Hospitalizations for Eating Disorders Increased Significantly Among Adolescents During COVID Pandemic

One hospital reports a significant increase in medical admissions among adolescents with existing or newly developed eating disorders during a pandemic.

The number of adolescents hospitalized for serious illness from eating disorders has increased significantly during the COVID-19 pandemic, new research suggests.

At one center, hospital admissions among young people with eating disorders more than doubled in the first 12 months of the pandemic, according to the study appearing in a preliminary publication of Pediatrics.

The 125 hospitalizations among patients aged 10-23 at Michigan Medicine in those 12 months reflect a significant increase from previous years, as eating disorder admissions averaged 56 per year during the same period between 2017 and 2019.

“These findings highlight how deeply the pandemic has affected young people who have faced school closures, canceled extracurricular activities and social isolation. Their whole worlds were turned upside down overnight,” said lead author Alana Otto, MD, MPH, a pediatric physician at the University of Michigan Health CS Mott Children’s Hospital.

“For adolescents with eating disorders and those at risk for eating disorders, these significant disturbances may have exacerbated or caused symptoms.”

Findings may be the tip of the iceberg

But the numbers may represent only a fraction of those with eating disorders affected by the pandemic, researchers said, as they only include young people whose serious illness led to hospitalization.

“Our study suggests that the negative mental health effects of the pandemic may be particularly large in adolescents with eating disorders,” Otto said. “But our data doesn’t show the whole picture. These can be very conservative estimates.”

The study also suggests that the number of admissions to the institution has steadily increased over time during the first year of the pandemic. The highest number of withdrawals per month occurred between nine and 12 months after the start of the pandemic, and rates continued to rise when the study period ended in March 2021.

Restrictive eating disorders include anorexia nervosa and may be characterized by dietary restrictions, excessive exercise, and/or purging for weight loss.

Genetics, psychological factors, and social influences have all been linked to developing eating disorders, and adolescents with low self-esteem or depressive symptoms are at particularly high risk.

Changes in the daily lives of adolescents during the pandemic, such as school closures and cancellation of organized sports, may also disrupt eating and exercise routines, encouraging the development of unhealthy eating behaviors in those already at risk, Otto said. .

“A stressful event can lead to the development of symptoms in a young person at risk for eating disorders,” she said.

“During the pandemic, the absence of routine, disruptions in daily activities and a sense of loss of control are all possible contributing factors. For many adolescents, when things get out of hand, the only thing they think they can control is their food.”

Some patients also reported that restrictions on exercise and other physical activities worried them about gaining weight, leading to an unhealthy diet or exercise. Increased use of social media during the pandemic may also expose young people to more negative messages about body image and weight.

There may also be indirect links to the pandemic, Otto said. For example, an adolescent with significant symptoms of an eating disorder and severe malnutrition may not have received medical treatment until they moved back in with their parents after their school closed unexpectedly during closures.

Increased demand but limited access to care

Another possible factor could be delayed care for non-COVID-19 conditions, including eating disorders, and fewer face-to-face visits as part of measures to reduce transmission risks, authors noted.

Adolescents with eating disorders may be particularly affected by reduced availability of personal care, Otto said. Assessment and treatment of patients with malnutrition generally requires measurement of weight and vital signs and may include a full physical examination or laboratory tests.

Confidentiality, a critical part of adolescent clinical care, may also be limited in virtual environments.

Although the study is limited by the small sample size, it’s because international reports point to an increase in both outpatient referrals to child and adolescent services for eating disorders and inpatient admissions related to anorexia nervosa in adolescents, Otto said.

“While our findings reflect the experience of a single institution, they are consistent with emerging reports about the potential of the pandemic to have profound negative effects on the mental and physical health of adolescents around the world,” Otto said.

“Adolescents may be particularly vulnerable to negative effects of societal unrest related to the pandemic and to developing eating disorders during the COVID-19 era. Providers who care for adolescents and teens should be tailored to these risks and monitor patients for signs and symptoms of an eating disorder.”

According to the study, the demographics of patients before and during the pandemic were similar. But patients admitted during the COVID-19 pandemic were less likely than those admitted before the pandemic to have public insurance, something that needs further study, the authors said.

Otto noted that medical admission for adolescents with eating disorders is often the beginning, not the end, of treatment, which can be a long journey. One of the biggest barriers to healthcare is a shortage of qualified health care providers and gaps in insurance coverage.

“Access to care was already limited before the pandemic and we are now seeing an increasing demand for these services. As we see a wave of young people coming to the hospital for emergency medical care related to eating disorders, we need to be prepared to continue to care for them after they leave the hospital,” Otto said.

“I am hopeful that if adolescents can go back to school and make friends and engage in activities that are of interest to them, we will see the number of admissions decrease,” she added. “But it takes time for these symptoms to develop, and eating disorders generally last for months or years.

“We expect downstream effects of the pandemic on adolescents and young people for some time to come.”

Reference: “Medical Admissions Among Adolescents With Eating Disorders While the COVID-19 Pandemic” by Alana K. Otto, Jessica M. Jary, Julie Sturza, Catherine A. Miller, Natalie Prohaska, Terrill Bravender and Jessica Van Huysse, July 2021, Pediatrics .
DOI: 10.1542/peds.2021-052201