A few months into the COVID-19 pandemic, Alyssa desperately wanted to make a competitive middle school soccer team. So the 13-year-old started exercising vigorously in preparation for tryouts. When her weight kept dropping, she ended up at the Children’s SHINE (Support and Help In Nutrition and Exercise) Clinic at Children's of Alabama and was diagnosed with anorexia.
Alyssa is among a growing number of adolescents who have developed eating disorders or have seen eating disorders worsen during the pandemic. Contributing to this trend are changes in routine, lack of social connections, heightened anxiety and increased use of social media, according to experts.
Stephenie B. Wallace, M.D., M.S.P.H., FAAP, medical director of the SHINE Clinic, said many of her patients have told her their troubles began when schools were locked down and activities suspended.
“Personally, and in our clinics, we're seeing a lot of young people who are facing all kinds of mental health disorders that are on the rise, as our young people have been in the COVID-19 pandemic for over a year, and eating disorders are included,” said Dr. Wallace, a member of the AAP Committee on Adolescence.
An estimated 20 million women and 10 million men in the U.S. will have an eating disorder during their lifetime, according to the National Eating Disorders Association. The mean age of onset is 12.5 years (Swanson SA, et al. Arch Gen Psychiatry. 2011;68:714-723).
Anne Marie O’Melia, M.D., M.S., FAAP, chief medical officer and chief clinical officer at the Eating Recovery Center in Denver, describes eating disorders as “bio-psycho-social,” meaning there are “genetics, psychological factors and social influences all at play.”
“Eating disorders are disorders of isolation that interfere with emotional and social development,” Dr. O’Melia said. “The circumstances of the pandemic have placed kids at higher risk of developing and maintaining high-risk disordered eating behaviors.”
Many teens who have not been able to get together with friends due to stay-at-home orders and school shutdowns have turned to social media to fill the void. While these apps can help teens stay connected, they also have downsides.
“Social media offers a constant way to compare yourself to others and to rely on superficial means of building self-esteem, such as how many ‘likes’ or comments you get on a post,” Dr. O’Melia said. “And unlike magazines or TV and movies, where even kids generally know there’s a certain amount of professional make-up and editing happening, social media gives the impression that it’s more ‘real,’ when it can be anything but. So young people are comparing themselves to an unrealistic and often impossible standard, which can lead to dangerous behaviors in an attempt to achieve something unachievable.”
Also contributing to the rise in disordered eating during the pandemic is feeling a lack of control — “anorexia on the one hand as a manifestation of controlling food and binge eating disorder on the other hand as a manifestation of the lack of control,” said Natalie Digate Muth, M.D., M.P.H., R.D.N., FAAP, chair of the AAP Section on Obesity Executive Committee and director of the WELL healthy living clinic in Carlsbad, Calif.
Dr. Muth suggests that pediatricians increase their competencies in behavioral health so they can recognize eating disorders and connect patients to treatment early.
A recently updated AAP clinical report (https://bit.ly/3ss6XeB) provides guidance on screening for eating disorders, evaluating patients’ medical and psychological status and serving as part of the treatment team.
“The kids are not OK,” Dr. Muth said. “It is on us to do everything we can to take steps and partner with our communities to safely return some normalcy to their lives.”