ANN ARBOR – Michigan Medicine has seen a sharp rise in hospitalizations among adolescents with severe illness from eating disorders during the COVID-19 pandemic.
According to a new study, during the first 12 months of the pandemic, hospital admissions among this group more than doubled with 125 patients age 10-23 admitted compared to an average of 56 patients per year between 2017 and 2019.
The findings are consistent with the social upheaval caused by the pandemic, said the study’s lead author Alana Otto, an adolescent medicine physician at University of Michigan’s C.S. Mott Children’s Hospital.
“These findings emphasize how profoundly the pandemic has affected young people, who experienced school closures, cancelled extracurricular activities, and social isolation,” Otto said in a release. “Their entire worlds were turned upside down overnight. For adolescents with eating disorders and those at risk for eating disorders, these significant disruptions may have worsened or triggered symptoms.”
Otto said the numbers may only represent a small amount of adolescents with eating disorders who were negatively impacted by the pandemic, since the study only included those whose severe illness led them to be admitted to hospital.
The highest monthly admission rates occurred between December, 2020 and March 2021, when the study period ended.
Restrictive eating disorders may be marked by excessive exercise, dietary restriction and/or purging to lose weight.
Adolescents with depressive systems and low self-esteem are at high risk of developing eating disorders. Psychological factors, social influences and genetics also play roles in the development in such conditions.
“A stressful event may lead to the development of symptoms in a young person at risk for eating disorders,” Otto said in a release. “During the pandemic, the absence of routine, disruptions in daily activities and a sense of a loss of control are all possible contributing factors. For many adolescents, when everything feels out of control, the one thing they feel they can control is their eating.”
Some patients said they became stressed about gaining weight due to limitations in playing sports during the pandemic. Increased use of social media among young people may have also led to the exposure of negative messaging around weight and body image.
Otto said the closure of colleges may have caused more adolescents with severe malnutrition to seek help once they moved back in with their parents.
Another factor could be delayed care for non-COVID patients. Treatments for many patients over the past year shifted online, reducing in-person visits to help reduce transmission of the virus, said the authors.
This reduced availability of face-to-face care could have impacted adolescents with eating disorders, said Otto. Patients undergoing treatment for eating disorders tend to have their weight and vital signs measured regularly and may undergo physical exams or lab tests.
Virtual visits may also compromise confidentiality for some patients.
“Although our findings reflect the experience of a single institution, they’re in line with emerging reports of the pandemic’s potential to have profound negative effects on the mental and physical health of adolescents across the globe,” Otto said in a statement. “Adolescents may be particularly vulnerable to negative effects of societal upheaval related to the pandemic and to developing eating disorders during the COVID-19 era.
“Providers who care for adolescents and teens should be attuned to these risks and monitor patients for signs and symptoms of an eating disorder.”
According to the study, adolescents admitted during the pandemic were less likely to have public insurance than those admitted prior to COVID. Insurance coverage gaps and qualified providers continue to be the greatest barriers to care.
“Access to care was already limited before the pandemic and now we’re seeing an increased demand for these services,” Otto said in a release. “As we see a wave of young people coming to the hospital for urgent medical concerns related to eating disorders, we need to be prepared to continue to care for them after they leave the hospital.
“I’m hopeful that as adolescents are able to go back to school and engage with friends and activities that are meaningful to them, we will see admissions decrease. But it takes time for these symptoms to develop and eating disorders generally last for months or years.”