Eating disorders are known to be exacerbated by stress, and this was observed during the COVID-19 pandemic in studies of adult patients with pre-existing eating disorders who reported a worsening of symptoms during the first wave. But researchers in Canada were curious if more cases of anorexia actually started during the pandemic and if they were more severe.
The study included 1,883 kids, the majority female, between ages 9 and 18 diagnosed for the first time with anorexia nervosa or atypical anorexia nervosa during the first wave of the pandemic, March to November 2020. Atypical anorexia includes people who are not underweight but have the same behaviors and distortions as those with typical anorexia, such as restrictive food intake, extreme exercise, body dysmorphia and an obsessive fear of gaining weight.
Researchers assessed the incidence and hospitalization rates within 7 days of each new anorexia case from 6 pediatric hospitals and compared them to data from the five years before the pandemic's first wave. New diagnosis rates jumped from around 24.5 cases a month before the pandemic to 40.6 cases a month during the first wave.
New-onset anorexia cases also appeared to be more severe during the pandemic. Hospitalization rates rose from 7.5 cases a month pre-pandemic to 20 cases a month during. Cases also progressed faster over a period of 7 months compared to 9.8 months pre-pandemic, with a mean weight loss increasing from 17.5% to 19.2%. Symptoms of bradycardia, or low heart rate, were also worse in these pandemic new-onset cases.
Researchers theorize that confinement during the pandemic worsened mental health and led to less structured eating routines that made it easier for youth to develop disordered eating habits. Interestingly, the highest number of anorexia cases occurred in areas with the highest COVID-19 infection rates.
A limitation of the study included a possible selection bias since treatment centers prioritized the most severe anorexia patients during the pandemic.