For eight years, Waheeda Giga has struggled with an eating disorder that was triggered by the death of her father. She viewed food as an enemy that needed to be restricted, and if she failed, she’d throw herself into a punishing routine of vigorous exercise.
“I use food and exercise to control and feel safe when I can’t deal with heavy emotions or grief,” she says of her ongoing battle with anorexia nervosa and compulsive exercise.
Giga, a 37-year-old city of Toronto employee, is now a year into her recovery at the eating disorders outpatient program at St. Joseph’s Hospital in Hamilton, which she participates in virtually from home. It’s a journey that took place under the unusual backdrop of the global pandemic, for better and for worse.
It’s also a journey that isn’t unique to Giga. Hospital data from the Greater Toronto Area points to an alarming rise in eating disorders like anorexia and bulimia during the pandemic, as people try to cope with widespread grief from losing loved ones, income, or even a sense of routine and normalcy. The pandemic has also disrupted the way eating-disorder care is provided, shedding light on cracks in the system and the continued need for access as more people struggle.
Ontario’s public health officials nodded to the issue in their latest COVID-19 projections on Feb. 11, where they noted a substantial increase in eating-disorder-related hospitalizations and emergency department visits among young people aged three to 17. In July 2020, the hospitalization rate for youth was three per 100,000, higher than the average of around 1.8 per 100,000.
The National Eating Disorder Information Centre helpline has seen a 70 per cent increase in calls and texts, said Alexa Giorgi, a spokesperson for the University Health Network, which runs the helpline. This includes an 87 per cent increase in chats from individuals 25 and younger.
Experts and people with lived experience say it’s a problem that has affected adults too.
Dr. Michele Laliberte, a clinical psychologist and lead of the eating disorders program at St. Joseph’s Hospital, which treats adults, said wait-times for the program have doubled from three months to five or six months since the pandemic began, partly due to COVID’s interruption of the admission process while the program was transitioning to virtual care.
But a virtual outpatient program may stay for the long-term beyond the pandemic, Laliberte added, as it could improve access to an already-scarce type of eating-disorder care in the region.
It’s been especially helpful for Giga, who was able to attend her recovery program from the comfort of her own home instead of commuting weekly to Hamilton — the closest city to Toronto that houses an outpatient eating disorder program covered by OHIP.
“I was scared to start because I didn’t know what it would involve with getting accommodations from work, and I was anxious because of the commute,” said Giga, who began treatment a month before the pandemic after being on a five-month long wait-list.
At that point, Giga’s Body Mass Index (BMI) reached a critical point of 17.5 — what is considered to be close to severely underweight. She had weighed about 102 lbs. at that time, and was told she would require more intensive treatment if her BMI slipped any further.
“I think that was a wake-up call for me,” she said.
Limiting barriers to care is now paramount with more people looking to access eating-disorder care as a result of the pandemic.
Kyle Ganson, an associate professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work, said COVID-19 has presented many triggers for eating disorders, all tied to how our lives have changed in the last year.
“The major disruptions in routines for people is key,” Ganson said. We’ve been forced to stay home where opportunities for exercise are limited, which could trigger changes in eating habits for some who worry about maintaining “a healthy lifestyle.”
Some anticipate they will gain weight as a result of these changes, Ganson added, which creates stress, anxiety and even feelings of stigma.
“There’s also a lot of loss and a lot of trauma,” Ganson said. “Food is a way to control some of that.”
Maria Estrada, a 25-year-old woman who struggled with an eating disorder at age 15, said some elements of the disorder have resurfaced during the pandemic, mainly due to isolation and feelings of losing control over her life.
“Nobody’s supervising you, nobody’s seeing you, nobody’s gonna notice,” Estrada said. “You’re not seeing your friends. They’re not going to feed you, or ask to go out for lunch. I don’t have that anymore.”
Ganson is careful to add that these issues affect both women and men, albeit in different ways. For men, eating disorders can sometimes manifest in the form of seeking masculinity or leanness through excessive exercise or the use of supplements.
“In our culture, we are much more OK with these types of behaviours and we don’t necessarily shun them or acknowledge there might be a problem,” Ganson said.
For youth in particular, the pandemic has meant more time spent on screens and social media as schools transitioned online. Research has shown that increased time spent consuming social media can lead to issues like body dissatisfaction, Ganson said.
“We also know that kids with eating disorders are known to have what we call co-occurring mental health issues, specifically anxiety and depression,” said Christina Bartha, the executive director of the brain and mental health program at Sick Kids Hospital in Toronto.
At Sick Kids, the number of admissions for eating disorders began to dramatically increase in late August of last year, said Dr. Debra Katzman, co-founder of the hospital’s eating disorders program. It’s a trend that continues to be observed well into 2021.
“We’re seeing a 35 per cent increase in the number of kids we are admitting in the hospital, and they’re coming in primarily in the latter half of the year,” Katzman said. Since April of last year, Sick Kids admitted 175 children for eating-disorder-related issues, compared to 120 children in the same time-frame before the pandemic.
The wait-times for the outpatient program at Sick Kids have also more than doubled as a result, Katzman said.
“Our systems were not designed for this sort of level of necessary clinical intervention, so we’re trying to adjust to that,” she said.
Eating disorders are hard to treat, Katzman added. It’s not a health issue that is treated with prescription medication, but rather one that requires intensive care with a multidisciplinary team of experts that can continue for weeks to months on end.
“I think we are taxing the system right now given the number of kids that are presenting to care,” Katzman said.
The Ontario government announced a few funding initiatives geared towards eating disorders last October, though none involve directly supporting existing services. One includes $3.7 million for a new eating disorders program for youth aged 25 and under, with four pilot sites to start.
“At this time, the program is in development as it is brand new,” said Alexandra Hilkene, spokesperson for the Ministry of Health, in an email.
Another $800,000 has been put forward to support the creation of Eating Disorders Ontario, a pilot program to train and deploy eating disorder prevention experts who will work with local communities and schools in the province. The program is also currently in development, Hilkene said.
At St. Joseph’s Hospital’s eating disorders program, demand has quadrupled since 2010, Laliberte said. Despite that, staffing hasn’t increased in that time due to lack of resources.
“Eating disorders are never at the table,” Laliberte said.
But the pandemic hasn’t been all bad, especially for patients like Giga who have endured lengthy waits to receive adequate treatment.
For example, the closure of gyms in Toronto heightened her anxiety as she tried to increase her food intake, a necessary and early component of her recovery plan. But gym closures also meant she had to increase her calorie-count knowing she wouldn’t be able to offset it by vigorous exercise — a feat that would have been harder to achieve with the temptation of open gyms and yoga studios.
Being able to receive treatment in her own home, she added, meant she could receive treatment in a space she considered safe without the pressure of commuting.
“My nutritionist at treatment called it a divine intervention,” Giga said. “Sometimes I feel like it honestly probably took a pandemic for me to recover.”
Giga is now close to a fully-restored weight of 112 lbs. and a BMI of 20.3.
It’s a small hopeful note in an otherwise difficult time for many. With a renewed focus on eating disorders, Laliberte and others hope the pandemic could be an opportunity to revamp what has been traditionally an inaccessible care system for the long term.
Nadine Yousif is a Toronto-based reporter for the Star covering mental health. Her reporting is funded by the Canadian government through its Local Journalism Initiative. Follow her on Twitter: @nadineyousif_
Nadine Yousif, Local Journalism Initiative Reporter, Toronto Star