COVID-19 stress drives a disturbing rise in hospital admissions for children and young people with eating disorders
The COVID‐19 pandemic has deeply disrupted daily life across the globe, with profound effects on both our physical and mental health (Holmes et al., 2020).
While research on the mental health impacts of the COVID-19 pandemic on children and young people is still quite limited, a review of recent international studies shows that it is affecting the mental health of young people adversely, with over 50% showing significant signs of depression and anxiety.
As governments worldwide have had to react to the pandemic by imposing measures, such as self-isolation, physical distancing, and the closure of schools, the lives of young people have been greatly affected.
Most have had their lives turned upside down by the crisis and have had to adjust to dramatic changes in their routines, education/employment and home life. Many have also experienced bereavement or other traumatic experiences during the lockdown period, while groups that were already marginalised or isolated have become even more so.
It is clear that young people are under increasing pressure and struggling to get much-needed support.
As many countries are facing a second, and in some cases, a third wave of the pandemic, the magnitude of its impacts are becoming ever more apparent.
What we are facing is not just dangerous to our physical health, but is much more far-reaching.
Recent survey shows a rise in eating disorders
The latest evidence that the pandemic has taken an extreme toll on young people’s mental health comes from the Royal College of Pediatrics and Child Health (RCPCH), citing a survey of paediatricians, reporting that eating disorders are on the rise among children and adolescents in Britain.
The RCPCH heard from around 40 paediatricians and other specialists working in England, Scotland and Wales who said they had seen a record number of children and young people being admitted to hospital with eating disorders.
NHS Digital figures show an upward trend in eating disorder cases in children, up by a fifth in the last two years.
However, the reports to the RCPCH show a doubling, tripling and, in some areas, even quadrupling of young patients presenting with eating disorders compared to last year.
Centres that specialise in treating young people with eating disorders reported long waiting lists and a scarcity of spare beds for in-patient treatment.
Paediatricians said they were also seeing children being admitted with very progressed eating disorders, which is likely due to limited in-person interactions with friends, teachers or services during the pandemic, who may have noticed any signs or symptoms earlier.
Dr Karen Street, a consultant paediatrician at Royal Devon and Exeter Hospital and child mental health officer at the RCPCH, commented:
‘Young people are reaching us much sicker than they were before, and this is almost certainly because they are having less face-to-face interaction with general practitioners… GPs can’t see, or weigh, them during a telephone consultation, so by the time they arrive to us they are in worse shape.’
Leading mental health experts have warned that eating disorders are rising in the isolation brought on by the coronavirus crisis, with many losing access to community services and local support networks due to the pandemic.
The COVID‐19 crisis has created a situation across the globe that is not only increasing eating disorder risk and symptoms, but also decreasing factors that protect against them, and elevating barriers to care.
Eating disorder behaviours are likely to be triggered or intensified by the pandemic through multiple pathways, particularly among vulnerable groups, including those with eating concerns and body image issues.
- disruptions to daily routines and limited outdoor activities may increase weight and shape concerns, which can negatively impact eating, exercise, and sleeping patterns
- social restrictions can deny individuals the social support and adaptive coping strategies they need, while also removing protective factors
- increased use of social media – ED‐specific or anxiety‐provoking media – as well as increased reliance on video conferencing, may increase risk and symptoms
- technology, in general, may be responsible for part of the trend, in that screen time is much higher during lockdown, in the absence of anything else to focus on
- fears of catching the virus may increase symptoms, specifically related to health concerns, or the pursuit of restrictive diets to increase health/immunity
- elevated rates of stress, anxiety, depression and other negative effects due to school closures, exam cancellations, loss of extra-curricular activities and isolation from peers
- physical exercise has been encouraged during lockdowns, which for some, can become very obsessive and driven.
Evaluating and assessing these factors is key to better understanding the pandemic’s impact on eating disorder risk and recovery and to informing resource distribution and targets moving forward.
Agnes Ayton, who chairs the eating disorders faculty at the Royal College of Psychiatrists, said:
‘This deadly illness is thriving because people have lost many of their support networks alongside access to community services as a result of COVID-19. Infection control and social distancing at in-patient units have also led to a reduced number of beds, so desperately-ill patients are struggling to get help.’
Dr Karen Street added: ‘When lockdown disappears, the problem will remain.
The pandemic has potentially created a large number of eating disorders that will take two to three years to recover.
Eating disorders – information and support for parents
An eating disorder causes a young person to interact with food in an unhealthy way; limiting food intake or eating excessive quantities in an uncontrolled manner, and getting rid of food through purging, fasting, laxative intake or over-exercising. Sometimes a combination of these behaviours can occur.
A young person who has an eating disorder does not have a direct problem with food but with feelings that are provoked when eating. A sufferer may become fixated with their weight or body image, and use the intake of food to cope with their insecurities.
Eating disorders can also be co-occurring with other mental health issues, such as depression, anxiety and addiction.
You can read more about eating disorders here.
The RCPHC is urging parents to look out for signs of eating disorders in children and young people, particularly over the holiday period.
Dr Karen Street comments, ‘We know that the earlier eating disorders are spotted, the better the chance that a young person can be successfully treated… If you’ve noticed a difference in the way your child or teenager approaches food and exercise and it concerns you, talk to them about what’s normal and what is not – often those with eating disorders will try to convince you all is OK but trust your instincts.’
Signs and symptoms
Whilst many young people will experience some of the following signs and symptoms; it is important to reach out for advice from an eating disorder specialist if you notice any of the following:*
- Restricting food groups (meat, flour, butter, sugar, carbs, etc.)
- ‘Clean eating’, Vegan or Vegetarian (in families where not routinely practised)
- Refusing meals or skipping meals
- Changes to eating patterns
- Skipping family mealtimes of sharing foods
- Eating alone or in secret
- Sudden interest in menu planning, food shopping, cooking or baking, but refusing to eat what they have cooked or baked
- Going to the bathroom immediately after eating
- Adding water or other liquids to foods
- Cutting foods into small pieces, eating food in a specific order, or any other rigid habits around plating or ordered eating
- Insisting on certain plates or cutlery
- Time rules around eating (e.g. no food after 6 pm, or no carbs after 2 pm)
- Hiding, smearing, throwing or chewing and spitting food
- Eating large quantities of food (with or without appearing to gain body weight)
- Eating regularly overnight
- Drinking excessively (particularly water before meals or when hungry)
- Changing clothes types – wearing baggy clothes
- Starting a ‘Diet’ or ‘Food Plan’
- Regular use of meal replacements
- Vomiting after meals
- New exercise goals / over exercise / high exercise
- Increased concerns about appearance, shape or body size
- Expressing negative views on those in large bodies
- Feeling cold more often
- Stomach pains / constipation / loose stools (laxative use)
- Expressing guilt or anger after eating
- Irritable mood / increased feelings of stress at mealtimes
- Self-harm or thoughts of suicide / depression / insomnia
- Increased anger
* This list is for information only and by no means outlines all the signs and symptoms of eating disorders. Each young person will present with a slightly different set of symptoms and behaviours. Parents and young people should consult their GP, psychiatrist or the Admissions Team at The Wave Clinic for more detailed information and advice.
Dr Simon Chapman at Kings College Hospital adds:
‘I would say to any parent or teacher if they notice anything different about their young person and are worried they may be developing an eating disorder, talk early on to the GP about their concerns or reach out to their local eating disorders service for advice.’
Looking to the future
There are increasing calls for additional research to assess the short- and long-term effects of COVID-19 on children and young people’s overall mental health.
We need a better understanding of what children and young people have been experiencing during lockdowns, as well as how they can best be supported to resume normal life, or the ‘new normal’, over the coming months and years.
World Health Organization Director-General, Dr Tedros Adhanom Ghebreyesus, confirms that COVID-19 is not only a physical concern but also a mental health issue. ‘The mental health needs of young people need to be cared for and responded to by mainstreaming mental health services. There is no health without mental health.’
Youth charities have also expressed concern at the rise in figures for eating disorders and other mental health problems. They are calling on governments to invest more in prevention and training so that medical professionals can spot developing eating disorders earlier.
Tom Madders, director of campaigns at mental health charity Young Minds, said: ‘While there have been improvements in waiting times for eating disorder services for children in recent years, it can still be difficult for them to get the help they need before they reach crisis point. With it becoming clearer that the pandemic is deepening the crisis in young people’s mental health, governments must act to ensure that early support is there for those struggling and make prevention and early intervention a genuine priority.’
Looking to the future, United Nations Secretary-General, António Guterres, appealed for mental health to be given ‘the priority it has always been denied.’ He asked that governments ensure considerations on mental health are at the centre of responses to the pandemic (PDF download).
Guterres concluded he was ‘hopeful’ that young people’s contributions can change the way the world deals with mental health. ‘Young people are in the centre of the need but also in the centre of the innovative responses to mental health,’ he said.
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