Alongside the many impacts of the Covid-19 pandemic on pediatric care, researchers have seen a stark increase in young adults seeking treatment for disordered eating behaviors.
Across the United States, inpatient admissions for young adults and adolescents with eating disorders rose by a rate of about 0.7% a month in the two years before the pandemic, according to a new study published Monday in the journal JAMA Pediatrics. But in 2020, the first year of the pandemic, that growth increased to 7.2% a month on average.
From the spring of 2020 — when most Covid-19 restrictions/lockdowns were first put in place — through spring 2021, the number of eating disorder inpatient admissions about doubled. This number rose to its peak in April 2021.
“We were able to show that at multiple sites throughout the country, there were significant increases in patients with eating disorders after the start of the pandemic — that this wasn’t just a phenomenon in one place,” said the study’s first author Dr. Sydney Hartman-Munick, assistant professor of pediatrics at the University of Massachusetts Chan Medical School. “The results are in line with what we were all feeling working day to day in our clinics and in the hospital.”
Individual hospitals had reported a rise in eating disorder cases over the pandemic, but this study was the first to show the impact across the nation, said Dr. Jason Nagata, assistant professor of pediatrics at the University of California, San Francisco. Nagata was not involved in the study.
Diet culture and disordered eating
Researchers tracked data from 14 “geographically diverse” hospital-based adolescent medicine programs and one non-hospital eating disorder treatment program from 2018 through 2021, according to the study. The research showed that the number of people seeking treatment went up, but it cannot say that the pandemic caused the increase or if the severity of cases was worse during the pandemic, Hartman-Munick said.
“Eating disorders have been and continue to be a significant public health concern for adolescents and young adults,” she said. “Eating disorders can be severe, life-long and deadly, and recovery can take years even with timely and appropriate treatment.”
After the first year of the pandemic, the volume of new patients began to decrease in 2021 — but still remained at higher levels than before Covid-19.
“As of the end of the study, they haven’t reached pre-pandemic baseline levels, so we are likely to feel the impact of this increase in volume for quite some time,” Hartman-Munick said.
More hands on deck
There are many reasons why the pandemic might have influenced an increase in people seeking eating disorder treatment, Hartman-Munick said.
It was a time of uncertainty, with changes to daily routines, disruptions in food availability, concern over health and a loss of control, she added.
The stark rise in numbers show a need for more medical professionals trained to treat eating disorders, including mental health providers and dietitians with eating disorder expertise, she added.
“We need increased capacity at eating disorder programs to accommodate more patients, and expanded resources for patients with Medicaid, who face the most treatment limitations,” Hartman-Munick said.
Primary care physicians also need more guidance on medical management of eating disorders, Nagata added.
How to help your child
Teens and young adults facing eating disorders need professional treatment, ideally with an interdisciplinary team including mental health, medical and nutrition providers, Nagata said.
“Eating disorders can lead to severe medical complications affecting the heart, brain, liver, kidneys and other organs,” he added.
It’s important to know what to look for. These disorders can impact people of all genders, races, ethnicities, sexual orientations, ages and body sizes.
Eating disorder resources
US: National Eating Disorder Association
- The NEDA has a confidential, toll-free helpline at 800-931-2237 as well as an online click-to-chat service. For 24/7 crisis support, text “NEDA” to 741-741.
- The NEDA also has a list of online and free or low-cost resources. US:National Association of Anorexia Nervosa and Associated Disorders
- ANAD runs a helpline at 888-375-7767 from 9 a.m. to 9 p.m. CT and provides links to support groups and treatment providers. Australia:National Eating Disorders Collaboration
- A call center at 800-334-673 and online chat run by the Butterfly Foundation is open 8 a.m. to midnight AET every day except public holidays. UK:Beat (formerly known as the Eating Disorders Association)
- Helplines for England, Scotland, Wales and Northern Ireland are open 9 a.m. to midnight weekdays and 4 p.m. to midnight weekends and bank holidays, every day of the year.
“You cannot tell that someone has an eating disorder based on appearance alone,” Nagata said.
There is a stereotype that only girls develop eating disorders, but boys can, too, Nagata said. In boys, eating disorders often present as an obsession with excessive exercise and being muscular, sometimes with a focus on muscle-building supplements, he added. These cases are often underreported and undertreated.
Generally, warning signs for anyone with an eating disorder can include a preoccupation with size, weight, food or exercise that worsens a person’s quality of life, Nagata said. People with eating disorders may also withdraw from their friends and routines.
“Other red flags include if an individual engages in fasting, significant caloric restriction, vomiting or using laxatives or diet pills to lose weight,” he said.
Families should raise concerns with a health care provider if they see these signs, Nagata said. The professional can assess for an eating disorder and refer families to the resources to utilize next, he added.
Parents, caregivers and teens can also call the National Eating Disorders Association helpline (800-931-2237) for guidance.
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