First wave of COVID-19 in Canada magnified incidence of anorexia nervosa
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The initial surge of the COVID-19 pandemic uncovered a rise in diagnoses of and hospitalizations for anorexia nervosa in both children and adolescents, per a cross-sectional study from Canada published in JAMA Network Open Pediatrics.
“The association between stressful events and exacerbations in eating disorder symptoms has been documented,” Holly Agostino, MD, CM, of the division of adolescent medicine, department of pediatrics at Montreal Children’s Hospital, McGill University Health Centre, and colleagues wrote. “Studies of adult patients with preexisting eating disorders reported worsening symptoms during the first wave of the COVID-19-associated confinement, including greater caloric restriction, increased self-induced vomiting, worsening body dysmorphia and heightened exercise drive.
“To date, the association between the pandemic and its confinement measures and the genesis of new-onset anorexia nervosa or atypical anorexia nervosa has not been studied,” they added.
Agostino and colleagues attempted to determine the frequency and severity of diagnoses in a nationwide cross-section of nearly 1,900 children and adolescents before and during the first wave of the COVID-19 pandemic. The study was undertaken at six pediatric facilities across Canada between Jan. 1, 2015, and Nov. 30, 2020, involving patients ranging in age from 9 to 18 years who presented with novel anorexia nervosa or atypical anorexia nervosa. Diagnosis trends during the first wave of COVID-19, beginning March 1, 2020, were compared with similar data culled from the 5 years prior to the pandemic, from Jan. 1, 2015, to Feb. 28, 2020.
Among 1,883 participants diagnosed with anorexia nervosa or atypical anorexia nervosa, 91% were female (1,713), and the mean age for all patients was 16 years. Results showed that pre-pandemic anorexia diagnoses averaged 24.5 cases per month, but new cases increased sharply, to 40 per month during the initial COVID-19 surge.
Concurrently, the number of hospitalizations for patients diagnosed with anorexia nervosa rose significantly, from 7.5 to 20 per month. Increases in both diagnoses and hospitalizations were more pronounced in Canadian provinces that reported higher rates of COVID-19 infections. Significant severity of virus symptoms was found in patients diagnosed during the initial surge as opposed to pre-pandemic timeframe, along with evidence of a quicker progression of symptoms, including slower heartbeat.
The data also demonstrated the need for increased attention to treatment for eating disorders and mental health issues that arose as a result of the pandemic. Further research is required to understand the contributing factors behind these illnesses and how to address these needs should another pandemic, in which social isolation is a necessity, occur.
“Lack of a clear routine may be associated with a higher risk for eating disorder-related behaviors because it removes structures that normalize eating,” Agostino and colleagues wrote. “Confinement orders limit access to regular physical activity, which, in combination with disrupted eating patterns, may have a role in the heightened concern about body shape and weight.”
In an editorial related to the study, Youngjung Kim, MD, PhD, of the department of psychiatry at Massachusetts General Hospital and Harvard Medical School, stated that severity of anorexia nervosa symptoms and the impact of suffering during the pandemic may be more significant than revealed in the study’s findings.
“There may be many reasons for the observed differences, and Agostino and colleagues2
acknowledged that the shift toward prioritizing evaluations for those with more severe anorexia nervosa symptoms during the pandemic may be a possible source of selection bias, which is important in considering their findings on the rates of hospitalization and symptom severity,” Kim wrote.
“Such need for triaging according to escalating volume of patients with eating disorders highlights the possibility that the observed incidence of de novo anorexia nervosa may have been diluted, and the true burden of illness may unfortunately be greater.”