By LEORA PINHAS, and MAGGIE THISTLE
Not a single question was asked about the potentially fatal mental health issue in a major Ontario survey
The results of a major biennial Ontario mental health survey released last month failed to include any data on eating disorders, a life-threatening group of disorders that are common only in girls.
The Ontario Student Drug Use and Health Survey, which questioned thousands of students from Grade 7 to 12 and is conducted by the Centre for Addictions and Mental Health (CAMH), contains 600 pages of findings in what is considered important today in adolescent mental health.
Now consider that eating disorders occur in 1-out-of-6 adolescent girls (double the rate of obesity in adolescent girls) and are the most fatal of mental health disorders, killing 1-out-of-10 young women affected. These disorders are rendered invisible if left out of a provincial-wide comprehensive screen of mental health issues. It perpetuates the misperception that eating disorders are so rare they do not require our attention.
Without data, there is no imperative to address prevention and treatment needs. Currently, mental health programs barely provide token treatment for people with eating disorders and more typically, find ways to formally, or informally, exclude patients with eating disorders from access to treatment for other mental health disorders that they provide for everyone else.
CAMH is not alone in consistently failing to consider eating disorders as having relevance. Our government agencies, whether provincial or federal, do not track the rates of eating disorders or the mortality associated with them in the way they do most other medical or mental health disorders. In Ontario, we cannot even track how often family doctors treat patients with eating disorders, because unlike almost all other health care issues, Ontario has not created any diagnostic codes for this purpose. We know less about eating disorders than almost any other mental health disorder, however, we make no significant funding available for research or treatment development.
The survey did ask about weight and reported that 8.7 per cent of teens are underweight, 19 per cent are overweight and 7.4 per cent are obese. But the rate of obesity remains a singular focus, and there is no notice taken of the numbers of teens who are underweight. In the discussion, the overweight category is combined with the obesity category, which encourages an all-or-nothing approach. It implies that being even half a kilo above the “normal” weight range is equivalent to being at the extreme end of the obesity range; a notion that is untrue and only promotes negative body image ideals.
Examining the survey results hoping to glean any information, however, indirectly yielded some intriguing results. One-third of adolescent girls think they are too fat and two-thirds of girls are either trying to lose weight or trying to avoid gaining weight. Boys were half as likely to report this. More concerning, in the last 15 years, only in girls have we seen a rise in the number who report they are too fat. Many more girls are starting to increasingly report mental health issues that commonly co-occur with eating disorders.
Adolescent girls are twice as likely to rate their mental health as fair or poor, have poor self-esteem and report elevated stress, psychological distress or suicidal ideation. This is not true for boys, whose rates remain stable. We have no way of knowing how much of this increase in mental health problems is related to the psychological effects of an eating disorder or are the physical consequences of starvation, eating chaos, over-exercising, and misuse of medications in pursuit of weight loss.
The study examined the rates of medication misuse and asked about the misuse of steroids, which occurs in about 1 per cent of the male students and at no measurable rate in female students, but it did not ask about the misuse of laxatives or weight loss medication, which are much more commonly abused by girls.
In Western countries, eating disorders in young women are on the rise. The survey reports an increase in the number of girls who report feeling fat and experiencing mental health distress, and yet we get no information about how many girls in Ontario have developed eating disorders. When will publicly funded mental health institutions that inform and direct care start to connect the dots? Where do families turn for help for their daughters if they cannot look to the mental health care system that is working to avoid even noticing eating disorders exist?
Leora Pinhas is a psychiatrist working in the field of eating disorders. Maggie Thistle is a writer and the mother of a preteen daughter who advocates on girls’ mental issues. Opinions expressed belong solely to the authors and not the institutions where they work.