Research Spotlight: Understanding the Role of Geography in Anorexia Nervosa Recovery

Recovery doesn’t begin and end at the hospital. For many patients receiving treatment for anorexia nervosa, the circumstances surrounding their lives may shape how they experience and respond to care.

For Jesse McLean, PhD, Director of Research and Innovation at Royal Victoria Regional Health Centre (RVH) and Assistant Professor in the Department of Family and Community Medicine at the University of Toronto, these broader circumstances have become an important area of research.

Earlier in his career, Dr. McLean’s research focused on the study of neurodegenerative diseases such as ALS, Parkinson’s disease and Alzheimer’s disease. After his postdoctoral training at Harvard University, his work shifted toward developing new treatments, bringing him increasingly into contact with patients and care providers. These experiences broadened his perspective from the diseases themselves to how illness and care affect patients’ everyday lives, and whether they can access and benefit from specialized care.

This shift led Dr. McLean toward applied health-services research, with a particular interest in how factors such as geography, transportation, access to specialized services and socio-economic circumstances may shape patients’ experiences and outcomes.

“It’s one thing to ask if a patient living in a rural community can get through the door. It’s another to ask whether, once they’re through the door, they’re seeing the same benefits from the same care,” says Dr. McLean. “Living in a rural area doesn’t necessarily mean someone will have poorer health or care, but it can mean they experience the healthcare system differently.”

A recent study led by Dr. McLean at the RVH Research Institute examined this relationship among rural and urban patients with anorexia nervosa who received care through the Simcoe Muskoka Regional Eating Disorder Program at RVH. The study analyzed the records of 101 patients aged 12 to 25 and examined their clinical characteristics at presentation, treatment duration, and changes in physical and psychological outcomes over the course of treatment.

Anorexia nervosa is a serious eating disorder, part of a group of mental illnesses that can affect both physical and psychological health. It is characterized by restrictive eating, concerns about weight or weight gain, and disturbances in how a person experiences their body. Its effects can extend well beyond food and weight, affecting many aspects of a person’s health and daily life.

Patients were grouped by the rurality of their home community using residential postal codes and the Rurality Index of Ontario, which considers factors such as community size, population density, and travel time to healthcare services.

Overall, the findings showed that rural and urban patients entered treatment with broadly similar clinical profiles and experienced comparable physical improvement over the course of treatment.  Treatment duration was also similar between groups.

However, psychological outcomes followed a different pattern. While the groups started treatment with broadly similar psychological measures, patients living in rural communities reported greater psychological symptom burden at discharge. The clearest difference was seen in depression: patients living in rural communities had only about a 4 per cent decrease in average symptom scores, compared with about a 28 per cent decrease among urban patients.

This study offers an important starting point for understanding why patients living in rural communities may experience recovery differently. While the findings do not tell us what is driving these differences, they point to the need for future research into the circumstances surrounding treatment and recovery.

“Recovery doesn’t happen only during appointments,” says Nathan Little, MSW, RSW, Clinical Team Leader in the Eating Disorder Program and a member of the research team. “Understanding what patients are experiencing at home and in their communities may help us identify where additional supports could make a difference.”

Future research could explore factors such as travel and access to care, family and care partner burden, access to other mental health services, social connectedness, stigma and community supports. Just as importantly, it could examine the strengths of rural communities and how they might be better incorporated into care.

For RVH researchers, the goal is to build on these findings to help patients benefit more fully from specialized care. Because RVH serves both urban and rural communities within the same regional system of care, this research can help inform care that responds to the needs of patients across the region, closer to home.