The number of hospitalizations for health disorders has doubled across the US during the pandemic (between January 2018 and December 2020), according to new research. The largest part of this increase was represented by cases of anorexia or bulimia.

Despite this, other common behavioral health conditions such as depression, alcohol use, or opioid use disorder, haven’t registered any meaningful changes during this time.

Eating issues

“This pandemic era is going to have some long-term impacts on the course of disease and the course of weight over the lifespan,” says Kelly Alison, Ph.D., Director of the Center for Weight and Eating Disorders at the University of Pennsylvania, co-author of the paper. “What that does for eating disorders? We just don’t know.”

Although the team can’t yet tell what the cause of this increase is, they believe that we’re looking at the combined effect of several factors ranging from the toll the pandemic has taken on our mental health, an outsized focus on weight gain in parallel with constantly viewing ourselves on video calls, and even symptoms of COVID-19 itself. There is also very little data on how this trend will affect public health in the long run.

The study included data from over 3.2 million individuals across the U.S., with a mean age of 37.7 years old. According to the findings, the number of inpatient care cases for eating disorders remained pretty stable over time, at approximately 0.3 cases per 100,000 people per month, until May 2020. At that date, the number of cases doubled, to 0.6 per 100,000. This increase was registered across anorexia nervosa, bulimia nervosa, and other and unspecified eating disorders.

The average length of inpatient stays for such cases has also increased. This was on average 9 days and 8 days between June to December of 2018 and 2019, respectively, going up to 12 days between June and December of 2020. A similar increase was not seen for the 3 behavioral health conditions used as controls over the same timeframe.

As far as outpatient care cases for eating disorders have increased from around 25 per 100,000 people per month to 29 per 100,000. The age range of inpatient patients ranged from 12 to 20 pre-pandemic, rising to 18 to 28 after its onset.

The average length of inpatient stays for such cases has also increased. This was on average 9 days and 8 days between June to December of 2018 and 2019, respectively, going up to 12 days between June and December of 2020. A similar increase was not seen for the 3 behavioral health conditions used as controls over the same timeframe.

Stress caused by the pandemic and the changes it caused in our lives could be one of the drivers of this increase, the team reports. Additionally, the shift towards video calls for conferences at work gives us ample opportunity to look at ourselves, which can create a further drive towards the development of eating disorders.

“During the pandemic, having a lack of routine and structure primed us in terms of our behaviors around food,” says Ariana Chao, Ph.D., from Penn’s School of Nursing.

Social media reflects this increase in self-scrutiny and concerns regarding weight, the authors report. As far as eating disorders are concerned, discussions about weight can be “very triggering”, Allison explains, so social media can create a lot of stress in patients at risk. Different people handle this stress differently, the team adds, with some binge eating, while others didn’t eat enough.

For now, it’s not clear whether the rising trend in eating disorder cases will continue after the pandemic. The present study is based on data up to December 2020, so it’s missing the latest part of the picture. The team is now hard at work analyzing data recorded well into 2021 to see how these trends are evolving.

“We really need more research,” says Chao. “Adversity can be a long-term predictor of developing eating disorders. Even the transition back to ‘normal’ can exacerbate eating disorders. Everything is changing so rapidly. Then again, people are also resilient. It’s hard to say what the long-term implications will be.”

The paper “Trends in US Patients Receiving Care for Eating Disorders and Other Common Behavioral Health Conditions Before and During the COVID-19 Pandemic” has been published in the journal JAMA Network Open Psychiatry.