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Eating Disorders

E. Gucciardi, MHSc; N. Celasun, MPH, PhD; F. Ahmad, MBBS, MPH (University Health Network); D.E. Stewart, MD, FRCPC (University of Toronto)

Health Issue

Eating disorders and disturbances are characterized by an abnormal perception of one's body image - weight, or shape, or both. This perception is expressed as an obsessive preoccupation with food and weight that may lead to health-risk behaviours. Clinical eating disorders include anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified. Personal, behavioural and socio-environmental factors, such as negative body image, low self-esteem, fear of becoming fat, chronic dieting, and social pressures to be thin, are identified risk factors.

Key Findings

Eating disorders, preoccupation with weight and body image, and self-concept disturbances are more prevalent among women than men. Data from the 1996-1997 National Population Health Survey (NPHS) suggest that more women than men wish to weigh much less than their actual weight. Although eating disorders are observed across all age groups, the desire for an "ideal," thin body during a vulnerable stage of physical and emotional maturation places adolescent women at highest risk. Young girls and women face pressure to conform to idealized images of thin women in the media and popular culture, regardless of their natural body shape. Alarmingly, eating disorders and eating disturbances are increasingly identified among prepubescent youth.

In 1995, 95% of reported hospitalized cases of anorexia and more than 90% of hospitalized cases of bulimia in Ontario were women. Between 1994 and 1999, in-patient crude hospital separation rates in Canada for any diagnosis of anorexia, bulimia, and other unspecified eating disorders increased somewhat (by 4.7%), from 10.2 to 10.7 per 100,000 women. Although the rates among men were notably lower, they also increased slightly (by 4.8%) during the same period, from 0.6 to 0.7 per 100,000 men. These slight increases may be due to better awareness and detection of eating disorders and improved specialized inpatient treatment programs. Across Canada, age-standardized hospital separation rates for eating disorders were highest among women in British Columbia (15.9 per 100,000) and New Brunswick (15.1 per 100,000) and lowest in Saskatchewan (8.6) and Alberta (8.6 per 100,000).

Furthermore, in 2000, the prevalence of depression among women who were hospitalized with a diagnosis of anorexia (11.54%) or bulimia (15.36%) was more than twice the rate of depression in the general population of women (5.7%), according to the 1998-1999 NPHS. The highest prevalence of depression was found in women 25.39 years of age for both anorexia and bulimia.

Data Gaps and Recommendations

The authors identified the following data gaps and made the following recommendations:

• Hospitalization data captures only the severe cases of eating disorders. Therefore, individuals with eating disorders who visit clinics or family physicians, or use hospital outpatient services "or no services at all" are not included in this database. Across Canada, there is currently no systematic process for collecting prevalence data on eating disorders outside of hospitals.
• There were several limitations in the collection of data, including lack of longitudinal data, appropriate comparison groups, large samples, and ethnic group analysis. Most studies were based on clinical samples, making it difficult to generalize findings to the general population. Furthermore, many of these studies were cross-sectional and limited in their ability to make causal links.
• Data should be collected on eating disorders in Canadian women, including the prevalence and risk factors in subgroups such as disabled, immigrant, and visible minority women.
• Cross-cultural and longitudinal evaluations of attitudes and behaviours towards disordered eating should be conducted in large community samples to monitor trends, examine protective and non-protective factors, and assist in the development and planning of preventive and treatment programs.

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