It might come as a surprise to know that eating disorders have the highest overall mortality rate of any mental illness1. Since the pandemic, diagnosis, and hospitalization, has drastically increased. “In my practice, I have noticed a significant increase in cases related to eating disorders, particularly anorexia. This trend is consistent with broader patterns observed not only across Canada but also globally. The rise in cases of eating disorders, especially among young individuals, has been particularly noticeable,” says Serena Benali, Registered Dietitian and President of In Good Nutrition whose team of registered dietitians provides a full spectrum of nutrition care, from eating disorders and disordered eating to diabetes and digestive health, across Alberta and Nova Scotia.
Anorexia nervosa and binge eating disorder are more commonly encountered in Serena’s practice. Bulimia nervosa, though just as prevalent, tends to be under-treated. Like many other mental illnesses, determining if someone might be suffering from an eating disorder from their physical appearance is simply not possible. “Eating disorders are complex mental health conditions that manifest differently in each individual,” explains Serena. “They can affect people of all body sizes and shapes, and many symptoms are not visibly apparent.”
Despite progress made around mental health conditions, eating disorders are still vastly stigmatized—and with dire consequences. “In my practice, I’ve encountered numerous clients who postponed seeking help for their eating disorder because they didn’t align with the common societal image of someone with such a disorder,” says Serena. “Unfortunately, this delay often results in the eating disorder becoming more entrenched, posing additional challenges for treatment.”
There is often a myth that eating disorders are caused merely by a desire to look thinner. “This [myth] is a significant oversimplification of these complex conditions. While concerns about body image and societal pressure to conform to certain body standards can contribute, they are often deeper and more intricate. Eating Disorders, in fact, are complex conditions influenced by a combination of psychological, biological, and environmental factors,” explains Serena “Psychological aspects such as low self-esteem, perfectionism, and mental health issues like anxiety and depression often play significant roles. Additionally, genetic predisposition suggests a biological vulnerability to developing eating disorders. Environmental factors, including societal and cultural pressures, media influence, family dynamics, and peer interactions, also contribute. Furthermore, traumatic experiences and stressful life events can trigger these conditions.”
Societal perceptions and stereotypes also reinforce that eating disorders are primarily viewed as a female issue, resulting in under-diagnosed in men. Serena notes, “Men may be less likely to seek help due to stigma, and healthcare professionals might not recognize the symptoms in men as readily. Additionally, the diagnostic criteria for eating disorders have historically been based on studies in females, which may not always capture the nuances of how these disorders present in men.”
What are some key differences between disordered eating and eating disorders? “Eating disorders are specific, diagnosable mental health conditions with criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), involving serious disturbances in eating behaviour and related thoughts,” explains Serena. “Disordered eating refers to irregular eating behaviors that don’t necessarily meet the criteria for an eating disorder but can still be harmful. Disordered eating may include habits like excessive dieting or compulsive eating, which can potentially develop into an eating disorder. These behaviours can be problematic and can negatively impact one’s health and quality of life. It’s important to note that disordered eating can sometimes develop into a full-blown eating disorder and may require intervention.”
Is social media to blame for the recent increase? “Social media undoubtedly plays a significant role in the development and exacerbation of eating disorders and disordered eating behaviours.2 It presents idealized body standards through edited images and curated content, leading to body dissatisfaction. Social comparison on these platforms fosters continuous self-evaluation, contributing to heightened body image concerns. As their dietitian, my clients share with me their experiences with social media and its negative impact on their self-esteem and eating habits.”
Treatment for an eating disorder is rarely simple. “More serious eating disorders, such as anorexia, bulimia and binge eating, require longer term, more intense, multidisciplinary intervention,” explains Dr. Brian Forbes who leads the psychological services for CPA Assist—the profession’s free and confidential health program in Alberta and Saskatchewan. For these reasons, support for eating disorders falls outside the scope of CPA Assist’s direct counselling services and rather into each eligible person’s entitle one hour of non-direct services. “Provincial treatment centers, for the most part, will only accept a referral from a treating physician. This is where the CPA Assist program can assist in the referral to a treatment centre,” he says.
Adding to the problem, wait times have increased dramatically for publicly funded treatment and private care is not always possible for some. “To complicate matters, some treatment centers will only accept clients who are deemed “mentally and physically stable”.” says Dr. Forbes. This can leave families swirling to find help. In these situations, Dr. Forbes recommends, “CPAs and their family members can book a regular counselling session with a CPA Assist therapist in order to gain information on how best to help manage if their child or loved one has an eating disorder. They can also call the National Eating Disorder Information Centre.”
What can support look like if you know someone who is affected by an eating disorder? “The most important thing you could do is to talk to them,” explains Dr. Forbes. “This is easier said than done if the individual cannot accept that they have a problem. That being said, talking about their condition is needed in order for them to recover. It might be difficult for them to talk about what they are experiencing and may even come across as angry, even though they may be anxious and insecure. This being the case, in communicating with them be patient and listen carefully to what they are saying.”
Conversation tips Dr. Forbes finds helpful:
- Stay calm and focus on what they are saying—do not blame or judge them.
- Avoid talking about their appearance.
- Try to use sentences starting with “I feel like” or “I’m worried, because”.
- Don’t be upset if they are not willing to talk or are secretive, as this is part of their illness.
- Learn as much as you can about eating disorders. If uncertain about next steps, contact CPA Assist or another helpline.
There is still hope for change. We can all play a role in reducing the stigma around eating disorders. “Encouraging positive relationships with food, nurturing a healthy body image, and raising awareness about mental health can not only create a more supportive and empathetic environment for individuals affected by eating disorders and disordered eating but also contribute to prevention,” suggests Serena.
For more information about CPA Assist, visit www.cpa-assist.ca.
Support Organizations:
- National
NEDIC – National Eating Disorder Information Centre. Toll-free support line: 1-866-633-4220 - Alberta
Alberta Wellness Center for Eating Disorders
Eating Disorder Support Network of Alberta - Saskatchewan
BridgePoint Centre for Eating Disorder Recovery
If you or your loved one is in medical danger, call 911 or proceed to the nearest emergency department.
References