Barriers to care
Interdisciplinary treatment of eating disorders can be time-consuming, relatively prolonged and extremely costly. Lack of access to appropriate interdisciplinary teams or insufficient treatment can result in chronicity, social or psychiatric morbidity, and even death. Some provincial plans limit access to private care resources such as nutrition visits or mental health visits. Absent or low reimbursement rates for psychosocial services results in fewer qualified persons being willing to care for teenagers and young adults with eating disorders.
Some older adolescents are no longer eligible for treatment or coverage because of provincial medical insurance rules. Thus, withdrawal from treatment can occur at an age when leaving home, unemployment or temporary employment is the norm. Some institutions have age limit policies that negatively affect treatment and limit access to care during the transition from paediatric to adult care.
Legislation should provide reimbursement for intervention by multiple disciplines for adolescents with eating disorders. Coverage should ensure that for adolescents, treatment should be dictated by the severity and range of the clinical situation. The promotion of size acceptance and healthy lifestyles, introduction of prevention programs for high risk adolescents, and strategies for early diagnosis and intervention should be encouraged.
Position: Health care reforms should include provisions that address the needs of adolescents with eating disorders and ensure that they not be denied access to care because of absent or inadequate health care coverage.
Adolescent Medicine Committee, Canadian Paediatric Society (CPS)
Paediatr Child Health 1998;3(3):189-92
Reference No. AM96-04
Reaffirmed January 2011
1. Whitaker AH. An epidemiological study of anorectic and bulimic symptoms in adolescent girls: Implications for pediatricians. Pediatr Ann 1992;21:752-9.
2. Stein DM. The prevalence of bulimia: A review of the empirical research. J Nutr Educ 1991;23:205-13.
3. Drewmowski A, Hopkins SA, Kessler RL. The prevalence of bulimia nervosa in the US college student population. Am J Public Health 1988;78:1322-5.
4. Yager J, Andersen A, Devlin M, Mitchell J, Powers P, Yates A. American Psychiatric Association practice guidelines for eating disorders. Am J Psychiatry 1993;150:207-28.
5. Bachrach LK, Guido D, Katzman DK, et al. Decreased bone density in adolescent girls with anorexia nervosa. Pediatrics 1990;86:440-7.
6. Nussbaum M, Baird D, Sonnonblick, et al. Short stature in anorexia nervosa patients. J Adolesc Health Care l985;6:453-5.
7. Moore DC. Body image and eating behavior in adolescent girls. Am J Dis Child 1988;142:1114-8.
8. Casper RC, Offer D. Weight and dieting concerns in adolescents, fashion or symptom? Pediatrics 1990;86:386-90.
9. Maloney MJ, McGuire J, Daniels SR, Specker B. Dieting behavior and eating attitudes in children. Pediatrics 1989;84:482-9.
10. Schebendach J, Nussbaum MP. Nutrition management in adolescents with eating disorders. Adolesc Med State Art Rev 1992;3:541-8.
11. Fisher M. Medical complications of anorexia and bulimia nervosa. Adolesc Med State Art Rev 1992;3:481-502.
12. Palla B, Litt IF. Medical complications of eating disorders in adolescents. Pediatrics 1988;81:613-23.
13. Mitchell JE, Seim HC, Colon E, Pomeroy C. Medical complications and medical management of bulimia. Ann Intern Med 1987;107:71-7.
14. Hall RCW, Hoffman RS, Beresford TP, et al. Physical illness encountered in patients with eating disorders. Psychosomatics 1989;30:174-91.
15. Sharp CW, Freeman CPL. The medical complications of anorexia nervosa. Br J Psychiatry 1993;162:452-62.
16. Nussbaum MP, Blethen SL, Chasalow FI, et al. Blunted growth hormone responses to clonidine in adolescent girls with early anorexia nervosa. Evidence for an early hypothalamic defect. J Adolesc Health Care 1990;11:145-8.
17. Pfeiffer RJ, Lucas AR, Ilstrup DM. Effect of anorexia nervosa on linear growth. Clin Pediatr 1986;25:7-12.
18. Delaney DW, Silber TJ. Treatment of anorexia nervosa in a pediatric program. Pediatr Ann 1984;13:860-4.
19. Golden NH, Shenker IR. Amenorrhea in anorexia nervosa: etiology and implications. Adolesc Med State Art Rev 1992;3:503-17.
20. Kreipe RE, Hicks DG, Rosier RN, Puzas JE. Preliminary findings on the effects of sex hormones on bone metabolism in anorexia nervosa. J Adolesc Health 1993;14:319-24.
21. Biller BMK, Saxe V, Herzog DB, et al. Mechanisms of osteoporosis in adult and adolescent women with anorexia nervosa. J Clin Endocrinol Metab 1989;68:548-54.
22. Rock CLR, Curran-Celentano J. Nutritional disorder of anorexia nervosa: A review. Int J Eating Dis 1994;15:187-203.
23. Forbes GB. Nutritional requirements in adolescents. In: Susking RM, ed. Textbook of Pediatric Nutrition. New York: Raven Press, 1981:381-91.
24. Forbes GB, Kreipe RE, Lipinski BA, Hodgman CH. Body composition changes during recovery from anorexia nervosa: comparison of two dietary regimes. Am J Clin Nutr 1984;40:1137-1145.
25. Killen JDS, Hayward C, Litt I, et al. Is puberty a risk factor for eating disorders? Am J Dis Child 1992;146:323-5.
26. Bruch H. Eating Disorders. New York: Basic Books, 1973.
27. Comerci GD. Eating disorders in adolescents. Pediatr Rev 1988;10:1-11.
28. Kreipe RE, Uphoff M. Treatment and outcome of adolescents with anorexia nervosa. Adolesc Med State Art Rev 1992;3:519-40.
29. Steiner H, Majer C, Litt IF. Compliance and outcome in anorexia nervosa. West J Med 1990;153:133-9.
30. Nussbaum M, Shenker IR, Baird D, et al. Follow up investigation of patients with anorexia nervosa. J Pediatr 1985;106:835-40.
This position statement was adapted by the CPS Adolescent Medicine Committee from a paper by the Society for Adolescent Medicine. It represents a modification of the version published in the Journal of Adolescent Health (1995;16:476-480). We appreciate the permission of the authors, the Journal of Adolescent Health and the Society for Adolescent Medicine to adapt the manuscript to the Canadian context.