The number of female Ontario adolescents who visited emergency rooms or checked in to hospitals because of eating disorders skyrocketed during COVID-19, according to a new study that says elevated rates of anorexia and related illnesses among girls persisted even as the pandemic subsided.
The new paper, published Tuesday in the Canadian Medical Association Journal (CMAJ), reinforces earlier research that found severe eating disorders spiked among female adolescents across Canada in the second half of 2020 and early 2021, as the pandemic raged and public-health restrictions turned daily life upside down.
For instance, national data from the Canadian Institute for Health Information show hospital admissions for young women with eating disorders rose by nearly 60 per cent in the first year after COVID-19 emerged. A separate study in the journal JAMA Network Open found that the number of children and teens admitted to hospital for a new diagnosis of anorexia surged at six Canadian pediatric hospitals in the first nine months of the pandemic.
The problem didn’t wane when lockdowns lifted, the new CMAJ study shows. Rates of serious eating disorders among young people, especially those aged 10 to 17, continued to be higher than prepandemic levels until at least August, 2022, the most recent month for which researchers analyzed data.
The pandemic “did have a long-lasting impact,” said Alene Toulany, an adolescent medicine specialist at Toronto’s Hospital for Sick Children and one of the authors of the CMAJ paper. “It shifted friendships. Even just transitioning back to school is going to be a stressor after being out for so long … the impact of that doesn’t just stop when schools open their doors.”
The CMAJ study compared emergency department visits and hospital admissions for eating disorders in Ontario in the three years before COVID-19 and the 2½ years after. After a dip in the first three months of the crisis – when many people avoided hospitals for fear of catching the new virus – rates shot up, particularly for preteens and teens.
Before the pandemic, the monthly rate of emergency department visits for eating disorders in Canada’s most populous province was 3.33 per 100,000 for those aged 10 to 17. In the pandemic period, it rose to 7.38, an increase that was 121 per cent higher than expected.
For those aged 18 to 26, rates of emergency department use for eating disorders also rose during the pandemic, though not as sharply as for adolescents. The rates were slightly above expected for older adults, too, but hospital admission rates only increased for adolescents, a phenomenon that Dr. Toulany said could reflect a lack of beds for adults with eating disorders, especially when hospitals were filled with COVID-19 patients.
The study found that the vast majority of patients who made eating-disorder-related visits to hospitals were female, just like Dawn Murray-Lubbers’s daughter.
Ms. Murray-Lubbers spent six months by the teenager’s side as the girl recovered from a life-threatening bout with anorexia this year at CHEO, a pediatric hospital in Ottawa.
The teen, a high-achieving student and competitive hockey player, began cutting back on meals and portions while in lockdown, her mother said. Her hair began falling out and her period stopped, and she dropped to nearly 80 pounds at her lowest point.
Ms. Murray-Lubbers believes the stress of the pandemic triggered the disorder in her daughter, now 17, and made it more difficult for her to get a prompt diagnosis and treatment. For the teen, anorexia was less about body image – her friends are athletes of all shapes and sizes – than it was about exerting control during a frightening time, her mother said.
“She likes to keep in control of everything, food-wise,” Ms. Murray-Lubbers said. “What the expiry dates are. She wants to know what you’re cooking, who’s cooking it. Did you wash your hands? All of that is a control thing for her.”
Ms. Murray-Lubbers is grateful her daughter received intensive support during her stay at CHEO, which on Tuesday is set to formally announce a 12-bed partial hospitalization program for children and teens with eating disorders. The program, which CHEO says is the first of its kind in a pediatric setting in Canada, will see patients spend 12 hours a day in hospital and sleep in their own beds at night.
When it comes to eating disorders, “we continue to see elevated levels above what we were seeing prior to the pandemic,” said Leanna Isserlin, medical co-director of the child and adolescent eating disorders program at CHEO.
“The children that were nine years old in 2020 are now 13 years old. They didn’t have a normal 9th year or 10th year, and that has academic and social and psychological impacts that will follow them throughout their adolescence.”