Incident Anorexia Among Youth Increased During COVID-19 Pandemic

By Lisa Rapaport

January 14, 2022

(Reuters Health) - The incidence and severity of new-onset anorexia nervosa increased among children and adolescents during the COVID-19 pandemic, a Canadian study suggests.

Researchers examined data on a total of 1,883 kids aged 9-18 years newly diagnosed with anorexia nervosa or atypical anorexia nervosa during the first wave of the COVID-19 pandemic, from March to November 2020, and during the previous five years, from January 2015 through February 2020. Researchers assessed the incidence and hospitalization rates within 7 days of each new anorexia nervosa or atypical anorexia nervosa diagnosis at 6 tertiary care pediatric hospitals in Canada.

Over the five-year period before the pandemic, diagnosis rates for anorexia nervosa and atypical anorexia nervosa were little changed at a mean of 24.5 cases per month. Then, during the first pandemic wave, new diagnosis rates jumped to a mean of 40.6 cases per month.

Hospitalizations for anorexia nervosa and atypical anorexia nervosa climbed from a mean rate of 7.5 cases per month over the five-year pre-pandemic period to 20.0 cases per month during the first wave of the pandemic.

While the study wasn't designed to assess why more patients were diagnosed and hospitalized during the pandemic, it's possible that the lack of clear routines and the removal of the daily structure that normalized eating may have led teens to disordered eating habits, said lead study author Dr. Holly Agostino, an adolescent medicine specialist and director of the eating disorder program at Montreal Children's Hospital.

"Many adolescents with eating disorders also have comorbid psychopathology, including depression, anxiety, and obsessive-compulsive disorder," Dr. Agostino said by email. "A worsening of overall mental health status during the pandemic may also have contributed."

Cases also appeared to increase in severity during the pandemic, Dr. Agostino and colleagues report in JAMA Network Open.

For example, anorexia nervosa and atypical anorexia nervosa progressed over a mean of 7.0 months during the pandemic study period, as compared with a mean progression of 9.8 months during the five-year period prior to the pandemic.

Similarly, mean weight loss increased from 17.5% during the pre-pandemic period to 19.2% during the pandemic period.

Patients with anorexia nervosa also had more profound bradycardia during the the pandemic, with a mean heart rate of 57 beats per minute, compared with 63 beats per minute over the five-year period before the pandemic.

One limitation of the study is that it's possible factors other than the COVID-19 pandemic contributed to increases in cases, hospitalizations, and severity during the pandemic. Another potential limitation is that treatment centers prioritized the most severe patients during the pandemic, which might have contributed to selection bias in the study population.

While previous research has found that the pandemic has been contributing to worsening mental health, what's surprising about the current study is that the highest number of anorexia cases occurred in areas with the highest COVID-19 infection rates, said Dr. Youngjung Kim, a psychiatrist at Massachusetts General Hospital and Harvard Medical School in Boston and author of a commentary accompanying the study.

"This may be related to stricter confinement measures in regions with higher infection rates," Dr. Kim said by email. "While it is also worthwhile to consider more direct contributions from the SARS-CoV-2 virus, we are missing many pieces of the puzzle - a timely reminder that we need to expand screening and intervention, as well as the need for a better mechanistic understanding of anorexia nervosa."

SOURCE: https://bit.ly/3I4juNg and https://bit.ly/34Iq91f JAMA Network Open, online December 7, 2021.

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