Post-COVID-19 rise in eating disorders tackled with new guidelines

Lena Weib

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New guidelines in the U.K. will hopefully help avoid hospitalizations for eating disorders. JUSTIN TALLIS/AFP via Getty Images
  • Eating disorders affect almost 1 in 10 people during their lifetime.
  • People can recover fully if eating disorders are diagnosed and treated early.
  • The COVID-19 pandemic has accelerated the rise in eating disorders globally.
  • In the U.K., there has been an 84% rise in hospitalizations over the past 5 years. New guidelines from the U.K. Royal College of Psychiatrists aim to help health professionals diagnose eating disorders earlier to avoid hospitalization.

According to estimates from the National Institute for Health and Care Excellence (NICE), more than 700,000 people in the United Kingdom have an eating disorder (ED). Many people with EDs do not present to healthcare services, so NICE states that this is almost certainly an underestimate.

In the United States, Mental Health America reports that 20 million women and 10 million men will experience a clinically significant ED at some time in their life.

Worldwide, according to a wide-ranging review, 8.4% of women and 2.2% of men will have an ED during their lifetime.

Eating disorders include:

New analysis from the Royal College of Psychiatrists (RCPsych) has highlighted an alarming rise in hospital admissions for eating disorders in the U.K., with an increase of 84% over the past 5 years.

The greatest rise was in girls and young women under the age of 18. Fewer boys and young men are hospitalized with eating disorders, but their numbers have more than doubled in 5 years.

“Males represent 25% of individuals with anorexia nervosa, and they can be at a higher risk of dying, in part because they are often diagnosed later since many people assume males don’t have eating disorders.”

Dr. Mary Tantillo, professor of clinical nursing, University of Rochester, MA, and director of the Western New York Comprehensive Care Center for Eating Disorders

This rise in EDs and hospitalizations is not confined to the U.K. A review of studies between 2000 and 2018 found that, globally, the number of diagnoses had more than doubled in that period. And a study of 3.25 million people in the U.S. found a 100% increase in inpatient treatment for EDs between January 2018 and December 2020.

The RCPsych highlights the importance of early diagnosis and intervention to prevent hospitalizations. People with EDs often appear healthy with normal blood tests, so signs that an ED has become potentially life threatening are often missed in primary care and emergency settings.

To help healthcare professionals spot the signs that an ED is causing severe health problems, the RCPsych has published new Medical Emergencies in Eating Disorders Guidelines (MEED).

Dr. Dasha Nicholls, a Consultant Child and Adolescent Psychiatrist, who chaired the development of the guidelines, said:

“Eating disorders such as anorexia, bulimia, and binge eating don’t discriminate and can affect people of any age and gender. They are mental health disorders, not a ‘lifestyle choice’, and we shouldn’t underestimate how serious they are.”

Although the guidelines are aimed at medical health professionals, they also contain useful advice for carers and patients.

“There has been a shocking rise in hospital admissions for people with eating disorders, made worse by the devastating impact of the pandemic on the public’s mental health.”

— Tom Quinn, director of external affairs at U.K. eating disorders charity Beat

As early as May 2020, the UN highlighted possible mental health impacts of the pandemic. Since then, many studies have shown how the pandemic has increased mental health issues. Dr. Tantillo explained the effect of COVID-19 on eating disorders to Medical News Today:

“[People with EDs] do not do well with inconsistency, ambiguity, uncertainty, and unpredictability. So you can imagine the devastating impact COVID [has had] on folks with EDs. There has been increased onset of illness as well as relapses during the pandemic, even in patients who were doing pretty well before the pandemic.”

Dr. Tantillo also commented that social isolation has created opportunities for young adults to connect with unhelpful social media sources, adding to the risk of EDs. She highlighted the sharp rise in the U.S.: “The National Eating Disorders Association (NEDA) Helpline has experienced a 107% increase in contacts since the start of the COVID-19 pandemic.”

Alongside these pressures has been the difficulty of accessing treatment during the pandemic, as Tom Quinn noted, “The dramatic increase in hospitalization shows that people are not getting treatment quickly enough, with patients admitted to hospital having become too unwell to be treated in community care settings.”

“If we are to stop the eating disorders epidemic in its tracks, it’s vital that this guidance reaches healthcare professionals urgently and that government backs them with the necessary resources to implement them.”

— Dr. Nicholls

Clinicians and charities in the U.K. and U.S. have welcomed the new guidelines. Tom Quinn felt they would help with diagnosis: “MEED provides broader guidance on assessment and management of all eating disorders which can lead to patients presenting as a medical emergency,” he said.

Dr. Tantillo agreed: “I applaud the development of the Medical Emergencies in Eating Disorders Guidance. It is necessary and essential because there is still very little training regarding eating disorders received by primary care and behavioral health providers (during their initial training and once on the job).”

She added, “Front line staff at hospitals need this info to help bust many of the myths related to eating disorders.”

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