New study paints grim picture of adolescent anorexia during COVID-19 pandemic
TORONTO -- A new study examining the rates of adolescent anorexia in Canada paints a grim picture of how the eating disorder affected youth at the onset of the COVID-19 pandemic.
Published in the JAMA Open Network Tuesday, the study found that cases and hospitalizations for newly-diagnosed anorexia nervosa or atypical anorexia nervosa among children and adolescents in Canada increased during the first wave of the COVID-19 pandemic.
The study was a repeated, cross-sectional analysis of new eating disorder assessments conducted at six specialist hospitals in Canada between Jan. 1, 2015 and Nov. 30, 2020 in patients aged nine to 18 with a new anorexia nervosa or atypical anorexia nervosa diagnosis.
Atypical anorexia nervosa has the same symptoms associated with anorexia nervosa (often simply called anorexia) but with the distinct difference that the person does not have a low body weight.
The study notes that with the onset of the COVID-19 pandemic, public health authorities in Canada cautioned against unnecessary visits to health-care facilities to reduce the possibility of transmission and to accommodate surges in COVID-19 cases. But pediatric hospitals, while experiencing a decrease in emergency department visits for medical attention throughout 2020, “reported increased pediatric mental health visits,” researchers wrote.
Researchers analyzed data collected from patients at the Alberta Children’s Hospital, the British Columbia Children’s Hospital, Janeway Children’s Hospital in Newfoundland, McMaster Children’s Hospital in Ontario, Montreal Children’s Hospital and Sainte Justine Hospital in Quebec, which serve vast swaths of Canada’s population.
Researchers then compared incidence and hospitalization rates for all anorexia or atypical anorexia during the first wave of the pandemic with the rates from five years prior to the pandemic.
A total of 1,883 children and adolescents, 1,713 female and 170 male with a median age of 15.9, were included in the study. During the first wave of the pandemic, the number of newly diagnosed cases “demonstrated a steep upward trend” to about 40 cases per month, the study says.
Hospitalizations for new patients also increased sharply with the COVID-19 pandemic, increasing from 7.5 cases per month to 20 cases per month, on average.
In short, during the first wave of the pandemic monthly new cases of anorexia and atypical anorexia increased by more than 60 per cent and monthly hospitalization nearly tripled compared to pre-pandemic rates.
The study notes that the largest increases in both new anorexia diagnoses and related hospitalizations were reported in Quebec and Ontario, which had the highest mortality per capita rate in the first wave of the pandemic – leading to the most restrictive lockdowns.
Lockdowns led to substantial changes for children and adolescents, the study notes, with disruptions to eating, physical activity and social patterns which can be risk factors for developing an eating disorder.
“In addition, school closures likely expand social media use as a means of communication with peers. Media use has been associated with an increased risk for disordered eating, in particular through exposure to thin ideals and diet-related content,” the study says. “Social media trends referring to weight gain during confinement and a focus on home cooking and exercise routines may have further elevated the eating disorder risk among youth.”
The relationship between stressful events and exacerbations in eating disorder symptoms has been well documented, the study notes, with studies of adult patients with pre-existing eating disorders reporting worsening symptoms during the first wave of COVID-19 associated with confinement such as greater restrictions on eating, increased self-induced vomiting (purging), worsening body dysmorphia and heightened exercise drive.
Researchers wrote that many adolescents with an eating disorder also have depression, anxiety and obsessive-compulsive disorder, and that evidence suggests COVID-19 has detrimental consequences on the mental health of youth.
Rates of depression and suicidal ideation were higher in adults in COVID-19–associated lockdowns compared with those who were not under these restrictions, according to the study. “In children and adolescents, the disruption of routines and disconnection from peers were associated with the increase in mental health burden and emergence of depression and anxiety. A worsening of overall mental health status may explain the increased rate of newly diagnosed anorexia nervosa or atypical anorexia nervosa found in the present study.”
Disruptions to children and adolescents’ “protective factors” against eating disorders, such as social support, made them “more vulnerable to stressful circumstances,” the study says.
Researchers hope to continue studying how to better prepare for the mental health needs of children and adolescents who have eating disorders in the event of future pandemics or prolonged social isolation.
The following is a list of resources and hotlines dedicated to supporting people in crisis:
National Residential School Crisis Line: 1-866-925-4419
Hope for Wellness Helpline (English, French, Cree, Ojibway and Inuktitut): 1-855-242-3310
Trans Lifeline: 1-877-330-6366
Kids Help Phone: 1-800-668-6868