Eating disorders: More and more boys in Ontario are being hospitalized. What's behind the rise?

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New data from an Ontario study shows an increase in hospitalizations among children and adolescents suffering from eating disorders. Boys were among the "atypical" groups with rising numbers.

The study released on Monday, found an overall increase of 139 per cent in eating disorder hospitalizations in the province, with a total of 11,654 hospitalizations, from 2002 to 2019.

"Our study found that increasing numbers of pediatric eating disorder patients with characteristics traditionally considered atypical are becoming unwell enough to require hospitalization," said Dr. Sarah Smith, an attending physician in the Department of Psychiatry at SickKids, in a news release.

While the largest increases were reported in females and those in mid-adolescence, researchers at the Hospital for Sick Children (SickKids) and ICES found an increase of 416 per cent among males — an unusually high number for that demographic.

Why are more boys getting hospitalized for eating disorders?

Dr. Simon Sherry, a clinical psychologist specializing in eating disorders and a Dalhousie University professor, told Yahoo Canada the likely reason behind these numbers is stigma.

"I found the size of the increase surprising, but I'm not surprised that an increase is occurring," Sherry said. "Stigma hinders recognition, diagnosis and intervention. And in earlier years, eating disorders were heavily stigmatized among men and boys."

Sherry explained the stigma is born out of a pervasive assumption in society that eating disorders are a feminine problem and that it belongs in "the domain of women." But the numbers tell a different story.

"That's empirically inaccurate and this research also helps to challenge that assumption by showing the rising prevalence of these disorders among males," he claimed.

The authors of the study suggest these rising rates, especially among boys, might be the product of not just a reduction in stigma, but improved screening and detection.

Other groups have also been reported to have the large increases, including younger teens aged 12-14 with an increase of 196 per cent. The number of youth with eating disorders other than anorexia and bulimia nervosa (the most common disorders), is up by 255 per cent.

One limitation of the study, however, is that "provincial data is not collected on eating disorder diagnoses or services outside of acute care settings, which could mean that rates are greatly underestimated," the authors stated in the news release.

What needs to change?

Sherry pointed out that whether it's the public or health care providers, mental health literacy surrounding eating disorders is still very low.

"We need to make improvements across the board. We need to break down stereotypes and kill the stigma that's delaying recognition, diagnosis, help seeking and intervention," the doctor urged.

For instance, when it comes to the diagnosis of anorexia nervosa — a psychiatric disease in which patients barely eat or purge food through laxatives and vomiting — the absence of menstruation was included as a symptom in the diagnostic criteria, which completely excludes biological males, Sherry explained.

"There needs to be a greater movement towards gender neutral diagnostic criteria," he said. "Because being biologically male is a roadblock to recognition, diagnosis and intervention."

Sherry added there needs to be credible information put out to the public, and scientific findings, like in this research for example, needs to be effectively translated to physicians, psychologists and psychiatrists.

"Health care providers need to be aware of the increasing diversity of children and adolescents requiring intensive, inpatient, eating disorder care to help identify these patients earlier in their illnesses," said Sherry.

He called for existing treatments and programs for pediatric eating disorder patients to be evaluated, so that patients from atypical groups are being included and diagnosed effectively.

"We need to really shatter and challenge that stereotype of eating disorders as a women's disease. And more generally, this is a Canada-wide problem, where eating disorders are underfunded and understudied," said Sherry. "This lends impetus to not only the need for increased funding for eating disorders in general, but for men and boys in particular."

What do parents need to know about eating disorders?

The doctor advises parents of boys or young men to know that eating disorders are frequently overlooked in that group, adding it's a "blind spot" to watch out for.

"I'd want parents to understand that diagnoses and assessments for eating disorders were typically developed with females in mind, which result in their boy or their young adult son being overlooked."

This means boys may even need additional awareness and advocacy if they suffer from disordered eating.

Sherry added while the majority of parents are loving and supportive, they might have internalized unhealthy stereotypes that have stigmatized boys and men, as a byproduct of growing up in Canada. "I think parents have to look at that and (work through it)," Sherry advised.

Signs & symptoms

When it comes to what signs or symptoms to watch out for, Sherry said disordered eating can take on many different forms, but some are overt and observable — like sudden or excessive weight loss or gain.

"You would want to watch for a preoccupation with weight, shape, size, appearance and overeating. And for boys that can go both ways. There may be a push toward self-starvation, but there can also be a push toward bulking up and gaining muscle mass," he explained.

He also said to watch for binge eating where the child is eating a lot of food in a short period of time, which can often be a more "secretive act" and "harder to find" or see.

"You'd want to have an open line of communication with your child , and to make sure you're taking time to ask, to be curious, to connect and to care."

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