: Diagnosing and treating an eating disorder involves significant amounts of money. Patients often require multiple sessions with a multidisciplinary team of medical professionals. Sometimes, the cost of the group can be prohibitive, especially if the patient must pay for it without financial assistance.
- Co-occurring disorders: A majority of eating disorder patients also have a co-occurring disorder such as substance abuse, anxiety, depression or trauma-related disorders. Having two concurrent mental issues presents challenges in diagnosis, treatment, and getting support. Also, some mental health programs are not equipped to care for people with eating disorders.
- Research: Researchers are unable to collaborate and share information with their colleagues due to insufficient funds, resources and time. Additionally, the allocation of research funds in health care is uneven with some conditions which are equally or less prevalent than eating disorders receiving more funding.
Overcoming an eating disorder is not resolve but a process. There is no quick-fix solution, and you cannot do it alone. Recovery requires support in genuinely safe and caring ways throughout the treatment period. You do not have to be part of the grim statistics. You can get help through services and programs that fit your specific needs.