The impact of COVID-19 on adolescents with eating disorders: a cohort study

Abstract

Background There is a noticeable lack of evidence regarding the impact of COVID-19 and the associated lockdown on young people with eating disorders. The goals of this study were 1) to examine characteristics of adolescents presenting for eating disorder (ED) assessment since the onset of the COVID-19 pandemic; 2) to compare adolescents presenting for ED assessment since the onset of the COVID-19 pandemic to those that presented for assessment 1 year previously; 3) to examine implications of the pandemic on the system of care. Methods A retrospective chart review was completed on all patients assessed at a pediatric tertiary care ED program during the pandemic between April 1 and October 31, 2020, and on youth assessed during the same time frame 1 year previously. Data including body measurements and results of psychological measures was extracted from patients’ charts. Clinician reports were utilized for accounts of ED symptoms. Referrals to our program were also compared for the two time periods. Results Of the 48 youth assessed between April and October 2020, average age was 14.6 years and average percentage of treatment goal weight was 77.7%. 40% cited the pandemic as a trigger for their ED; of these youth, 78.9% were medically unstable compared to 55.2% of those whose ED was not triggered by the pandemic. When comparing the 2020 cohort to those assessed in 2019, youth who presented for assessment during the pandemic trended towards having lower percentage of goal weights and higher rates of self-reported impairment, and were significantly more likely to be medically unstable (p = 0.005) and to require hospitalization (p = 0.005). Higher rates of inpatient admissions, emergency room consultation requests and outpatient referrals deemed “urgent” were likewise associated with the pandemic period. Conclusions During the COVID-19 pandemic, youth assessed for an ED presented with high rates of medical instability and need for hospitalization. Caring for these youth may be more challenging during the pandemic, when access to services may be limited. Further research is required to better understand the impact of the pandemic on the clinical course and outcomes of EDs in adolescents.

A systematic scoping review of research on COVID‐19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field

“…The second theme identified was an investigation of the perceived impact of the pandemic on eating disorder or mental health symptoms. Twenty‐two studies examined this theme, with 16 studies sampling clinical populations (participant n s = 12–1,021; Akgül et al, 2021 ; Baenas et al, 2020 ; Branley‐Bell & Talbot, 2020 ; Favreau et al, 2021 ; Graell et al, 2020 ; Machado et al, 2020 ; Quittkat et al, 2020 ; Richardson et al, 2020 ; Schlegl, Maier, Meule, & Voderholzer, 2020 ; Schlegl, Meule, Favreau, & Voderholzer, 2020 ; Shaw et al, 2021 ; Spettigue et al, 2021 ; Spigel et al, 2021 ; Termorshuizen et al, 2020 ; Vitagliano et al, 2021 ; Vuillier et al, 2021 ) and six studies sampling non‐clinical populations (participant n s = 90–5,469; Athanasiadis et al, 2021 ; Buckley et al, 2021 ; Coimbra et al, 2021 ; Keel et al, 2020 ; Phillipou et al, 2020 ; Robertson et al, 2021 ). In all cases, the authors developed their own items assessing perceived impacts of COVID‐19.…”

“…Eight studies (participant n s = 48–8,613) assessed a cohort of participants during the pandemic and compared their symptom severity to a different cohort assessed prior to the pandemic (Calugi et al, 2021 ; Christensen et al, 2021 ; Kim et al, 2021 ; Koenig et al, 2021 ; Muzi et al, 2021 ; Richardson et al, 2020 ; Spettigue et al, 2021 ; Zhou & Wade, 2021 ). Only three of these studies (37%) reported no significant differences in certain demographic or clinical characteristics between the two cohorts (Calugi et al, 2021 ; Keonig et al 2021; Zhou & Wade, 2021 ).…”

“…One study (16%) found the pandemic cohort to report significantly higher levels of eating disorder psychopathology (Zhou & Wade, 2021 ), but this was not replicated in a different study (Koenig et al, 2021 ). Two studies (33%) found the pandemic cohort to report significantly higher levels of dietary restriction than the pre‐pandemic cohort (Richardson et al, 2020 ; Spettigue et al, 2021 ).…”

Trends in the Incidence of New-Onset Anorexia Nervosa and Atypical Anorexia Nervosa Among Youth During the COVID-19 Pandemic in Canada

“… 9 , 10 , 11 A recent single-center study at an adolescent eating disorder program found that, across all eating disorders, 40% of newly diagnosed patients cited the pandemic as a trigger for their eating disorder. 21 Interviews conducted with adults with an eating disorder revealed an exacerbation of symptoms that was associated with increased anxiety, social isolation, and reduced contact with their treatment teams. 9 , 22 Moreover, adults also reported worsening eating disorder symptoms in conjunction with a lack of distractions and constant exposure to stressful messages on social media.…”

Evaluation of the Effects of Telepsychotherapy in the Treatment and Prevention of Eating Disorders in Adolescents

“…In addition, the significant impact of the pandemic on the increase in eating disorders in adolescents was measured by comparing the number of urgent hospitalizations during the same period with the previous year, which increased by 63% [ 24 ]. The increase in visits and hospitalization compared to the year before COVID-19 was detected in a study involving children and adolescents with eating disorders in order to evaluate the effectiveness of treatments combined with telepsychotherapy for outpatients of a day-hospital.…”