Eating Disorder Treatment in Canada: A Privilege, Not a Promise

Eating disorders affect over 1 million people in Canada (Armour et al., 2024). How many of

those people actually receive treatment, though? What about a diagnosis? The unfortunate truth is that only a percentage of people with eating disorders will receive treatment.

Let’s take a closer look at who treatment is designed for, who gets access to it, and how our systems and society need to change.

Each province is responsible for the healthcare that it provides, meaning that access to treatment varies across Canada. In fact, few options for adult inpatient treatment centres exist, with some provinces having none at all. This leads to longer wait lists - some so lengthy that patients wait up to 2 years. With the delay in treatment, individuals experience a decline in their mental and physical health. By failing to provide timely and accessible care, we are expecting people to manage this illness on their own, which is an unreasonable expectation (Armour et al., 2024).

Some patients who have undergone inpatient treatment for eating disorders in Canada have shared their thoughts on the quality of care they received. Some of the problems they identified were the following: They felt that there was a lack of support during the waiting period between referral and admission to the services. Plus, the eligibility criteria are strict and rely on physical measurements like body mass index (BMI) (Armour et al., 2024). This perpetuates the idea that eating disorders are uniquely weight-based disorders. Imagine being told that you couldn’t receive treatment for something that takes over your life, for something you have little control over, and for which you know you need support. It takes courage to reach out, and it can be even harder to recognize that you need support, but denying patients care because of their BMI means denying them their life.

Additionally, patients feel that they don’t get a say in the treatment process. They would prefer empathy, shared goal-setting, and collaboration (Armour et al., 2024). Recovery can feel especially intimidating when you’re not being communicated with, and when your ability to make decisions or provide opinions is not being respected. After all, patients are people first, and they have the disorder, but that is not who they are.

While considering whether patient needs are being met in treatment, it’s worth looking at who benefits from this structure. For one, treatment is generalized, meaning that it’s a good fit for some, but not for all. For instance, spiritual care is lacking, which ostracizes individuals and makes them feel as though eating disorder support is for a specific “type” of person. Plus, some patients who are transgender and gender non-binary have reported dismissal of their concerns, with professionals stating that they provided eating disorder therapy, not gender therapy. They essentially failed to empathize with and understand the patient’s needs. Eating disorder recovery is not only about the eating disorder, food, and body; rather, it encompasses the whole person and their life. With this also comes the realization that eating disorder treatment is catered to cisgender women, ignoring the fact that eating disorders affect everyone (Armour et al., 2024).

In relation to this, men, 2SLGBTQI+ individuals, racialized minorities, neurodivergent individuals, older adults, people with low socioeconomic status, and people in larger bodies are more likely to go undiagnosed. Race-based stereotypes often prevent healthcare professionals from recognizing eating disorders in their patients in the first place. When clinicians fail to address or acknowledge these issues, it contributes to the idea that eating disorders don’t affect these populations, and it leaves them without help (Mittertreineret al., 2024). Even when programs claim to be inclusive and informed, we have to consider what this looks like in practice. There needs to be accountability, planning, and specificity.

Furthermore, while this information is, at first, discouraging, it’s also quite the opposite: This is the evidence that alerts us as to why the current systems need to change. It emphasizes that individualized care should be prioritized and that access needs to be increased, whether that includes changes to the programs themselves or implementing additional services across the nation.

It’s also important to recognize that not all treatment programs are lacking. Patients also said that they had good experiences, discussing the positive impact that compassionate staff members had on their recovery (Armour et al., 2024). Therefore, these particular instances should serve as a model for what we should aim for in developing treatment services. It’s time to reframe what recovery looks like so that a wide variety of individuals’ needs can be met, and so that treatment becomes something for all and not just for some.

References

Armour, C. Q., Feicht, B., & Gahagan, J. (2024, October 22). Improving adult inpatient eating

disorder treatment: perspectives of a sample of individuals in Canada with lived experience. Journal of Eating Disorders, 12.

https://doi.org/10.1186/s40337-024-01121-w

Mittertreiner, E. J.E., Couturier, J., Simone, M., Small, C., Courtney-Martin, G., Moisey, L.,

Panahi, S., & Lacroix, E. (2024, July 16). Overcoming barriers in eating disorder care:

advances, gaps, and recommendations for equitable assessment and treatment. Applied

Physiology Nutrition and Metabolism, 49(10), 1419-1425.

https://doi.org/10.1139/apnm-2024-0088