With eating disorders on the rise in Canada, experts break down common myths

Tips for parents of kids with eating disorders Gina Dimitropoulos, associate professor at the University of Calgary, has tips for parents of children with eating disorders.

As more Canadians are diagnosed with eating disorders, experts say stereotypes and common myths circulating on social media play a role in misinforming the public about the impact these disorders have on people and children.

Recent research has shown that the COVID-19 pandemic played a key role in the dramatic rise of eating disorders (EDs) among Canadian children and youth.

One study based on data from six pediatric care facilities across Canada, published in the Journal of the American Medical Association, revealed a 60 per cent rise in EDs from pre-pandemic levels. Some of the blame, the study said, can be placed on increased stress and further exposure to social media, especially during isolation periods.

Another report from the Canadian Institute for Health Information (CIHI), published last spring, showed that hospitalizations for young women with eating disorders increased by nearly 60 per cent since March 2020.

In light of these findings and other research that highlights the wide-reaching impacts of COVID-19 on the mental health of Canadian youth and adults, CTVNews.ca spoke to several experts who discussed what they say are some of the more common misconceptions and myths about eating disorders.

They say that EDs are deadly and do not discriminate against body type, race, gender or socio-economic status.

MYTH 1: EATING DISORDERS CAN BE SELF-DIAGNOSED

In Canada, doctors, nurse practitioners and psychologists can all diagnose EDs, typically relying on the Diagnostics and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

The National Eating Disorder Centre (NEDIC) estimates that, “at any given time,” between 840,000 and 1,750,000 people in Canada have symptoms of eating disorders.

Dr. Blake Woodside, professor at the University of Toronto psychiatry department and physician at Toronto General Hospital's eating disorder program, told CTVNews.ca in a phone interview that some people give themselves a 'diagnosis' based on information found online.

"There's a ton of stuff that's in the media," Woodside said. "Compulsive exercising, clean eating syndrome, like I can go on and on and on…But that stuff is not the subject of regular clinical activity or scientific scrutiny."

Woodside said there are misconceptions about what an ED is and social media can play a part in that.

Most people have some knowledge of these two EDs commonly diagnosed by physicians: bulimia nervosa and anorexia nervosa.

Bulimia is characterized by periods of food restrictions followed by binge eating and then purging. Anorexia is characterized by rapid weight loss due to severe restriction of food. Symptoms of both EDs include feeling guilty around food, restricting food intake and being concerned about body shape and size.

EDs have the highest mortality rate of any mental illness, with estimates of between 10 to 15 per cent, the 2019 to 2029 Canadian Eating Disorders Strategy reads. Suicide is the second-leading cause of death after cardiac arrest for those with anorexia.

"For females aged 15 to 24 years old, the mortality rate associated with (anorexia) is 12 times greater than that of ALL other causes of death combined," the report reads.

Experts say EDs should be seen as a serious medical condition and not something a person "chooses."

"This kills people dead. This is not trivial," Woodside said. "Some people do make spontaneous recoveries, which is wonderful, but many people suffer for years or decades with the illness before they recovered."

Other less-known EDs that people can be clinically diagnosed with include avoidant and restrictive food intake disorder. This disorder typically affects children and focuses on food's colours and textures; it can develop from a traumatic event. NEDIC says these fears are so disruptive to the child it can trigger them to be physically ill after eating food.

"If left untreated, it can develop into anorexia nervosa or bulimia nervosa later in adolescence or adulthood," the NEDIC website reads.

The Canadian Mental Health Association (CMHA) says binge-eating disorder affects about two per cent of all people in Canada.

It can be classified as the consumption of an unusually large amount of food over a short period of time and feeling out of control on how much is eaten and when to stop.

"The person with binge eating disorder will be in front of the television and over the course of the evening eat 1000s of calories, kind of without being aware of it, without any sensation of fullness or that it's time to stop," Woodside explained.

Some syndromes are merely avenues to an underlying ED, such as compulsive exercise. This can be described as someone who has feelings of guilt or distress if unable to exercise and continues to exercise despite injury or other medical complications, the U.S. National Eating Disorder Association website reads.

MYTH 2: ONLY THIN, WHITE, WEALTHY, YOUNG PEOPLE HAVE EDs

Experts say the most harmful misconception about eating disorders is that they only affect certain types of people.

Ary Maharaj, the outreach and education co-ordinator for NEDIC, sees many stereotypes in his work. Through speaking engagements with schools and non-profit organizations, he sees a pattern of myths perpetuated by social media and misunderstandings around EDs.

He said he often needs to dispel the myth that EDs affect only "thin, white, wealthy adolescent girls."

Access to health care is a barrier for lower-income individuals and if they cannot get help they are never counted in statistics and therefore do not fit the "typical" picture of people with EDs, Maharaj said. He also noted that, in some cases, food insecurity can trigger an ED.

"It's really hard to trust your body's cues when it tells you that you're hungry or you're full, if you don't know when you're getting food next," he said.

Experts also said EDs can present differently and be hard to detect in some people. For example, there’s a myth that a person with anorexia should look "thin."

"Our health-care system is built on weight-normative or weight-centric approaches to care," Maharaj said. At most health-care appointments, people whose body size is not considered to fit that ‘norm’ are told to “'watch their weight' and 'watch what they're eating,’” he said. “That almost naturally is going to lead to body image concerns for those folks."

There are many symptoms of EDs, including physical and mental indicators. EDs can occur in anyone, regardless of what they look like.

"Somebody who… is totally consumed with ongoing weight loss and totally consumed with never wanting to return to that previous weight and exercising up a storm, and thinking that they're still too heavy...That person might qualify for a diagnosis of anorexia nervosa," Woodside said.

Although the person may not appear to have anorexia, their actions and restrictive eating emulate patterns of disordered eating.

"Health looks different for every person," Maharaj said. "People do not owe us their health in order to be treated with respect and dignity, and health should not be the key factor that determines the worth of others."

MYTH 3: SOCIAL MEDIA IS THE MAIN CULPRIT BEHIND DISORDERED EATING

Research shows that EDs can be triggered by both environmental and hereditary factors. Woodside cited as an example a study published in 2001 that found in identical twins, if one is diagnosed with anorexia the other has a 74 per cent chance of also having the ED. Similar studies conducted on twins found a range of ED heritability from 28 per cent to 58 per cent .

"The way to think about it is genetics loads the gun, and environment pulls the trigger," he said. "So people are genetically at risk because of their genetic heritage, and then specific environmental things have to activate their genetic liability."

There are many ways genetic liability can be activated and researchers say being exposed to certain types of images and messages on social media is among them.

Researchers have not figured out the full impact of growing up in the age of social media. Maharaj said the increased use of social media marketing for the dieting industry can impact the way people, particularly youth, see their bodies.

"We are much more profitable if we experienced body dissatisfaction," he said. "If we all accepted ourselves, we probably wouldn't buy all of these products and fitness things."

Environmental factors such as comments from loved ones on someone’s weight or eating habits can also be a trigger for an eating disorder, Maharaj said. During his presentations, he tries to give alternatives for compliments on a person's characteristics rather than physical appearance.

MYTH 4: EDs ONLY AFFECT WOMEN

Woodside has focused his research and treatment on men with EDs and wants to dismantle the myth that men do not suffer from the illness like women. The physical differences between men and women mean that EDs can affect them differently, he said.

"When men or boys present with anorexia, in particular, they present quite a lot sicker than the women or girls," he said. This can include severe headaches, constant cold or chills, translucent or pale skin, hair loss and extreme fatigue. Woodside said they will also lose their sexual drive faster than women.

In reality, men can have the same genetic liabilities and environmental risks for EDs as women. The Canadian Eating Disorders strategy says more younger people are dieting, putting them at risk for an ED.

"In Canada, between 12 per cent and 30 per cent of girls and 9 per cent and 25 per cent of boys aged 10-14 report dieting to lose weight," the 2019 to 2029 action plan reads.

The U.S. National Eating Disorders website says that men with EDs are often at higher risk of death due to their likelihood of not getting treatment and not being diagnosed until much later.

Mental health complications associated with EDs can be triggered in anyone, regardless of sex.

"It's a giant myth that we can see an eating disorder with our eyes," Maharaj said.

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The following is a list of resources and hotlines dedicated to supporting people:

National Eating Disorder Information Centre provides resources and referrals supporting people directly or indirectly affected by disordered eating:

Toll-free: 1-866-633-4220

Kids Help Phone

1-800-668-6868

http://www.kidshelpphone.ca

Free, anonymous and confidential professional phone counselling and online counselling, available 24/7 for kids and youth 20 years of age and younger.

Canada Suicide Prevention Helpline

If you or someone you know is in immediate crisis or has suicide-related concerns, call or text:

1-833-456-4566 (24/7)

1-866-277-3553 in Quebec (24/7)

Text to 45645 (4 p.m. – Midnight ET). Text messaging rates apply. French text support is currently unavailable.