Eating disorder admissions increased during COVID-19 pandemic

The COVID-19 pandemic led to an increase in adolescents with eating disorders (EDs), according to a recent study.

Adolescents often have a greater risk of experiencing negative effects from EDs, as their brains could be negatively affected while in vital stages of development. ED care in the United States cost $64.7 billion in 2020, and up to 10% of individuals in the United States suffer from an ED.

These EDs include bulimia nervosa, anorexia nervosa, binge eating disorder, and restrictive food intake disorder. They can lead to major health consequences such as bradycardia and electrolyte disturbances from malnutrition. In severe cases, individuals may need hospitalization.

Anxiety, depression, and substance use are often seen with and affect EDs. EDs have also been associated with increased risk of death, which has largely been contributed to suicidality. Intensive treatment is often necessary to treat EDs, which is not accessible to many.

Studies have indicated an increase in anxiety and depression due to the COVID-19 pandemic, along with symptoms of EDs such as purging, binge eating, increased caloric restriction, and compulsive exercise. Investigators have proposed that disruptions to routines, uncertainty about the future, inconsistent access to food, and increased time in triggering environments could have led to these behaviors.

To understand how the pandemic affected the volume of patients affected with EDs, investigators gathered data from the National Eating Disorder Quality Improvement Collaborative. Data came from 14 medical centers across the United States and 1 private ED program.

The number of patients seeking ED admission per month and the amount seeking ED assessment per month were the 2 primary outcomes of the study. Secondary outcomes included monthly hospital admissions and monthly requests for care at the ED program. 

Monthly data from the hospitals was provided from January 2018 to December 2021, while data on admissions to the ED program was provided from January 2018 to November 2021, and data on requests for care from January 2018 to August 2021. All sites were located in areas with school closures and stay-at-home orders.

Prior to the COVID-19 pandemic, admissions saw a mean increase of 0.85% per month. Admission volume was 109 patients in February 2020, which decreased by 30.6 in April 2020. Following this, admissions surged by a mean of 9.8 admissions per month through April 2021.

Admissions peaked at 208 in April 2021. From May 2021 through December 2021, admissions saw a decline of 5.08 admissions per month.

Assessments increased by 2 per month prior to the pandemic, reaching 254 in February 2020. This declined by 118.1 in April 2020, then increased by a mean of 21.3 per month through April 2021. After assessments peaked at 425 in March 2021, there was a mean decrease of 5.13 assessments per month from April 2021 through December 2021.

For the ED program, admissions remained stable until a slight decrease of 4.2 starting in May 2021. Other levels of care saw similar patterns. 

Requests for care had a slight decline prepandemic which rose in April 2020. Following this, requests for care saw a mean increase of 8.2 per month through April 2021. From May 2021 until the end of the study period, requests decreased by a mean of 17.

Increases in volume of admissions and assessments were greatest following the onset of the pandemic. This indicated a need to increase resources toward treating ED.

Reference

Hartman-Munick SM, Lin JA, Milliren CE, Braverman PK, Brigham KS, Fisher MM, et al. Association of the COVID-19 pandemic with adolescent and young adult eating disorder care volume. JAMA Pediatr. 2022. doi:10.1001/jamapediatrics.2022.4346