Eating disorder rise during pandemic may have been linked to exercise

While research is limited, a Scottish child mental health expert said there is evidence that Covid led to young people “starving themselves harder” with higher levels of over-exercising.

Not having access to school PE and being restricted from competitive sport is thought to have resulted in more rigorous home fitness regimes.

The message that if people “weren’t feeling themselves” it was the effects of the pandemic, may also have normalised symptoms of an eating disorder.

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One boy, who sought help from his guidance teacher, is said to have told her that he felt as if the daily exercise guidance, promoted heavily during lockdown, was aimed at him.

“While the Joe Wicks stuff was really helpful for some folk, for others it has gone the other way,” said Duncan Clark, Clinical Director for Child and Adolescent Mental Health Services (CAMHS) for NHS Lanarkshire.

He said it was too early to draw any firm conclusions about the effect of the pandemic on prevalence of eating disorders but said research carried out so far, whilst involving small numbers, has provided “helpful” indicators.

A Canadian study, involving around 48 young people, compared the experiences of young people with eating disorders before and during lockdown.

“It found that those with onset during Covid were starving themselves harder and over exercising more than in previous times,” said Mr Clark.

“In terms of the symptoms and onset and presentation, they are physically compromised at a much higher level than previous referrals.

“There is a higher rate of urgent referrals to inpatient units.”

He said there has been a rise in eating disorders among children and young people, globally, pre-pandemic and Covid may have exacerbated factors which contribute to their onset.

“Social isolation has been named,” said Mr Clark.

“The other two indicators that are named by the young people themselves are boredom and lack of things to do and generalised higher levels of anxiety.

“We are seeing that across the board. A lot of the symptoms that go along with eating disorder are anxiety disorder based.”

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He said there was “no doubt” that the numbers of children and young people requiring hospital treatment had risen in the past two years.

“Again, we have to be careful as, thankfully, the numbers are still quite small,” he said.

“But the experience is that the number of referrals to community services and leading to inpatient admissions is higher, there is no doubt about it and this is reflected in the Canadian study.”

He said that while some CAMHS services were stood down during the first phase of the pandemic, eating disorders are always categorised as urgent, so there should not have been any treatment delays for those most at risk.

“At no time has anybody in Lanarkshire who was referred with an eating disorder not been given an assessment and an intervention plan.

“What I do think is that during the first wave all of our referrals fell off a cliff when we went into March to June and I think people weren’t seeking help -it wasn’t necessarily an access issue. 

“The nature of the condition means it’s secretive and young people hide it so the social isolation, not being in at school, disrupted meal times - all those kinds of things. 

“Young people may have been able to hide it and combined with starving themselves harder and exercising more than in previous times means that when it did become apparent - psychology and physically they were in a worse condition.”

The NSPCC said there was a 4% rise in contacts from children across the UK to Childline about eating disorders and body image in 2020-2021.

Adeniyi Alade, head of NSPCC Scotland, said: “Some experienced unhealthy eating behaviours for the first time, while others suffered relapses or worsened symptoms. 

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“Our Childline counsellors heard children’s fears of putting on weight and about a disruption to routines and organised activities that previously helped maintain a sense of control over eating and body image and give a confidence boost. 

“Some also shared concerns about reduced access to support services, such as eating disorder clinics, therapists and social workers.”

Estimates suggest up to 1.25 million people in the UK have an eating disorder and growing numbers (25%)  male. Dedicated charity Beat says Scotland does not collect data on referrals “so we have no idea what the prevalence is in Scotland.”

It takes an average of three and a half years for someone to get treatment after their symptoms first emerge. The longest delay, for both children and adults, is because they do not realise they are ill, according to the charity.

The most common is binge eating disorder but there has also been a rise in calls about ARFID - avoidant restrictive food intake disorder, where people avoid certain foods or types of food which compromises calorie consumption.

Emma Broadhurst, the charity’s National Officer for Scotland, said she agreed that the focus on exercising may have been a factor in the rise in eating disorders.

She said: “During lockdown I worked on our helpline and it used to be something that I would see quite a lot that people would say ‘all I’m hearing is how much exercise I should be doing’. 

“You have to enforce that it’s not aimed at you - it’s okay for you to sit outside or do a small walk.

“It’s been really challenging for young people, everything has gone out the window.

"They might think, ‘what is it that I can do? I can exercise, I can eat healthily, that’s what they are telling me to do' and that just spirals.

“The other thing is, that if you weren’t feeling yourself, you were told that it was the pandemic and it will all be okay afterwards. 

“We were told not to trouble the NHS so people just sat with it. It wasn’t until afterwards that suddenly there was this rush and influx of very ill people - young people and adults.

“They were much more unwell.

“Anecdotally we might hear that there are 12 inpatient beds in a health board area and there are normally two or three people in there and suddenly they were having 11 or 12 and that has continued.”

She said services were beginning to see younger children before the pandemic, 

“We tend to think of eating disorders as white, middle-class girl, about 14 or 15 but we are getting more and more calls about primary aged children being referred. 

“It could be because we are doing a very good job of raising awareness, it could be because of the pandemic.” Ms Broadhurst said it was known that children were more likely to disclose mental health issues to teachers than parents, which may also have led to delays in diagnosis and more severe presentations.

The charity leader, whose own daughter is recovered from anorexia, says warning signs may be noticeable weight loss or increased awareness of the calorie content of different foods. Children may develop mood swings or spend more time alone to exercise excessively.

She said: “My daughter was ill and if someone had pointed all that out to me beforehand I’d have been like...’aah’...but I didn’t put all of the pieces of the jigsaw together.”

For advice and support go to beateatingdisorders.org.uk or call the charity’s helpline on 0808 801 0432