Eating disorder trends post COVID-19: Recommendations for paediatricians from CPS

OTTAWA – Rates of eating disorders (EDs) have risen dramatically in recent years. These conditions—which can have severe medical and psychosocial complications and are potentially life-threatening— typically emerge in the teenage years but can affect all ages, genders, sexual orientations, racial/ethnic identities, and socioeconomic backgrounds.

“Anorexia has the highest mortality rate of any psychiatric disorder, but diagnosis can be missed or delayed – especially when a patient doesn’t present with the classic signs,” said Dr. Holly Agostino, an adolescent medicine specialist and co-author of new eating disorder guidelines from the Canadian Paediatric Society (CPS).

“During the COVID-19 pandemic, we saw a major increase in the complexity and severity of cases.” said Dr. Holly Agostino. This trend was also noted in a recent Canadian Paediatric Surveillance Program study looking at new-onset eating disorders during the pandemic.

The new guidelines from the CPS Adolescent Health Committee will help community-based healthcare providers identify and treat eating disorders. Primary care providers are often the first to be approached for signs of an eating disorder, which may include changes in weight or behaviors around food, abdominal pain, fatigue, or irregular menstrual cycles. Routine health care appointments provide an opportunity to screen for disordered eating, and these new guidelines can improve physician confidence in identifying and beginning treatment.

Early recognition and diagnosis is associated with improved prognosis, so the CPS recommends that all adolescents be screened for EDs during annual health check-ups.

Current recommendations name family-based treatment as the preferred intervention when a restrictive eating disorder has been confirmed. This begins by helping parents and caregivers regain control over meals and nutrition, with a reduction in food supervision as the adolescent’s condition improves.

Recovering from an eating disorder is a complicated and lengthy process that impacts the lives of all family members. “Families, including siblings, may also need personal support and should be encouraged to seek help as needed,” Dr. Agostino noted.

Parents should seek medical assistance if their teen:

• Has a significant and unexplained weight change
• Fails to reach an expected height or weight on their growth curves
• Is showing delays in puberty
• Has serious body image concerns, including a strong desire for weight loss or fear of weight gain
• Has restrictive eating patterns
• Exercises obsessively

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About the Canadian Paediatric Society

The Canadian Paediatric Society is a national advocacy association that promotes the health needs of children and youth. Founded in 1922, the CPS represents more than 3,300 paediatricians, paediatric subspecialists and other child health professionals across Canada.