The impact of COVID-19 on adolescents with eating disorders: a cohort study

Abstract

Background There is a noticeable lack of evidence regarding the impact of COVID-19 and the associated lockdown on young people with eating disorders. The goals of this study were 1) to examine characteristics of adolescents presenting for eating disorder (ED) assessment since the onset of the COVID-19 pandemic; 2) to compare adolescents presenting for ED assessment since the onset of the COVID-19 pandemic to those that presented for assessment 1 year previously; 3) to examine implications of the pandemic on the system of care. Methods A retrospective chart review was completed on all patients assessed at a pediatric tertiary care ED program during the pandemic between April 1 and October 31, 2020, and on youth assessed during the same time frame 1 year previously. Data including body measurements and results of psychological measures was extracted from patients’ charts. Clinician reports were utilized for accounts of ED symptoms. Referrals to our program were also compared for the two time periods. Results Of the 48 youth assessed between April and October 2020, average age was 14.6\u2009years and average percentage of treatment goal weight was 77.7%. 40% cited the pandemic as a trigger for their ED; of these youth, 78.9% were medically unstable compared to 55.2% of those whose ED was not triggered by the pandemic. When comparing the 2020 cohort to those assessed in 2019, youth who presented for assessment during the pandemic trended towards having lower percentage of goal weights and higher rates of self-reported impairment, and were significantly more likely to be medically unstable ( p \u2009=\u20090.005) and to require hospitalization ( p \u2009=\u20090.005). Higher rates of inpatient admissions, emergency room consultation requests and outpatient referrals deemed “urgent” were likewise associated with the pandemic period. Conclusions During the COVID-19 pandemic, youth assessed for an ED presented with high rates of medical instability and need for hospitalization. Caring for these youth may be more challenging during the pandemic, when access to services may be limited. Further research is required to better understand the impact of the pandemic on the clinical course and outcomes of EDs in adolescents. The objective of this study was to examine characteristics of adolescents presenting for eating disorder (ED) assessment during the COVID-19 pandemic, and also to compare them to a similar group assessed 1 year previously. A review of medical charts was completed on patients assessed at a pediatric ED program between April 1 and October 31, 2020 and on patients assessed between April 1 and October 31, 2019. Forty-eight adolescents were assessed during the pandemic-specific timeframe and 43 were assessed during the same timeframe the year previously. Forty percent of those in the 2020 cohort cited pandemic effects as a trigger for their ED; these youth had a shorter course of illness and were somewhat more likely to be medically compromised compared to those whose ED was not triggered by the pandemic. Compared to those seen in 2019, adolescents assessed for an ED in 2020 exhibited higher rates of nutritional restriction and functional impairment, were significantly more likely to be medically unstable, and required more hospitalizations or urgent consultations. Further research is required to better understand the impact of COVID-19 on the clinical course and outcomes of EDs in youth.