Mapping the Gap: Geographic Disparities in Eating Disorder Prevalence and Service Access Among Adolescents and Young Adults in Ontario, Canada

Background/Purpose:

Eating disorders represent a significant global public health challenge, with up to 4% of the global population affected by conditions such as anorexia nervosa, bulimia nervosa, and binge eating disorder. These disorders have complex psychological and physiological symptoms, often reducing quality of life, and have been associated with high mortality rates. Manifesting primarily in late adolescence to young adulthood, eating disorders frequently coincide with other mental health issues, yet many individuals fail to receive adequate treatment due to barriers including recognition, cost, and access to services. To date, limited research exists on the prevalence of eating disorders according to geographic location, which would be key to further understanding eating disorders and to develop strategies to addressing eating disorder treatment. As such, the current study addresses this gap in understanding by examining the geographic distribution of eating disorders and the accessibility to care, with a particular focus on the rural-urban disparities within the context of Ontario's healthcare system.

Methods:

Data were collected using a cross-sectional design from 2,731 adolescents and young adults from the Canadian Study of Adolescent Health Behaviors. Participants were recruited using a non-probability sampling method and was aimed at Canadians aged between 16 and 30. A subset of 1,381 responses from Ontarians were utilized for this study given this is the most populous province in Canada and has a robust eating disorders prevention and treatment strategy.

To identify eating disorder psychopathology the Eating Disorder Examination Questionnaire (EDE-Q) was used. Utilizing Geographic Information System (GIS) technology, we mapped the geographic prevalence of eating disorders and examined proximity to specialized eating disorder services. Multiple linear and logistic regression analyses were utilized to determine the association between geographic region and eating disorder symptomatology, and to determine the association between time/distance to specialized services and eating disorder symptomology.

Results:

Just over half (54%) of participants identified as cisgender girls/women, 58% identified as heterosexual, 63% identified as White, and 44% had an education of high school or less. The majority of participants lived in highly (47.4%) and mainly (33.1%) urban settings. The average EDE-Q score was 2.2 (SD = 1.5), and 37.3% of participants scored 2.48 or higher, indicating a clinical risk of eating disorders. By applying geospatial analysis techniques, we detected significant spatial clusters denoting higher eating disorder scores in rural areas and areas with fewer specialized services. Likewise, our findings found disparities between rural and urban areas, suggesting that rural regions exhibit elevated rates of eating disorders. There were no associations between distance/time to services and eating disorder symptomology.

Conclusions and Implications:

The findings of this study highlight a significant and previously understudied aspect of eating disorders among adolescents and young adults in Ontario and the disparity in prevalence across the province. The discrepancies in eating disorder symptomology between urban/rural may stem from limited healthcare access, stigma, and unique socio-cultural contexts in rural communities. The study underscores the need for targeted interventions including telehealth in addressing the eating disorder challenges faced by adolescents and young adults in rural regions.