A study from Canada has shown an increase in the number of anorexia nervosa or atypical anorexia nervosa cases among children and adolescents during the first wave of the Covid-19 pandemic.¹ An increase in their hospitalization rates was also observed.

The study, reported in JAMA Network Open, included 1883 children and adolescents with newly diagnosed anorexia nervosa or atypical anorexia nervosa during the first wave of the pandemic from March to November 2020. The incidence and hospitalization rates were then compared with that seen during the five years before the pandemic, from January 2015 to February 2020. Their age ranged from 14 to 17 years and more than 90% of them were female. These children had been examined at six pediatric tertiary-care hospitals in Canada between January 2015, and November 2020.

Results showed that during the first wave of the pandemic, the incidence of new-onset of anorexia nervosa or atypical anorexia nervosa increased from 24.5 to 40.6 cases every month showing a steep rise of more than 60%. The number of children hospitalized on account of their diagnosis also increased 3-folds, from 7.5 cases to 20 cases per month.

Children who were diagnosed during the pandemic had more severe disease compared to those who had been diagnosed prior to the pandemic. Particularly in areas with high spread of Covid-19, which had more stringent restrictions in place, the progression of disease was faster (7 months vs 9.8 months); they also suffered greater weight loss (19.2% vs 17.5%) and more severe bradycardia (57 beats per minute vs 63 beats per minute).

Covid-19 pandemic has caused an unprecedented loss of lives and has affected not just physical health but also mental health. Children too are not untouched. Fear of acquiring the infection, closure of schools, not being able to meet friends or play outdoors has had an impact on their emotional health and well-being. This lack of social support makes them more vulnerable to stress, which is a known precipitating factor for anorexia nervosa, along with loneliness or social isolation, as is evident from this study.

According to the authors, many adolescents with an eating disorder also have concurrent anxiety, obsessive-compulsive disorder and depression. “A worsening of overall mental health status may explain the increased rate of newly diagnosed anorexia nervosa or atypical anorexia nervosa found in the present study,” they write. This study highlights the need for better understanding of eating disorders, their triggers and prognosis as well as the mental health needs of affected children during future such pandemics.

Reference

1. Agostino H, et al. Trends in the incidence of new-onset anorexia nervosa and atypical anorexia nervosa among youth during the COVID-19 pandemic in Canada. JAMA Netw Open. 2021 Dec 1;4(12):e2137395. doi: 10.1001/jamanetworkopen.2021.37395.