Eating disorders increased during COVID-19

What roles did loss of control and greater access to food play in the increase of eating disorders during COVID-19?

Eating disorders have increased around the world amid the COVID-19 pandemic’s lockdowns and other changes.

Eating disorders thrive in isolation and are fueled in part by social media, according to Andrea L. Krause, M.D., a pediatric hospitalist with Norton Children’s Inpatient Care, affiliated with the UofL School of Medicine. The pandemic supplied plenty of both.

During COVID-19 lockdowns, children and adolescents typically were more isolated as they took classes remotely and had easier access to screens throughout the day, according to Dr. Krause.

The pandemic also brought anxiety, emotional distress and changes in routine, including many youth sports and activities shutting down, all which could trigger or intensify eating disorders.

“As soon as COVID-19 started with the lockdowns in March 2020, current patients at the time were having worsening resurgence of symptoms,” said Dr. Krause, who treats patients at Norton Children’s Hospital.

The most common types of eating disorders among older children and adolescents are anorexia, bulimia and binge eating.

Anorexia is driven by fear of gaining weight and involves either limiting food intake (restrictive anorexia) or bingeing and purging by vomiting, excessive exercise, or misuse of laxatives or diuretics. The peak ages for anorexia are 13 to 18. Anorexia results in significant weight loss.

Bulimia involves binge eating within a two-hour period, with a sense of lack of control —overeating, followed by purging, fasting or excessive exercise. Bulimia typically occurs in older teens and college-age young adults. Unlike anorexia, bulimia does not always result in weight loss.

Help for kids struggling with eating disorders

If you think your child needs help, talk to a member of the Norton Children’s team about pediatric mental health services

Binge eating is characterized by recurring episodes of out-of-control eating in which a large amount of food is consumed within a two-hour period, often to the point of being uncomfortably full. Binge eating is not followed by purging such as vomiting. Binge eating is most common among older adolescents and young adults.

A need for control during the COVID-19 pandemic could contribute to eating disorders

Eating disorders typically are kept secret from family and, for young people with restrictive anorexia, involve a need for control. With the pandemic lockdown, young people often spent their days in close contact with their families during an unpredictable situation that may have made the need for control worse.

Greater access to food throughout the day also may have made things worse for adolescents with bulimia, in part because of the added difficulty of purging after eating through physical activity, vomiting or other means.

An estimated 900,000 Kentuckians experience an eating disorder, according to Aubrey’s Song Foundation, a nonprofit in Kentucky that works to provide education and training for health care professionals to address and treat eating disorders. Others may be following disordered eating patterns, without meeting the clinical definitions of an eating disorder. These include fasting or skipping meals, binge eating, avoiding certain food groups or types of food, purging or using laxatives, and an unhealthy preoccupation with body image or weight.

Among Kentucky high school students, 1 in 10 have more than three disordered eating type behaviors, according to the Kentucky Youth Risk Behavior Survey.

People who have an eating disorder tend to be secretive about their condition. They might wear more clothes to disguise weight loss, avoid social eating at restaurants or family gatherings, and behave differently.  

Eating disorders also can be extremely dangerous. Early intervention is key, according to Dr. Krause, who recommends that treatment should involve a therapist, a dietitian and a physician. Some children and adolescents with eating disorders may need to be hospitalized to stabilize their medical condition.