Over the last 17 years, the number of eating disorders among male children and teens has seen a shocking increase, ballooning to 400 per cent higher than the rates seen in the early 2000s.
The data comes from an Ontario study which looked at the changing rate of children and adolescents with an eating disorder, the vast majority of which were girls.
But while researchers found that number of female teenagers and high-school aged teenagers with eating disorders saw the largest increase in sheer numbers over the study period, the most surprising increases were among those once considered unlikely to have eating disorders: teenage boys and younger children aged 12-14 years old.
These patients, once a rare sight for doctors, are increasingly ending up in hospital.
"Our study found that increasing numbers of pediatric eating disorder patients with characteristics traditionally considered atypical are becoming unwell enough to require hospitalization,” Dr. Sarah Smith, an attending physician in the department of psychiatry at SickKids Hospital and an ICES trainee, said in a press release.
Smith is the lead author behind the new study, which was published in the peer-reviewed journal JAMA Network Open on Monday and tracks how the presentation of pediatric patients with eating disorders has changed between 2002 and 2019.
Researchers looked at more than 11,600 Ontario hospitalizations of children aged five to 17 years old due to eating disorders, and found that the base rate of these hospitalizations had increased 139 per cent over the past 17 years.
Around 91 per cent of these hospitalization were female patients, while 65 per cent were among adolescents aged 15-17 years, with the median age of patients being 15 years old.
Girls have always made up a significantly higher percentage of pediatric eating disorder patients, but the rate at which male patients increased is something researchers say clinicians should keep an eye on to inform care standards.
Across the study period, the rate of hospitalizations for girls increased by 123 per cent, while it increased for boys by 416 per cent. In 2002, boys made up just five per cent of all pediatric eating disorder patients, but in 2019, they comprised 11.8 per cent of these patients.
This shift could be explained by a couple of factors, researchers suggested.
It could be a sign of a growing problem among young boys—but it could also be the result of growing awareness around mental health, and the ongoing work to destigmatize discussions of eating disorders. Researchers theorized that possibly more male teenagers might be able to ask for the medical help they need now than had felt comfortable doing in decades past. More inclusive criteria for diagnosing eating disorders in clinical settings, introduced in 2013, may also have resulted in more cases of eating disorders being caught which could have been dismissed as other issues in the past.
Researchers saw a spike in hospitalizations from 2010 to 2013, with 2013 showing the highest incidence rate during the whole 17 year period.
Whatever the reason for the jump in hospitalizations of boys with eating disorders, the data outlines a group that doctors need to take into account when planning care for children and teens with eating disorders.
“Health care providers need to be aware of the increasing diversity of children and adolescents requiring intensive, inpatient, eating disorder care to help identify these patients earlier in their illnesses,” Smith said. “The effectiveness of existing treatments and programs for pediatric eating disorder patients with these characteristics should also be evaluated,”
Rare eating disorders have also seen a spike in Ontario in the past two decades, researchers found.
Anorexia and bulimia nervosa are still the most common eating disorders among children and adolescents, with anorexia making up 45 per cent of all hospitalizations in the study period, but eating disorders outside of these two have seen a 255 per cent increase in incidence since 2002.
These include pica, an eating disorder in which a person compulsively eats things that aren’t food and hold no nutritional value; rumination, which is a pattern of spitting food back up with seemingly no physical cause; feeding disorders of childhood and any unspecified eating disorder that doesn’t fall under other categories.
When it came to different age groups, the most startling increases were among younger patients. Apart from the 196 per cent increase in the incidence rate of hospitalizations among patients aged 12-14 years, there was also a 140 per cent increase in hospitalizations among patients younger than 12 years old across the study period.
In 2002, patients aged 12-14 made up 26 per cent of all pediatric eating disorder hospitalizations. In 2019, 32 per cent of hospitalizations for eating disorders among children was those aged 12-14.
The increase in hospitalizations of younger children with eating disorders is far from a Canadian phenomenon—the study cited similar data showing an increase in these patients in the U.S., the U.K. and Norway. While more inclusive criteria and destigmatizing efforts may be contributing to these numbers as well, researchers noted that there is limited information on how best to serve these younger patients, and how common their incidence truly is.
The study is limited by the fact that it focuses on hospitalizations, with researchers acknowledging that the incidence rates of eating disorders among children could be much higher than the current data suggests, since it only captures those who grow ill enough to require hospitalization.
But this data alone suggests that clinicians need to keep up with the changing face of eating disorders among children, researchers say—or they could risk a delay in delivering the aid that a child struggling with an eating disorder desperately needs.
“Our findings should be communicated to health care practitioners, as misperceptions about who is at risk for developing eating disorders contribute to delays in help seeking, misdiagnosis and appropriate referrals, particularly for male patients and younger patients,” the authors wrote in the study’s conclusions. “Such delays in appropriate eating disorder treatment may exacerbate serious medical concerns, including impaired growth, developmental delays, or reductions in bone density acquisition, that can be irreversible.”
If you or someone you know is in crisis, here are some resources that are available.
National Eating Disorder Information Centre (1-866-NEDIC-20 and 416-340-4156)
Centre for Addiction and Mental Health (1-800-463-2338)
Kids Help Phone (1-800-668-6868)
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