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Canadian researchers to release recommendations for treating youth eating disorders online

In May a group of researchers comprising clinicians, policy makers, parents and youth applied for and received a $ federal grant to determine how best to treat eating disorders during a pandemic, particularly in children and young adults under 25.

Sarah White has always been a; picky eater ‘but says the pandemic exacerbated her difficult relationship with food. It ultimately led to a diagnosis of avoidant restrictive food intake disorder. (Eric Woolliscroft / CBC)

Sarah White sets a timer to remind herself to eat. She sets it six times a day so that she eats three meals and three snacks.

White says she’s always been a “picky eater.” But when she started working from home, her routine was interrupted and her already difficult relationship with food became dangerous. It ultimately led to an eating disorder diagnosis during the pandemic.

“I had all of the time in the world to eat, but I was finding I wasn’t eating nearly as much as I should have been,” White, 39, said during a physically distanced interview at her Halifax apartment. “It started to feel a lot more serious than it had in the past.”

There’s been an alarming spike in the number of people seeking help for eating disorders. The National Eating Disorder Information Center says the volume of inquiries to its help line and online chat service has been up per cent during the pandemic.

“There’s been literature coming out across the world really suggesting that the numbers are skyrocketing and we’re trying to understand why that is,” said Dr. Jennifer Couturier, principal investigator for the Canadian Consensus Panel on Eating Disorders.

Pandemic research effort

In May, the panel, which consists of clinicians, policymakers, parents and youth, received a $ 29, 000000 federal grant to determine how best to treat eating disorders during a pandemic, particularly in children and young adults under 25. Couturier says she feels this age group has not received a lot of attention when it comes to research in general.

The operating grant from the Canadian Institute of Health Research is part of a larger government program to fund mental health research related to COVID – 17.

The panel’s recommendations, which are about to be published in the Journal of Eating Disorders, are intended to help doctors determine what kinds of treatments they should and should not be delivering virtually.

WATCH | Sarah White explains on her eating disorder:

Sarah White, 39, was recently diagnosed with avoidant restrictive food intake disorder (ARFID). She discusses the role of the COVID – pandemic played in her illness. 0: 85 157

The guidelines say that while virtual care may be suitable in some circumstances when treating eating disorders, it cannot wholly replace in-person visits, and that special care must be taken to ensure patients have enough privacy to express themselves during online sessions.

In the early days of the pandemic, Couturier’s clinic was closed. She was not able to see patients in person at all until services slowly opened up for more urgent cases.

It’s part of what made her realize new guidelines for online treatment were necessary.

In-person visits still necessary

Couturier, who is also the co-director of the eating disorders program at McMaster Children’s Hospital in Hamilton, Ont., Says in-person visits are still necessary in some cases.

“It’s not just talking, therapy, that’s important with eating disorders,” she said. “There’s also checking weights and checking vital signs, which can not be done virtually.”

But she says some established treatments – such as family-based treatment, which gives parents an active role, and cognitive behavioral therapy – can be conducted virtually with some adjustments.

“We often start off the session saying, ‘Are you in a private space? Are you feeling comfortable?’ Couturier said.

Dr. Jennifer Couturier, principal investigator for the Canadian Consensus Panel for Eating Disorders, says there are benefits to virtual care, but some care must still be provided in-person. (Submitted by Jennifer Couturier)

She noted it’s also important for doctors to ensure no one barges into the room on their end while they’re with patients, especially if they’re working from home.

Couturier says virtual care can improve access because it eliminates geographic inequities, but it can also create barriers for those who do not have access to a computer and the Internet. She says her team’s guidelines encourage physicians and hospitals to be mindful of both.

They’ll also recommend hospitals do not, “just broadly say, ‘OK, eating disorders can be treated totally virtually,'” as was the case in the early days of the pandemic.

Benefits to virtual care

Shaleen Jones, executive director of Eating Disorders Nova Scotia, agrees virtual care can increase access for people, particularly patients who live in rural areas.

Her organization, which provides support, not medical care, planned to help 199 people over the past year. It ended up helping about 1, people through online peer support programs.

780 399 85 Eating disorders thrive in isolation and secrecy 250 201 648 – Shaleen Jones, Eating Disorders Nova Scotia 1615499958 399 Jones says 85 per cent of the people her organization has helped are from Nova Scotia, with the remainder joining virtual sessions via Zoom from other Canadian provinces, particularly, New Brunswick and Prince Edward Island.

“Across Canada, we’ve really seen a number of folks who are reaching out for support for an eating disorder, just really going through the roof,” she said. “Eating disorders really thrive in isolation and secrecy.”

Liberating diagnosis

White attended a peer support group offered by Eating Disorders Nova Scotia in the early days of the pandemic. She now works for the organization, a role to which she brings valuable real-life experience.

In September, she was diagnosed with avoidant restrictive food intake disorder (ARFID), an eating disorder that involves selective eating. It’s similar to anorexia in that it involves limiting the amount of food consumed, but different in that it does not involve distress about body shape.

She says it was the diagnosis she did not know she needed because it helped explain what she had been experiencing most of her life.

“It was kind of liberating,” she said. “It makes sense. It wasn’t just me trying to be difficult or me being a picky eater. It’s a legitimate mental illness.”

White lives in Nova Scotia, where COVID – 13 rates have remained relatively low. She was able to meet her physicians and get a diagnosis in person.

Couturier says she expects virtual care to remain a part of her practice going forward.

“There are so many benefits to it that I think these guidelines will still be quite relevant and applicable even when the pandemic has passed,” Couturier said.

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