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, 33, 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 Centre says the volume of inquiries to its help line and online chat service has been up 100 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 for Eating Disorders.
Pandemic research effort
In May, the panel, which consists of clinicians, policymakers, parents and youth, received a $50,000 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 hasn't received a lot of attention when it comes to research generally.
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-19.
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.
The guidelines say that while virtual care can 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't be done virtually."
But she says some established treatments — such as family-based treatment, which gives parents an active role, and cognitive behavioural 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.
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 don't 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 don't, "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 250 people over the past year. It ended up helping about 1,000 people through online peer support programs.
– Shaleen Jones, Eating Disorders Nova Scotia
Eating disorders thrive in isolation and secrecy
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."
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 didn't 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-19 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.
About the Author
Kayla Hounsell is a network reporter with CBC News based in Halifax. She covers the Maritime provinces for CBC national news on television, radio and online. She welcomes story ideas at firstname.lastname@example.org.
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