“I just needed more control” Anne, a college student from Massachusetts, took a deep breath as she recounted her experiences with disordered eating during the pandemic. Anne had been aware of her struggles with food for much of her life, but it wasn’t until the pandemic hit that she started to feel completely out of control, “… I was acutely aware that I wasn’t moving (exercising) as much… I needed to compensate.” While she has since been able to receive treatment for her eating disorder, Anne’s case represents a surge of young people who have struggled with new or relapsed eating disorders since the beginning of the pandemic. Many of these young people are still struggling without access to treatment.
During the first 12 months of Covid-19, the number of hospital admissions among adolescents with eating disorders at the University of Michigan Medical School has more than doubled. According to an analysis of medical record data from 80 hospitals, there has been a 25% increase in the number of adolescent eating disorder patients since March 2020. Over the course of the pandemic, the National Eating Disorder Association helpline has reported a huge 40% increase in call volume.
Isolation, lack of structure, and heightened anxiety are three possible triggers for the increase in eating disorders. While the majority of the population faced all three as the world entered lockdown, Anne describes the unique pressures that young adults and adolescents faced on social media, “there was a general discourse on social media about not gaining weight during Covid or focusing on getting fit during Covid. So many people were equating self-improvement with weight loss or changing eating habits and it really affected me.”
Dr. Jillian Lampert, the Chief Strategy Officer at a treatment center called the Emily Program, is unsurprised by the impact of social media on young people, “given the isolation that Covid brought, all of the messages on social media platforms were one of the main interactions that people had with the world… we’ve seen a huge influx in the need for care.”
Despite the demonstrated need for eating disorder care, it has become clear that telehealth models used during the pandemic are no substitute for in-person treatment. In a survey of eating disorder patients, 74% of participants who had transitioned from in-person treatment to telehealth during the pandemic found that telehealth was less effective than their in-person treatment, “It became so easy to hide… all that my treatment team could see was my face so I would throw away certain parts of my meal or go to the bathroom immediately after the session.” Anne says.
Telehealth has addressed geographical barriers to care, yet significant financial barriers to eating disorder treatment still exist, indicating that there may be an even greater number of adolescents suffering from eating disorders that are unaccounted for by treatment center or hospital statistics.
The average cost for in-patient eating disorder treatment in 2016 was $19,400 and lasted approximately 14 days. Many insurance companies will provide some form of financial support, but sometimes insurance only provides coverage for outpatient or short-term mental health treatment.
Dr. Lampert notes that a lack of proper insurance coverage is one of the greatest barriers to people receiving care for their eating disorders, “Right now, if you have diabetes—another nutrition related illness, you’ll have coverage to see a dietician… if you have an eating disorder, you won’t. It really makes no sense to not have nutrition related coverage for a nutrition related illness… When insurance doesn’t cover people’s healthcare, they tend not to get the care they need.”
The financial barriers to eating disorder treatment are especially relevant as recent studies have demonstrated that food insecurity, which predominantly affects low-income households of color, can be a significant indicator for eating pathology. In a review of studies that examined the relationship between disordered eating habits and food insecurity among adults, it was found that food insecurity was associated with binge eating, weight controlling behaviors, and bulimia. While it is an emerging area of research, this relationship is significant within the context of the pandemic where food insecurity more than doubled in households with children and adolescents.
Dr. Christine Peat, a psychologist and professor in the Center of Excellence for Eating Disorders at University of North Carolina Chapel Hill, has seen the effects of food insecurity in her own patients, “Patients have come to me and said listen, I grew up in a food insecure household and it almost set me up for this pattern where at the beginning of the month when we had our SNAP benefits I might just eat everything in sight because I wasn’t sure when we were going to have food again… when those benefits were low, they were then forced into restrictive eating patterns.”
Because of this relationship, individuals from low-income, food-insecure households are especially at risk for eating disorders but are less likely to have access to treatment, which has only been exacerbated by the pandemic.
Covid-19 has exposed a huge number of mental health trends and disparities that exist in our current healthcare system. As the prevalence of adolescent eating disorders continues to rise, it is up to us to recognize these faults in our treatment systems and to rally for policy changes and insurance models that can support the growing mental healthcare needs that are being demonstrated across the nation.
If you or a loved one is struggling with an eating disorder; you can call the toll-free, confidential NEDA Helpline, Monday-Thursday from 9:00 a.m.- 9:00 p.m. and Friday from 9:00 a.m. – 5:00 p.m. at 1-800-931-2237.