Learn about eating disorders and how to find help for children and youth in Ontario.
Understanding eating disorders
“Disordered eating,” sometimes called chaotic eating, is common in our culture. It can range in severity from mild to extreme. At the milder end are irregular eating patterns, such as skipped meals, or yo-yo dieting. But at the extreme end are medically defined eating disorders that can become life-threatening.
Eating disorders are hard on both physical and mental health. They can disrupt family life, friendships, and everyday life. Eating disorders almost never disappear without professional help. The earlier help is obtained, the easier recovery will be.
If thoughts about food, eating and body image start making you feel bad, it’s time to get some help. The sooner, the better.
Eating disorders are complex conditions that can start at a young age. There are four medically defined types of eating disorders: anorexia nervosa, bulimia nervosa, binge eating and eating disorder-not otherwise-specified (EDNOS).
- Between 1% and 2% of adolescents and young adults have an eating disorder.
- Most of those affected are female.
- Anorexia usually starts in puberty, while bulimia tends to develop a few years later.
- Eating disorders often develop gradually and may grow out of cycles of dieting.
Once an eating disorder gets rolling, it can be hard to stop. So pay attention to warning signs. It’s important to get help as early as possible. Over time, a person’s life can become so focused on food-related activities there is little time left for anything else.
There’s no single cause of eating disorders, but some people are more likely than others to experience them. Personal risk factors include:
- feelings of low self-esteem or self-worth
- feeling a general lack of control, feeling powerless
- a need for perfection
- difficult family relationships
- a history of abuse or trauma.
Eating disorders are more about issues of control and self-worth than about food. The ability to control food intake and the body itself become tightly connected to feelings of self-worth.
Eating disorders usually mask other problems. They may start as a way of coping with personal issues, but in time they create more problems than they solve. It’s common for persons with eating disorders to have other mental health problems such as depression, anxiety or substance abuse issues.
People with eating disorders seldom see that they have a problem, which is a barrier to getting the help they need. At the same time, persons with eating disorders can experience shame and guilt and may try to hide their food-related activities. This can make it difficult for friends or loved ones to know there’s a problem.
So if you, or someone you know, are experiencing trouble with food and eating, it’s important to pay attention to the warning signs and get help early. Eating disorders are dangerous and do not go away by themselves.
Types of eating disorders
Anorexia nervosa usually starts at puberty and 90% to 95% of those with anorexia are female. Within 10 years of its onset, 10% of people with anorexia will die from the illness and its complications, including suicide.
Anorexia amounts to self-starvation and includes:
- the need to be very thin along with a fear of being fat
- a preoccupation with weight and body image
- a distorted body image; feeling overweight no matter how thin
- obsession with food
- low self-esteem and feelings of self-worth that are closely tied to body image.
Outward signs can include:
- eating very little, sometimes to the point of starvation
- limiting the types of foods consumed, becoming more restrictive over time
- over-exercising, spending more and more time working out
- using diet pills and laxatives
- denial of hunger
- obvious ongoing weight loss that cannot be reasonably explained
- making frequent comments about feeling fat or overweight
- avoiding situations that involve food, so avoiding mealtimes or social occasions.
As the disorder progresses, health impacts can include:
- slowed heart rate and low blood pressure
- lethargy, muscle weakness, risk of fainting
- signs of starvation such as hair loss, lack of menstrual periods, pasty skin, yellowing of the palms or soles of the feet
- growth of downy hair all over the body to keep the body warm
- reduced bone density
- irritability, depression, difficulty concentrating
- increased risk of heart failure.
If you see signs of anorexia it is important to seek professional help. With treatment, recovery is possible.
For someone with anorexia, weight is controlled by severely limiting the amount eaten. A person with bulimia nervosa eats, but follows it with purging. More common than anorexia, bulimia can involve:
- an ongoing cycle of uncontrollable binge-eating followed by purging – that is, getting the food out of the body – in an effort to erase the effects of the food binge
- forced vomiting and overuse of laxatives, diuretics and diet pills
- over-exercising, fasting and dieting
- extreme concern about weight, though body weight may remain normal, or “yo-yo” up and down
- self-esteem tied to body image.
Signs of bulimia can include:
- obsessive exercising
- physical effects from frequent vomiting such as swollen cheeks or jaw, discoloured teeth, or hardened, thickened skin on the back of hands
- evidence of purging, such as frequent trips to the washroom after meals, packaging from laxatives or diuretics in the trash, or signs (smell, traces) of vomit or diarrhea
- lack of energy
- rapidly disappearing food supplies or empty packaging from a lot of snack products
- frequent weight checks
- reduction of normal activities, including withdrawal from social activities, as the bulimic activities become an intense, consuming interest.
Health impacts of bulimia can include:
- bowel disturbances, constipation
- inflamed esophagus, possible ruptures
- tooth decay and staining
- heart trouble.
The fact that a person with bulimia may be a “normal” weight can help to hide the disorder from others. But, like anorexia, bulimia is a very serious medical condition that requires professional help.
Binge Eating Disorder
Binge eating involves:
- frequent episodes of overeating, often in secret, often of junk food
- feeling a loss of control during the binge
- feelings of guilt, shame or disgust about bingeing.
This disorder does not include the purging seen in bulimia, but it can involve cycles of dieting or fasting. Outward signs may include:
- weight gain
- eating alone.
Health impacts of bingeing can include:
- high blood pressure
- joint pain and distress (from carrying extra weight)
- heart disease.
Eating Disorder Not Otherwise Specified (EDNOS)
Some eating behaviours that cause a great deal of distress do not fit neatly into one of the three main types of eating disorder. EDNOS is the diagnosis used in these cases.
Treatment and support
Eating disorders are complicated. Treatment will include help from a combination of medical, psychological and nutrition experts, along with help from the family. The basic goals of treatment are to restore health, reach and maintain a healthier weight, normalize eating habits, and feel better psychologically and physically.
Treatment may include:
- individual counselling
- family-based therapy (FBT)
- medications, sometimes
- hospitalization, if necessary.
Also, there are support groups in many areas for those experiencing eating disorders. Support groups may also be available for family members.
How you can help
It often takes time for a person to admit they need help. If you know someone who may have an eating disorder:
- Get the facts.
- Be patient.
- Offer support.
- Don’t judge.
Find services close to home by searching the Ontario Health Care Options directory.
Kids Help Phone
Free, anonymous and confidential professional phone counselling and online counselling, available 24/7 for kids and youth 20 years of age and younger.
National Eating Disorder Information Centre (NEDIC)
NEDIC is a program of the University Health Network, Toronto. The website has some very good tips on how friends and parents can help (http://nedic.ca/give-get-help/help-friends-family). A toll-free helpline is staffed from 9 a.m. to 9 p.m. EST/EDT: 1-866-633-4220 (or, in Toronto, 416-340-4156).
NEDIC takes a non-dieting, client-centred approach and will not refer clients to diet centres. The website offers extensive information and comprehensive help resources, as well as links to other sources. Contact information and program details are provided for provincially funded programs, plus links to private providers with details such as how to access services, range of services, costs (if any), and practitioners’ credentials.
Ontario Community Outreach Program for Eating Disorders
OCOPED is a partnership between the eating disorder programs at the University Health Network – Toronto General Hospital and The Hospital for Sick Children. It is designed to improve specialized services across the province through professional training, consultation and network development. Under “About Us,” you will find a downloadable list of eating disorder treatment programs funded by the Ontario Ministry of Health and Long-Term Care. Links are available to the latest research, practice and prevention guidelines, provincial policies, and related resources.
Bulimia Anorexia Nervosa Association (BANA) (Southwest Ontario)
BANA, a not-for-profit, community-based organization, serves Windsor-Essex, Chatham-Kent and Sarnia-Lambton. BANA provides specialized treatment, education and support, including programs for children, adults and families. Their website provides a range of downloadable educational resources and links to other organizations.
Hopewell – Eating Disorder Support Centre (Eastern Ontario)
Hopewell is a not-for-profit, charitable organization providing information and support, including a mentoring program, workshops, and expressive art groups. The Helpline (613-241-3428) is available Monday to Friday, 9 am to 5 pm, offering confidential one-on-one, peer support. The site includes a list of individual (private) practitioners (whose services may not be covered by OHIP), as well as hospital-based treatment programs available in Eastern Ontario.
Aimed first at parents, the Maudsley approach is an established, evidence-based outpatient family-based treatment (FBT) for anorexia that was developed at the Maudsley Hospital in London, UK. It’s now used by eating disorder programs around the world, including several in Ontario. The website has extensive information on the Maudsley approach and contact information for several Ontario providers.
Children and Youth Mental Health Services and Support Directory, listing providers in Southwest Ontario – Elgin, Huron, London, Middlesex, Perth and Oxford.
More information about eating disorders
Information and resource links on eating disorders in children, youth and adults; includes a brief screening tool, helpful information and ideas for parents, and help finding services in your area.
Kids Help Phone
Youth friendly information, links and tips on what to do to help yourself or a friend.
Kelty Eating Disorders (BC)
Information from the Kelty Mental Health Resource Centre, affiliated with the BC Centres for Excellence in Eating Disorders. The website includes personal stories, facts about eating disorders, treatments, healthy living and recovery.
NEDA – National Eating Disorders Association (US)
The website offers a variety of resources, including a very thorough Parent Toolkit (http://www.nationaleatingdisorders.org/parent-toolkit). While some of the information is specific to the US, most of it would be helpful to parents anywhere, including understanding the disorder and details of treatment approaches and regimens.
TeensHealth (Nemours, US)
A youth-friendly site providing clear information on eating disorders and related issues.