Eating Disorder Hospitalizations Increase in Canadian Kids

Hospitalizations of children with eating disorders increased by 139% in Ontario, Canada, from 2002 to 2019, data indicate. The largest relative increase was among patients who usually are considered atypical, such as boys and younger teens.

Findings from the population-based, cross-sectional study, which included 11,654 pediatric eating disorder hospitalizations, showed a 416% increase among boys compared with a 123% increase in girls , a 196% increase among the 12- to 14-year-old age group, and a 255% increase in disorders other than anorexia or bulimia nervosa.

“Eating disorders are often portrayed in the media as illnesses of thin, older, female adolescents who want their bodies to be smaller,” lead author Sarah Smith, MD, a psychiatry resident at the University of Toronto, told Medscape Medical News. “My concern is that clinicians who don’t work in the eating disorder field may share the same stereotypes as the public.”

The findings were published on December 4 in JAMA Network Open.

Increasing Psychiatric Complexity?

The investigators examined linked health administrative and demographic databases in Ontario to identify patients aged 5-17 years who were hospitalized with a diagnosis of eating disorder from April 1, 2024 to March 31, 2020.

Overall, 10,648 hospitalizations (91.4%) involved female patients, and patients’ median age was 15 years. The researchers identified 5268 hospitalizations (45.2%) for anorexia nervosa and 1374 (11.8%) for bulimia nervosa. During the study period, the rate of hospitalization of boys per 10,000 population increased from 0.2 to 1.1 compared with an increase from 3.9 to 8.7 among girls. This meant that the relative proportion of male hospitalizations rose from 5.4% to 11.8%.

Hospitalization rates for anorexia nervosa increased by 118% over the study period (from 1.0 to 2.2 per 10,000 population), and hospitalizations for bulimia nervosa remained relatively stable (0.4 per 10,000 population). But the largest relative increase occurred for a category that included “eating disorder not otherwise specified, unspecified eating disorders, pica, rumination, and feeding disorders of early childhood.” The increase for this diagnostic group was 255% (from 0.6 to 2.1 hospitalizations per 10,000 population).

“The administrative data used in this study don’t allow us to speak to why this is happening, but clinically, what I see as a physician who treats pediatric eating disorders is an increasing number of children and adolescents who engage in disordered eating for reasons other than wanting to lose weight (ie, being afraid of vomiting or choking),” explained Smith. Some of these children or adolescents “go to dramatic lengths to change their bodies, after having lived in larger bodies, so that even with dramatic weight loss, excessive exercise, or very restricted eating, they don’t qualify as underweight, despite how dangerous their behaviors may be for their health,” she added. “In my clinical opinion, clinicians should be concerned about sudden changes in diet, exercise, or weight in any pediatric patient and aware that a desire to be healthy, fit, or to avoid events like choking may drive these changes.”

In addition, the researchers found an increasing number of co-occurring psychiatric diagnoses over time, “suggesting that the psychiatric complexity of these patients is increasing,” said Smith. “I would also encourage asking about eating or exercise behaviors in children and adolescents with these conditions.”

The authors emphasize that their findings “should be communicated to healthcare 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. 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.”

Clinical Experience Similar

Commenting on the findings for Medscape Medical News, Jennifer Couturier, MD, associate professor of psychiatry and behavioral neurosciences at McMaster University in Hamilton, Ontario, said that “it is a really well-designed study” that needs to be replicated by other institutions. Couturier did not participate in the research.

She added that she is not surprised by the results. “This fits with what we are seeing clinically: more boys, younger age, and more atypical presentations. Boys’ reasons for weight loss are often very similar to girls’: They talk about body image and wanting to be healthier and perform better at a sport. Boys might mention wanting to be bulkier or have bigger muscles, which we usually don’t hear from girls.”

When it comes to recognizing atypical presentations of eating disorders, Couturier emphasized that “clinicians should be open to recognizing that eating disorders come in all shapes and sizes, as well as cultural backgrounds, and that people who live in larger bodies also have serious eating disorders, at times requiring hospitalization. In addition, we are also seeing eating disorders presenting with other fears that are not body image based, such as fear of choking or vomiting, or persistent low appetite, lack of interest in food, or sensory sensitivities to food.”

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. The senior author of the study reported receiving personal fees from The BMJ journal Archives of Diseases in Childhood outside of the submitted work. Smith and Couturier reported no disclosures.

Kate Johnson is a Montreal-based freelance medical journalist who has been writing for more than 30 years about all areas of medicine.