Canada's pandemic public health measures related to eating disorders among adolescents, finds study

A new study led by Dr. Nadia Roumeliotis, clinician-researcher at CHU Sainte-Justine and professor in the Department of Pediatrics at Université de Montréal, shows that the public health measures imposed in Canada during the COVID-19 pandemic were directly related to the hospitalization rate for adolescents aged 12 to 17 for eating disorders.

An analysis of pan-Canadian data reveals a significant increase in the hospitalization rate during the most stringent public health measures, all across Canada.

These findings were published today in JAMA Pediatrics in collaboration with researchers Sylvana Côté and Kate Zinszer, professors at UdeM's School of Public Health, biostatistician Ofélie Trudeau-Ferrin, Drs. Baudouin Forgeot D'Arc, Soren Gantt and Caroline Quach-Thanh, of CHU Sainte-Justine's Centre de recherche Azrieli and UdeM's Faculty of Medicine, and Katia Charland.

The results underscore the importance of taking into account the indirect effects of health measures when managing pandemics in order to prevent the propagation of the virus while also supporting youth health and wellness.

Stricter measures, more hospitalizations

Between April 2016 and March 2023 in Canada, there were 11,289 hospitalizations for eating disorders among 6- to 20-year-olds, including 8,726 (77%) among girls aged 12 to 17. In about 60% of the cases, it was a first hospitalization for this type of disorder. Using administrative data obtained by the POPCORN collaborative platform (Pediatric Outcome ImProvement through Coordination Of Research Networks), the team identified a significant increase in the hospitalization rate after March 2020 in Québec (+42%), Ontario (+50%) and the Prairies (+41%).

The numbers are far higher, however, if we look at March 2021.

"Our analyses show that hospitalization rates peaked a year after the start of the pandemic," specified Dr. Roumeliotis, who is also an assistant professor at Université de Montréal. "In all the regions of Canada that we studied, the rate at that time was more than double what was projected by pre-pandemic trends. That is enormous."

To assess the impact of public health measures, the researcher and her team used the Bank of Canada's COVID‑19 Stringency Index, which includes a variety of restrictions, from bans on gathering to wearing face masks to temporary school closures.

"In all the provinces, this index is associated with the hospitalization rate for eating disorders," explained Dr. Roumeliotis. With every 10% increase in the stringency index, we see a 5% increase in hospitalization rates in Québec and Ontario, 8% in the Prairies and 11% in British Columbia."

Toward better acknowledgement of the indirect effects of health measures

The results highlight the need to support adolescents living with eating disorders, especially during a pandemic. The team is continuing its research with youth who have lived experience, to include their perspectives and enhance the interpretation of the results. Qualitative analyses are underway to gain a better understanding, from a subjective point of view, of how public health measures affected these adolescents living with an eating disorder.

The conclusions have already proven useful for informing public health authorities in their preparations for future pandemics.

"It is crucial to improve our understanding of the indirect and long-term effect of health measures on the health and wellness of youth, so we can put the appropriate resources and services in place," added Dr. Caroline Quach-Thanh, CHU Sainte-Justine researcher and co-author of the study. "This is one of the issues we will continue to study through the POPCORN Collaborative Research Platform, to ensure that Canada is ready to face another pandemic."