Eating Disorders Background and the COVID-19 Public Health Emergency

Eating disorders are complex, serious mental illness with high rates of co-morbid conditions including depression, anxiety, substance use disorders, and other co-morbidities. Nearly 30 million Americans of all ages, races, ethnicities, genders, and sexualities will experience an eating disorder in their lifetime, and over 10,000 of them will die every year. This is equivalent to 1 death every 52 minutes as a direct result of an eating disorder. Specifically, people of color with eating disorders are half as likely as their white peers to be diagnosed or receive treatment; women are twice as likely as men to have an eating disorder; and a 2020 study of college students found women identifying as questioning and bisexual had about 1.4 times the odds of elevated ED risk than heterosexual women and among both men and women at elevated risk for an ED, sexual minorities overall were more likely to have received an ED diagnosis than their heterosexual peers. These troubling statistics have worsened with the COVID-19 pandemic because of increased isolation, stress, economic precarity, and food insecurity. As it relates to food insecurity, emerging research has consistently indicated that food insecurity elevates a person’s risk for eating disorders pathology and dietary restraint by as much as five times compared to food secure households. We also know that food insecurity is associated with a 257% higher risk of anxiety and 253% higher risk of depression. When families across the nation do not have access to mental health treatment at all levels of care and delivery modalities, they are not able to engage in lifesaving treatment. Studies show that when a person with a severe eating disorder does not receive comprehensive treatment, 41% of patients will relapse and are two times more likely to end up seeking care in the emergency room than someone without an eating disorder. Barriers to comprehensive treatment cost the U.S. economy $64.7 billion each year, with $17.7 billion shouldered by the federal government. There have been dozens of news and research articles documenting the rise in eating disorder diagnoses since the onset of the pandemic.

(NCEED)12 found in July 2020, 62% of people in the U.S. with anorexia experienced a worsening of symptoms as the pandemic hit, and nearly one-third of Americans with binge eating disorder, which is far more common, reported an increase in episodes. Hospitals across the nation are reporting an inability to keep up with demand, with recent reports of hospitalizations for eating disorders doubling for children and adolescents. St. Louis Children’s Hospital in Missouri is seeing 8-15 kids per day for behavioral health issues including suicide attempts, eating disorders, anxiety, and psychosis. At C.S. Mott Children’s Hospital in Ann Arbor, Michigan, administrators found medical admissions among adolescents with eating disorders during the first 12 months of the pandemic more than doubled the mean for the previous 3 years. Arkansas Children’s Hospital CEO, Marcy DodererThe uptick in pediatric mental health conditions has led the Children’s Hospital Association, American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatrists to launch “Sound the Alarm for Kids,” The pediatric mental health crisis will have lasting impacts on children for years to come. During this time, it has been challenging for eating disorders providers to keep up with the demand for care. Eating disorder treatment providers have seen a 30-100% increase in demand for care, with call volumes and inquiries for care doubling, significantly increased acuity in nature of illness presented and wait times expanding from 1 week to 6-8 months in some areas of the country. Among our partner organizations, the National Eating Disorders Association saw a 40% increase in helpline call volume during the first year of the pandemic, and the National Alliance for Eating Disorders, staffed by licensed, specialized therapists who can assess for safety of callers, saw an 80% increase in helpline call volume in 2021. Additionally, the Alliance saw a 108% increase in referrals and an 82% increase in support group attendance in 2020 and has surpassed those figures this year.

December 14, 2021 Letter from Eating Disorders Coalition to  Rachel Levine, USPHS, MD Assistant Secretary for Health Office of the Assistant Secretary for Health