It was last fall when Dr. Alanna Otto really started noticing the change.
Normally, the C.S. Mott Children’s Hospital at the University of Michigan where she works gets one or two patients admitted a week for complications from eating disorders. But lately, those rates had been soaring.
“One of the things that we've heard over and over again during the pandemic, is that our patients either began to make changes to what they were eating, or to the way that they were exercising, as a way to try to control their weight or control their body,” Otto said. “Because it felt like everything else was out of control.”
But Otto and her team wanted to know if what they thought was happening - a major increase in eating disorder hospitalizations during the pandemic - was actually real. And even though their data only reflects one hospital’s experience, the numbers are telling: eating disorder admissions shot up from an average 53 patients a year, to 125 patients between April 1, 2020 - March 31, 2021.
And those are just the cases that got serious enough for hospitalization.
“These are kids whose bodies are failing because of their poor nutritional intake,” said Dr. Terry Bravender, chief of Adolescent Medicine and Professor of the Department of Pediatrics at the University of Michigan. “And the medical hospital is really a safety net rescue for them, so that they don’t starve to death. So this is really the tip of the iceberg for the adolescents who are suffering with eating disorders.”
For months now, eating disorder specialists have been sounding the alarm, warning of skyrocketing hotline calls, months-long waiting lists for treatment, and swellingpatient loads. But Otto and her coauthors believe their study, which will be published in the American Academy of Pediatrics’ journal, can add to what limited data we have at this point about the pandemic’s medical impact on kids and teens.
But is there something unique to eating disorders that COVID is exacerbating? Or are eating disorders just one of the more visible ways that mental and physical health has suffered during the pandemic, especially in the adolescent population?
“I think it's a combination of both,” Otto said. “...I think part of the unique challenge with eating disorders during the pandemic is that access to medical care was limited. I think there was probably a component of some people not coming to medical attention as soon as they might have if the pandemic had not been going on.”
Eating disorders hurt the entire body, Dr. Otto says, even in ways the patient themselves may not realize. You can tell if you’re feeling weak, fainting, or having seizures.
But it’s harder to detect changes in the electrical conduction in the heart, or dangerous losses of electrolytes, low blood pressure, or heart rate. And reintroducing nutrition can be dangerous, too: ‘refeeding syndrome,’ as it’s known, happens when the body shifts out of starvation mode too quickly, causing sudden shifts of salts and fluids in the body that can lead to heart problems and even be fatal.
All of that is difficult to catch if a kid or teen didn’t come in for their annual physical last year, or only saw their doctor virtually.
And the pandemic itself, with its isolation and the loss of normal life, is what eating disorder specialists would consider a mass “precipitating event,” Otto said. That’s especially true for younger people.
“They weren't able to go to school. They weren't able to do their extracurriculars or spend time with friends. I hear a lot that patients who are used to excelling in school, [who] were suddenly struggling when things moved online. A lot of people, like adults, were worried about their own health care, about the health of their loved ones...And so I think for many people, this was an impetus to try to make some changes in their behavior. And for some people who are at risk for eating disorders, that quickly became out of control and led to some really serious consequences.”
Something else changed during the pandemic, too. Overall, the demographics of who was being hospitalized for eating disorders, stayed pretty much the same at Mott Children’s: most of them are white and female. But suddenly, far fewer patients with public insurance (like Medicaid) were being admitted.
That worries both Otto and Bravender. It’s not that teens without private insurance just stopped having eating disorders during the pandemic, Bravender says, or even needing hospitalization. He just doesn’t know where they went. Did their outpatient clinics close down? Did they not have internet access to see their doctor virtually?
“It may be that those who have Medicaid had a much more difficult problem accessing care during the COVID pandemic era, whether it's because of job loss, or maybe it's because their parents are more likely to be working hourly jobs, that don't allow them to work from home and don't allow them to get in to see us to access the care. So I do worry about those patients, and where they are, and if they are continuing to be ill.”
Even if patients do get medical care, eating disorder treatment doesn’t end with hospitalization. And many families find their insurance won’t cover all the specialized therapy our outpatient programs that doctors recommend, Otto said. Even if they can afford it, the demand for these services is much bigger than the current supply.
“We're hearing over and over from families... ‘I called 20 therapists and they're all full. No one's taking new patients. I can't get my child in for treatment anywhere,’” she said.
“So I think there's really an onus on everybody who works with children, to sort of up what they're doing to care for these patients...We need to figure out how to work together to take care of these patients.
“And that might mean on my end, [as] the type of doctor who specializes in eating disorders, figuring out how we can educate primary care providers to be better prepared to take care of these patients.
“That might look like connecting therapists who have this type of expertise with other therapists, to provide them with some guidance and support as to how to care for young people with eating disorders. I think that means really studying this transition to virtual care, and figuring out what about that has been helpful, what has been less than ideal, and how we can optimize the care that we're able to provide going forward.”
If you or someone you know needs help for eating disorders, don't wait to get help.
You can call, text, or chat online with someone from the National Eating Disorders Association hotline here. They've also got a free screening tool for when to get professional help, and a map of medical professionals who may treat eating disorders near you. Always call 9-1-1 in a medical emergency.
