Eating disorders began to increase among adolescents shortly after the onset of the COVID-19 pandemic.
Experts believe that the increase was due to disturbances in daily life, emotional distress and more time spent on social media – which research has shown can lead to lower self-esteem and negative body image.
A peer-reviewed study shows that eating disorder diagnoses increased by 15% in 2020 among people under the age of 30 compared to previous years. Other studies have suggested that patients who were already diagnosed with an eating disorder got worse during the pandemic. The researchers reported an increase in eating disorder symptoms along with anxiety and depression.
Eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder and other specified eating and eating disorders such as atypical anorexia. The highest age for onset is 15-25 years old, but individuals can develop eating disorders at any age.
We are a physician and a psychotherapist specializing in the treatment of eating disorders in teens and young adults. We have seen the increased demand for eating disorders in our own clinic.
While eating disorders have historically been underdiagnosed in certain groups – specifically men, racial / ethnic minorities and people who are overweight, LGBTQ or from a poorer background – the recent COVID-related increase in patients attending treatment has intensified , that no group is immune to them.
Here are three groups of young people who are often overlooked when it comes to eating disorders.
1. Young boys and young men
Historical research in the diagnosis of eating disorders has focused on women. This has made it harder for doctors, families and patients to recognize eating disorders in men. For example, young boys may be more likely to focus on muscle strength and steroid use – indicators that are not captured in traditional, women-focused screening tools and diagnostic criteria.
Recent research, however, suggests that men may account for up to half of all cases of eating disorders. While men have likely been underdiagnosed in all categories of eating disorders, male teens appear to be more likely to avoid restrictive eating disorders. This is a relatively new eating disorder that involves inadequate food intake but not concerns about body shape or size.
Eating disorders – a pattern of problematic eating behaviors that include dieting, skipping meals, and shame, but which do not meet the formal criteria for an eating disorder diagnosis – are increasingly being self-reported by male athletes. This means that high school coaches and athletic trainers are a potential source of increased awareness and recognition of problematic relationships with food or exercise in young men.
2. Sexual and gender minorities
Recent studies have also revealed that eating disorders and eating disorders are more common among sexual and gender minority youth than among cisexual heterosexual adolescents. This is thought to be related to higher levels of dissatisfaction with the body, stigma and sacrifice in these groups.
Psychologists believe that the inequality and discrimination to which homosexual, bisexual and transgender young people are exposed increases their stress, negative thoughts and isolation. This can lead to dissatisfaction in the body and eating disorders.
Particularly for transgender adolescents, eating disorders and focus on body shape and size may also be related to dissatisfaction with physical changes during puberty that are inconsistent with their gender identity.
3. “Normal” -weighted youth
Many eating disorders are not associated with being thin. This means that young people can develop serious medical complications related to their eating disorders regardless of their body size.
For example, adolescents with atypical anorexia nervosa meet the criteria for anorexia nervosa – such as intense fear of gaining weight or gaining weight, and persistent behaviors that prevent weight gain – but they are not underweight. However, they may require hospitalization due to severe malnutrition and dangerous vital signs such as abnormally slow heartbeat or low blood pressure.
Similarly, people with bulimia nervosa – who overeat and then use forced vomiting, laxatives or other unhealthy behaviors to avoid weight gain – may also have normal body mass index or BMI. Still, they can develop electrolyte abnormalities and severe gastrointestinal problems.
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Relatives, coaches, healthcare professionals and all those who interact with young people should be made aware of the increased incidence of eating disorders that occur during the pandemic.
The signs that a young person may develop a disturbed behavior or a full eating disorder are not always clear. For example, indications may include: inability to take a day off or train more than recommended by a trainer or athletic trainer; an intense focus on muscle building; avoid eating in public; a sudden desire to eat “clean” or eliminate certain food groups such as dairy products, meat or desserts; and use of steroids, diet pills or laxatives.
Eating disorders are devastating mental illnesses that have enormous social and economic costs. They also have among the highest mortality rates of all the psychiatric diagnoses and cause chaos on the lives of individuals and their loved ones.
Early intervention is important to reduce long-term illness and the emotional and physical damage that can occur from eating disorders. Breaking down barriers to identification and treatment for all individuals – including boys, adolescents with sexual and gender minorities, and children across the weight spectrum – will improve outcomes for those struggling with these significant diseases.
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