An Alarming Eating Disorders Epidemic

We are experiencing an epidemic of eating disorders in our country. Eating disorder rates have significantly increased during the pandemic. Hospitals are full and there are long waiting times for inpatient and residential care for eating disorders. In my practice in Raleigh and in Elizabeth’s practice in the Washington, DC area, we have seen an unprecedented number of calls from individuals seeking eating disorders treatment for themselves or their child.  We have a long waiting list. We’ve never had a waiting list before. 

Need for Eating Disorder Treatment

Because of this increase in need for eating disorder care, individuals are not able to access the eating disorders treatment they need. Parents with children with life threatening eating disorders are desperate to get themselves and their children the help they need. A Michigan study showed that admissions of adolescents with eating disorders have more than doubled over the course of the pandemic. Simone Seitz, Executive Director of Carolina Resource Center for Eating Disorders explains this impact, “As a nonprofit resource and referral organization, Carolina Resource Center for Eating Disorders has definitely felt the significant impacts of the pandemic. When comparing the calls to our Helpline from September 2019-20 to September 2020-21, there has been an alarming increase of 63% in volume. This is in addition to working through the difficulties of more people presenting with (and the rapid onset of) symptoms/behaviors, severity, and connection to care.”  We have a crisis and few people are discussing it.  

"Alarming" Weight Gain?

Instead, the CDC released last week a fear mongering report about the increase in weight gain rates among children during the pandemic. A CDC representative said the increase in weight gain which is noted to be 2-6#, depending on the prepandemic BMI categories per their report, was “alarming.”  We have collectively been through and continue to go through a global pandemic. Nearly 700,000 Americans have died from COVID-19 and we have all, especially our children, had our lives turned upside down. Focusing on this weight gain among the survivors of the pandemic is nothing more than fatphobia. Calling this weight gain “alarming” not only misses the mark, but contributes to the truly alarming mental health crisis that our children are experiencing. Why isn’t the CDC discussing the increase in eating disorder rates? A focus on weight only fuels fear and confusion about weight gain and is a contributing factor to the development of eating disorders. 

Why an increase in eating disorders? 

There are many potential reasons for this increase. Individuals’ daily routines have been upended. As a society we are more isolated and have less personal connections. With excess time on our hands, some turn to eating disorder behaviors as a way to cope with anxiety, depression and isolation. Many teenagers went from having a variety of activities and social interactions, to having events canceled and a lot of time alone. This lack of control and change in physical and social activity, coupled with a society’s fear of weight gain, has made a perfect storm for eating disorders to thrive. As soon as the pandemic started, there was media messaging about the “quarantine 15” and concern about “what if people gained weight” during the pandemic. Children heard that. Trauma and food insecurity are also playing a significant role in the increase in eating disorder incidence. 

When to be concerned.

Unfortunately, eating disorder behaviors are often celebrated in our society, making it confusing to know when to be concerned about someone's eating or exercise behaviors. Dieting and weight loss is often complemented. Exercise can be a positive coping mechanism, unless it is underfueled or becomes compulsive and harmful to the exerciser’s life.  “Eating healthier” can seem like a self-care strategy, but for some it means not eating adequately, leading to food thoughts and obsession. As a parent, how do you know if your teen is being ‘healthy’ or developing concerning behaviors?  

Here are some behaviors to look out for: 

• Cutting out an entire food group (including wanting to go vegetarian or vegan)
• Not eating with others. 
• Weighing frequently. 
• Having trouble eating what the family is eating. 
• Needing to control what they are eating or strictly plan it out. Not being flexible. 
• Although not a behavior, weight loss in a child or teen. 
• Food disappearing from the kitchen or finding evidence of sneak eating. 
• Not being able to take a break from exercise or becoming anxious when not able to exercise. 
• Counting calories, tracking exercise
• Refusing to eat foods they used to love
• Negative body image
• Changes in mood and/or energy level
• Skipping meals
• Cooking food for others but not eating what they prepare

Concerned? What should I do? 

If you are concerned about your child’s eating or exercise, it can feel confusing about whether to be concerned or what to do. 

Here are a few steps if you are worried about your child's eating or exercise: 

• Express your concern.  We usually recommend to do this at a time that is not an eating time. Tell them that you care about them and are worried. 
• Seek out support. As a start, talk to your pediatrician about your concerns and ask for referrals to trusted professionals.  There are also organizations such as Carolina Resource Center for ED and the Alliance for Eating Disorders who can connect you with trained professionals. 
• Set loving, supportive boundaries.  As a parent, if you believe your child is skipping meals, it’s okay to tell them they need to eat meals with you. If you’re worried they are exercising too much, it’s okay to put structure around how much they exercise.  We all need loving, supportive boundaries to feel safe. And having a parent step in with appropriate structure is often needed and a step towards getting better.