Eating Disorders in Children Increased During the Pandemic

COVID-19 repercussions have contributed to a national mental health crisis among children, and this includes a a rise in eating disorder (ED) symptoms. While 95% of people who have an ED are between the ages of 12 and 25, the National Eating Disorder Association reported that in the first quarter of 2021 its helpline call volume went up 53%, year over year.

Studies so far have shown a sharp increase in eating disorder diagnoses and behavior among previously diagnosed youth since the start of the pandemic. Parker L. Huston, PhD, pediatric psychologist and owner of Central Ohio Pediatric Behavioral Health, says it's impossible to know each patient's story and how the pandemic impacted them.

“In general, eating disorders are seen as a maladaptive way of establishing control in one's life. With so much out of control, many of us turn to things we can control, like our eating and exercise habits,” says Huston.

Other possible triggers could include feelings of isolation and changes in structure and routine, which cause stress and anxiety, he adds. Dr. Yolanda Evans, member of the Division of Adolescent Medicine at Seattle Children's Hospital, agrees. She says referrals to her hospital’s adolescent clinic for concerns of eating disorder more than quadrupled during the pandemic. Evans points to the following as additional reasons for the increase: 

• Shift in coping strategies due to physical distancing and inability to connect with friends and others who help manage stress
• Lack of close monitoring of kids from school personnel and parents trying to navigate work
• Significant increase in screen time and media platforms, which portray harmful messaging and imagery about body size and health claims 

Eating Disorder Myths

There are many misunderstandings about EDs, including the following:

Eating disorders only affect girls of certain demographics

“Eating disorders affect people from all different gender identities, race, ethnicity, cultural backgrounds, body shapes and sizes,” says Evans. 

Eating disorders don’t affect overweight people

If a person has a higher weight body, Evans says they can still have anorexia or restrictive eating disorder. “We definitely see people with severe malnutrition whose body size is still higher than average.” 

Eating disorders are a choice

EDs are just like other psychiatric conditions. “They are not a choice and can't be changed easily,” Huston says. 

Eating disorders aren't a big deal; it's just like being on a diet

EDs have a significant impact on the health and wellbeing of those who experience them, says Huston. “Eating disorders can be fatal if not treated appropriately because of the chronic malnutrition sufferers go through,” he says. 

It’s a parents fault when their child has an eating disorder

While Evans emphasizes to parents that it’s not their fault their child has an ED, she stresses to them, “Your child is going to need you in order to recover.” 

Warning Signs of Eating Disorders

Huston says there are many subtle warning signs, and they differ among the various types of
disordered eating. However, the following are some common signs to watch for: 

• Attitudes/discussion about dieting and weight loss becoming a primary topic or concern
• Frequent stomach complaints to avoid eating
• Abnormal lab findings indicating malnutrition
• Skipping meals or eating a lot less than usual
• Extreme concern with body shape and size
• Fainting or lack of energy
• Dental problems from frequent vomiting
• Being preoccupied with calories/nutrition/fat content
• Increasingly limited number of foods they will accept
• Excessive fear of choking or vomiting, which limits their food intake

 For Anorexia

•  Dramatic weight loss
• Frequent comments about being "fat" or needing to lose weight
• Excessive and rigid exercise routine
• Always feeling cold 

For Bulimia

•  Evidence of binge eating, such as lots of wrappers in their room or hidden in the trash
• Signs of purging, including frequent trips to the bathroom, especially following meals
• Excessive use of mouthwash/gum/mints
• Dental erosion

Many types of eating disorders can also impact social connections, says Evans. “For example, [if a youth says], ‘I want to eat healthy, so I’m going to cut out all carbohydrates and if a friend has a birthday party and they’re serving cupcakes I cannot eat that.’” 

Treatment for Eating Disorders

Because eating is critical for life, embedded in cultural and ethnic identities, and often the essence of socializing, having an ED is a difficult disease to manage, and treat.

“There’s a lot of hope [for recovery], but it is really challenging because of the nature of food. It’s not a quick fix and there’s not a medication that we can give that’s going to make it all better. It’s really time intensive on everyone’s part who cares for the youth and for the youth too,” says Evans. 

If you are concerned your child may have an eating disorder, early mitigation is necessary. First, let your child know you are worried about them without judgement. “Parents, siblings and others can say, ‘I notice some things that make me worried about you; do you feel comfortable talking about it?’ The biggest thing is not ignoring or being afraid to let your child know you’re worried,” says Evans. 

Then reach out to your child’s pediatrician or primary care provider; however, not all medical professionals have training and experience with EDs, so involve a therapist who specializes in the condition. “Eating disorders…almost always require support from both medical and behavioral health professionals,” says Huston. “Much of this treatment is completed in an outpatient setting.” 

Other professionals who might be part of the team could include a dietician and psychiatrist, if your child lives with additional mental health conditions. “There are often comorbidities where someone with an eating disorder also has depression or anxiety or OCD symptoms. It’s hard to know what came first and what’s related to what because they can all be intertwined,” says Evans. 

Family based treatment is a form of treatment often used to treat adolescent eating disorders including anorexia nervosa, bulimia nervosa, and more. 

“For parents and families [family based treatment] has the most evidence behind it. It’s when you work with a therapist who instructs a parent on how to refeed their child in the first phase, and then the autonomy is gradually given back to the youth,” Evans says. 

While it may be difficult to seek treatment for your child, the following organizations can offer information, support, and help locating good treatment options for EDs.

• National Alliance for Eating Disorders
• National Eating Disorders Association (NEDA)
• National Association of Anorexia Nervosa and Associated Disorders (ANAD)