Study Finds Hospitalizations for Eating Disorders Doubled During the Pandemic

Over the past two years, the COVID-19 pandemic has exacerbated mental health conditions for many people. In particular, reports continue to find that eating disorders are on the rise.

According to a new study, the number of people hospitalized for the conditions like anorexia, bulimia, and other diagnoses doubled in 2020.

The November study, which was published in JAMA Network Open, looked at data on a little over 3, 250,000 people collected from January 1, 2018, to December 31, 2020.

In the first months of 2020, the number of people hospitalized for eating disorders stayed more or less the same. However, a spike occurred right after the pandemic started. By March 2020, the number of people hospitalized with eating disorders had doubled.

The data also showed that the age of patients with eating disorders decreased and younger people were increasingly hospitalized for eating disorders during the pandemic. How long a person stayed in the hospital also increased from an average of 8 or 9 days to 12 days per hospitalization.

Now, experts want to understand why and how the trend developed, as well as identify what can be done to help people with eating disorders moving forward.

What Triggered Disordered Eating?

The pandemic has brought about several factors—such as forced isolation at home, high levels of stress, and little to no control over the future—that can all contribute to eating disorders.

For example, heightened stress can trigger disordered eating—which could take the form of binge eating disorder or obsessing over weight loss—both as a reaction to shock and a coping mechanism.

All of the factors likely contributed to the spike in hospitalizations for eating disorders amid the pandemic. Experts feel that understanding them is key to preventing the trend from continuing.

“This was a very stressful time, and stress can trigger people to want to have control over other areas of their lives,” Kelly Allison, PhD, director of Center for Weight and Eating Disorders at Penn Medicine, and one of the lead authors of the study, told Verywell. “For those at risk for eating disorders, it likely turned their attention to food and wanting to control their eating, shape, and weight.” 

Because there was little structure to people’s days during the pandemic, the stress may have promoted binge eating without compensatory behaviors like being surrounded by loved ones, spending time in nature, and exercising. 

Stress and Isolation

Allison Chase, regional clinical director at the Eating Recovery Center, who was not involved in the study, told Verywell that while eating disorders do involve a behavioral component, "they are also a result of challenges in one’s emotional functioning and the greater the emotional challenge, the more unhealthy the disordered eating patterns become."

The fear of getting COVID-19 likely made people more fearful about leaving the house, meaning fewer trips to the supermarket. Due to the loss of jobs and a spike in unemployment, buying groceries was also a challenge for many people.

For people prone to anorexia, these behaviors could have contributed to more skipped meals, food restrictions, and avoidance of eating. For people prone to binge-eating, it might have meant stocking up on processed, canned, and commercialized foods.

Family Changes

Being at home also changed family living situations. With the many physical manifestations of eating disorders, it's possible that parents, caregivers, guardians, and partners became more aware of a loved one's disordered eating patterns.

A rise in hospitalizations may mean more people were able to get treatment.

Social Media

Discourse on social media also contributed to personal stress about weight. All that buzz made weight a constant topic of conversation.

“This focus on weight gain could have also contributed to disordered eating behaviors in an effort to lose weight or engage in extreme dietary restriction that is difficult to maintain, leading to more loss of control eating,” Allison said. In fact, several studies have associated more social media use with the rise in eating disorders.

“Many people were told that the pandemic was causing weight gain among those isolated to their homes because of illness, quarantines, and working or schooling from home,” Kerry Heath, a certified eating disorders specialist-supervisor at Choosing Therapy, told Verywell.

“This is like media hype over the ‘freshman fifteen’ or the inevitable holiday weight gain,” Heath said. “Those with eating disorders become concerned that they, too, will experience weight gain and overcompensate with eating disorder behaviors such as restrictive eating, over-exercise, and calorie counting.”

Later, warnings that people who are overweight or obese are at a greater risk of complications from COVID-19 became part of the discourse and intensified fears about weight gain.

Will This Concerning Trend Last?

Two years into the pandemic, experts wonder whether the effects we've seen will linger or fade away.

“It is hard to know if this will continue or not,” Allison said. “I would hope that with the return to normalcy that less severe cases may improve with the structure of normal life and eating routines.” 

In more severe cases, the symptoms of an eating disorder will persist even if the initial stressor is resolved or the situation improves.  

“I think that eating disorders are a growing trend, and here to stay largely because of social media influences and stressors brought on by the pandemic,” Caroline Carney, MD, MSc, FAMP, the Chief Medical Officer at Magellan Health, told Verywell. 

For others, the pandemic may have simply shed light on something that had been there all along.

“I am not convinced that it is a growing trend, but rather one that has existed, meaning that there has been disordered eating in our communities and often at a higher level,” Chase said. "We’re just seeing it more now, as the shift in environment exacerbated the physical symptoms."

Greater recognition of the need for treatment in people who may have kept their eating disorder symptoms hidden in the past means having more open conversations, more people reaching out for help, and better access to treatment.

“One good thing to come out of the pandemic is the increased use of telehealth,” Heath said. “Patients who would not otherwise be able to access therapists, registered dietitians, psychiatrists, and other healthcare providers are now getting help for their conditions.” 

The Way Forward

Gathering as much data about what happened during the pandemic and changing our mindset based on what we observe, is key to moving forward with a plan to curb the effects of the past two years and radically reduce the chances of another spike happening in the future.

According to Allison, we should stop focusing on weight and appearance and instead focus on behaviors and health more generally to change our mindset about weight.

"We can help destigmatize eating disorders, as these disorders are often viewed as under someone’s personal volition, instead of being based in the brain, like other mental health disorders," Chase said. "Eating disorders are not a personal choice."

On a smaller scale, thinking consciously about our access to and use of social media—specifically the places on social media that promote unhealthy body image—is also essential. Reading, sharing, and speaking up about how bodies come in all shapes and sizes and that none are "ideal" is one of the first cognitive steps that we can all take.

“Research suggests that prevention can work, particularly with programs like the cognitive dissonance approach which encourages girls and women to question the social influences and pressures and to speak out against them,” Carney said. “In the long run, we need to focus on healthy eating, and not the appearance of the body. We need to teach kids the skills to grocery shop, cook, and exercise in moderation.”

How to Help a Loved One

"Learning the truths and the myths about eating disorders can be helpful in order to not get lulled into believing that your loved one is 'acting in a healthy way,'" Chase said, noting that this is often what someone with an eating disorder believes because of the psychological nature of the disorder.

Allison said that when we are around other people, we can avoid talking about weight and weight gain related to the pandemic, as these topics can trigger disordered eating thoughts and behaviors.

"If you’re concerned for a loved one, you can use 'I statements' if you are concerned about friends or family having disordered eating," Allison said. "For example, you could say, 'I’ve noticed that you have not been eating dinner with us recently and I’m concerned. Can we talk about it?'"

It can also be useful to research possible treatment centers or providers to share with loved ones when you have that conversation, which demonstrates that you're ready to help—and help them take action.

“For anyone struggling with an eating disorder, the support of loved ones is essential,” Chase said. “We often talk about the ‘eating disorder’ as an external entity that has a very strong hold on the individual, which adds to the complexity of treating it. Therefore, having the support of loved ones is vital.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.