Eating Disorders in Teens Have ‘Exploded’ in the Pandemic

The New York Times

By Lisa Damour

April 28, 2021

Here’s what parents need to know.

As a psychologist who cares for adolescents I am well aware of the prevalence of eating disorders among teenagers. Even still, I am stunned by how much worse the situation has become in the pandemic.

According to the psychologist Erin Accurso, the clinical director of the eating disorders program at the University of California, San Francisco, “our inpatient unit has exploded in the past year,” taking in more than twice as many adolescent patients as it did before the pandemic. Dr. Accurso explained that outpatient services are similarly overwhelmed: “Providers aren’t taking new clients, or have wait-lists up to six months.”

The demand for eating disorder treatment “is way outstretching the capacity to address it,” said the epidemiologist S. Bryn Austin, a professor at the T.H. Chan School of Public Health and research scientist in the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital. “I’m hearing this from colleagues all across the country.” Even hotlines are swamped. The National Eating Disorders Association helpline has had a 40 percent jump in overall call volume since March 2020. Among callers who shared their age over the last year, 35 percent were 13 to 17 years old, up from 30 percent in the year before the pandemic.

What has changed in the pandemic?

There are several possible explanations for this tsunami of eating concerns in teenagers. When adolescents lost the familiar rhythm of the school day and were distanced from the support of their friends, “many of the things that structured a teenager’s life evaporated in one fell swoop,” said Dr. Walter Kaye, a psychiatrist and the founder and executive director of the eating disorders program at the University of California, San Diego. “People who end up with eating disorders tend to be anxious and stress sensitive — they don’t do well with uncertainty.”

Further, eating disorders have long been linked with high achievement. Driven adolescents who might have normally poured their energy into their academic, athletic or extracurricular pursuits suddenly had too much time on their hands. “Some kids turned their attention toward physical health or appearance as a way to cope with anxiety or feel productive,” Dr. Accurso said. “Their goals around ‘healthy’ eating or getting ‘in shape’ got out of hand” and quickly caused significant weight loss.

For some, an increase in emotional eating in the pandemic has been part of the problem. Attending school from a home where food is constantly available may lead some young people to eat more than usual as a way to manage pandemic-related boredom or stress. “Being at school presents a barrier to using food as a coping mechanism; at home, we don’t have that barrier,” noted Kelly Bhatnagar, psychologist and co-founder of the Center for Emotional Wellness in Beachwood, Ohio, a practice specializing in the treatment of eating disorders.

In many households the pandemic has heightened food insecurity and its attendant anxieties, which can increase the risk of eating disorders. Research shows that, compared to teenagers whose families have enough food, those in homes where food is scarce are more likely to fast, to skip meals, and to abuse laxatives and diuretics with the aim of controlling their weight.

The Instagram influence

What teens see on their screens is also a factor. During the pandemic, teenagers have spent more time than usual on social media. While that can be a source of much needed connection and comfort, scrutinizing images of peers and influencers on highly visual social media has been implicated in body dissatisfaction and disordered eating. Dr. Austin noted that teenagers can be prone to comparing their own bodies to the images they see online. “That comparison creates a downward spiral in terms of body image and self-esteem. It makes them more likely to adopt unhealthy weight control behaviors.”

When adolescents take an interest in managing their weight, they often go looking for guidance online. Indeed, a new Common Sense Media survey found that among teenagers who sought health information online between September and November of 2020, searches on fitness and exercise information came second only to searches for content related to Covid-19 — and ahead of searches on anxiety, stress and depression.

What young people find when they go looking for fitness information can be highly problematic. They are likely to come across harmful “thinspiration” and “fitspiration” posts celebrating slim or sculpted bodies, or even sites that encourage eating disordered behavior. Worse, algorithms record online search information and are “deliberately designed to feed harmful weight loss content to users who are already struggling with body image,” such as advertisements for dangerous diet supplements, Dr. Austin said.

When to worry

With so many forces contributing to teenagers’ body dissatisfaction and eating disordered behavior, how do parents know when to worry?

Parents should be alarmed, Dr. Kaye said, “if your child suddenly loses 10 to 20 pounds, becomes secretive about eating, or if you are seeing food disappear,” as becoming furtive about what, how and when one eats is a common occurrence in anorexia, bulimia and other eating disorders.

Experts agree that adults should be on the lookout for behaviors that veer from previous norms, such as suddenly skipping family meals or refusing to eat food from entire categories, such as carbohydrates or processed foods. Worth concern, too, is the teenager who develops fixations such as carefully counting calories, exercising obsessively or hoarding food, which may be a sign of a binge eating disorder. Parents should also pay close attention, said Dr. Accurso, if adolescents express a lot of guilt or anxiety around food or eating, or feel unhappy or uncomfortable with their bodies.

According to Dr. Bhatnagar, the view of eating disorders as a “white girls’ illness” can keep teens who are not white girls from seeking help or being properly screened for eating disorders by health professionals, even though eating disorders regularly occur across both sexes and all ethnic groups.

“Boys are having the same troubles,” said Dr. Bhatnagar, “but heterosexual boys may talk about body image a little differently. They tend to talk in terms of getting fit, getting lean or being muscular.”

Dr. Austin also noted that it is common to see elevated rates of eating disorders in lesbian, gay and bisexual youth of all genders as well as transgender and gender diverse young people.

“Eating disorders,” Dr. Accurso said, “don’t discriminate.”

How to help

Research shows that early identification and intervention play a key role in the successful treatment of eating disorders. Accordingly, parents who have questions about their teen’s relationship with eating, weight or exercise should not hesitate to seek an evaluation from their pediatrician or family health provider. Trustworthy eating disorder information, screening tools and support can also be found online. And when necessary, online resources can provide guidance and support to those on treatment waiting lists. “It may not be ideal for many,” Dr. Kaye said, “but it’s the reality of the situation we’re in.”

Parents can also take steps to reduce the likelihood that an eating disorder will take hold in the first place. Experts encourage adults to model a balanced approach to eating and to create enjoyable opportunities for being physically active while steering clear of negative comments about their teenager’s body or their own. Parents should also openly address the dangers of a ubiquitous diet culture that emphasizes appearance over well-being, creates stigma and shame around weight and links body size to character and worth. As Dr. Accurso noted, “We are not defined by a number on a scale.”