Eating disorders among youth skyrocketed during pandemic and so did associated costs, report finds

The number of young people experiencing eating disorders surged during the height of the pandemic as the social and economic costs skyrocketed too, a new pan-Canadian report has found.

Data analysed by Deloitte Access Economics and led by the CHEO Research Institute, in conjunction with more than 40 healthcare and academic partners across Canada, found a 60 per cent increase in inpatient hospitalisations from 2020 to 2022, when compared to one year prior to the pandemic. During that same period, there was also a 126 per cent increase in emergency department presentations.

Ottawa's Children Hospital of Eastern Ontario saw that surge first hand.

"If we had better data to really understand how those trends moved with the pandemic, we might have been able to understand those factors a little better and tried to get ahead of them," said Dr. Nicole Obeid, scientist and lead of the Eating Disorders Research Lab at the CHEO Research Institute.

CHEO was among the hospitals whose researchers participated in the study that was able to quantify the cost of eating disorders for the first time. The researchers found that the incremental costs of the impact to children and youth with eating disorders reached $39.5 million over the course of the pandemic, representing a 21 per cent increase. The study suggests that figure is likely even higher since GP services, day treatment programs and other services including transitional/supportive housing costs were excluded.

"Our study group was really interested in trying to see if we could quantify that increase and figure out the cost associated with that so we could see if we could shift services to help our young people during the pandemic a little quicker, if we could have had more data available in real time to guide services in that time of pandemic," said Dr. Obeid

What caused the spike?

In November or December 2020, Toronto's Hospital for Sick Children, whose staff also participated in the study, started seeing a surge in the number of young people with eating disorders who showed up to the emergency room and were hospitalized.

"They were really sicker than ever," said Dr. Debra Katzman, the head of the adolescent medicine department in the department of pediatrics at the Hospital for Sick Children. "They were severely malnourished; they had numerous medical complications and they had numerous mental health comorbidities."

Katzman says she believes a number of factors are behind the surge, such as isolation, more time on social media, and less time with friends and trusted adults, including coaches and teachers.

"They had an increase in time on social media both in terms of down time and school time," she said. "They were seeing themselves online a lot and were being exposed to a lot of fat phobic messages, diet talk that they would not have normally been exposed to in such excess."

While researchers do not know exactly what caused the surge, the study suggests the COVID-19 pandemic increased anxiety and stress levels, as well as a sense of loss of control, and that increased time spent online exacerbated self-esteem and distorted body image issues. The study also says the pandemic made environmental factors worse by reducing access to eating disorder services and supports, disrupted routines and activities in the communities and increased exposure to unhelpful social media messaging.

What is an eating disorder?

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. Eating disorders are psychiatric disorders characterised by severe and persistent disturbances in eating behaviours that may be accompanied by distorted body image, a pre-occupation with body weight and/or shape and frequent behaviours to control weight and/or shape.

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. But many experts say global data suggests the number is likely higher, around 7.8 per cent of people which could mean anywhere between 1 and 2.7 million Canadians are impacted by eating disorders.

"That's a much larger number and a reason we need a national surveillance strategy to make sure that we can directly measure the amount of Canadians impacted by this issue," said Aryel Maharaj, the Outreach and Education Coordinator at the University Health Network's National Eating Disorder Information Centre.

What's next?

Since the study only covered the two-year period between 2020 and 2022, experts say more research is needed to determine the full scale of the issue as well as the prevalence of eating disorders among youth. Maharaj believes hospitalizations are only "the tip of the iceberg" and that many more cases are likely going unreported or under-reported.

For example, National Eating Disorder Information Centre's toll free telephone help line and anonymous live chat service are as busy today as they were during the height of the COVID-19 pandemic.

"I think it's probably worse than we are even seeing here," said Maharaj. "I think we have always heard the message that mental health and mental illness were an under current of the pandemic and I think this report really shows that."

It's estimated that only 19-36 per cent of people living with an eating disorder receive treatment.

Researchers hope this study will help translate into better, more effective and targeted treatment for patients. They also hope it will start a national conversation about the need for a national surveillance program and for continued research to track the prevalence and financial impact of eating disorders.

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: [phone] or text 686868

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

If you or someone you know is in immediate crisis or has suicide-related concerns, call or text the Suicide Crisis Helpline: 9-8-8