Taking Stock of Care for Eating Disorder Patients in Canada

Creation of The Eating Disorder Association of Canada 5 years ago has afforded researchers an opportunity to explore the current state of eating disorders treatment throughout the country. Members of the Association meet every 2 years to compare notes. According to results from a recent survey of intensive eating disorder treatment programs at tertiary care centers, treatment practices differ and program structures throughout Canada differ, and there still is no consensus on best practices for medical and/or psychological treatment of adolescents with severe eating disorders.

Dr. Mark Norris of the Children’s Hospital of Eastern Ontario, Ottawa, Ontario, and colleagues recently designed a 90-item survey to examine eating disorders services for adolescents throughout. The questionnaire was completed by clinical directors and program coordinators from 11 tertiary care institutions across the country (J Can Acad Child Adolesc Psychiatry. 2013; 310).

The questionnaire responses showed that all 11 programs treat patients with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS), all offer inpatient and outpatient treatment, and all use a multidisciplinary, team-based approach to treating adolescents with eating disorders. In contrast, only 4 institutions offer treatment for adolescents with binge eating disorder. Slightly more than half of the programs also provide day or partial hospitalization programs, and 91% offer consultation services within the hospital for patients not in the eating disorders program. Only a little more than half of the day programs are currently active, which is probably the result of budgetary restraints, according to the authors.

When Dr. Norris and his fellow researchers evaluated referrals and assessments for treatment, they found a wide discrepancy between the number of stated referrals received and those completed during 2009. The variance in numbers of patients treated by the programs was large, and could not be easily explained by the size of the area served or by the degree of program resources available. At most programs, the average time from first assessment to discharge back to the care of a primary care physician was 2 years. Nine of the 11 programs offer patient and or parent psychological measures at the time of assessment, most commonly the Eating Disorder Inventory-3 (64%), the Children’s Depression Inventory (CDI) (45%), and a motivation-based scale (the individual scale used varied by treatment site) (36%). Seven sites collect information when a patient enters the program or leaves a part of the program (such as day treatment) as well as at discharge from the program.

Family-based therapy, CBT, are most commonly offered

All 11 institutions provide medical stabilization as well as nutritional restoration and use a variety of therapeutic approaches. Most programs use family-based therapy (91%)–either the traditional Maudsley therapy approach or formalized family-based therapy (Lock & LeGrange, 2001) for patients with AN. Other approaches include cognitive behavioral therapy (100%), readiness motivational models (55%), narrative therapy (45%), interpersonal and psychodynamic approaches (36%), and multi-family therapy (27%).

The 11 Canadian treatment centers took different approaches to patient nutrition. For example, some allowed patients to continue a vegetarian diet all through treatment, while others allowed patients to retain their vegetarian diets only if the patients had been vegetarians before being admitted for treatment. While high-calorie liquid supplements were available at all inpatient and day programs, 4 institutions did not use dietary supplementation for outpatients. All programs used enteric feeding via nasogastric tubes, and all employed meal support therapy.

Areas for improvement

Some areas could definitely use improvement, according to the authors, including better standardization of funds allocated to eating disorder programs. Three provinces could not participate in the survey due to lack of stratified intensive eating disorder treatment available to youth. In addition, all 11 programs continue to have waiting lists, and some patients must wait a full year before receiving treatment. Eight sites, or 73% of the centers surveyed, reported having regular waiting lists for inpatient beds, and the average wait was 6.5 weeks.