Epidemiological Review on Eating Disorders: The Impact of the COVID-19 Pandemic and Optimizing Care Pathway

Abstract

The COVID-19 epidemic, which originated in Asia in late 2019, spread rapidly across the globe, prompting the World Health Organization to declare it a pandemic. Governments around the world imposed lockdowns, drastically altering daily life and social interactions. While these measures effectively controlled virus transmission, they also exacerbated social isolation and mental health problems, particularly among children and adolescents, who experienced increased anxiety, depression and suicidal tendencies. In the area of eating disorders, the pandemic exacerbated the conditions of existing patients and increased the number of new cases. The disruption to traditional medical services necessitated a shift to telemedicine, which was essential but also challenging. This transition affected routine medical practices, creating barriers to effective treatment. The prevalence of eating disorders in Japan has increased, with younger patients becoming more common, underscoring significant changes in the medical environment surrounding eating disorders.

Epidemiological studies prior to COVID-19 indicated that the prevalence of eating disorders varied and was influenced by economic and cultural factors. Across all eating disorder subtypes, the number of patients showed a marked upward trend until the 2000s, after which the numbers plateaued. During the pandemic, there was a significant increase in newly diagnosed cases of eating disorders in the United States and Europe, particularly among adolescent females. The clinical characteristics of eating disorder patients also changed after the pandemic, with more severe symptoms and lower target weights. In Japan, about one-third of the onset of symptoms in eating disorder patients was associated with the pandemic, with new cases tending to be younger. Patients with pre-existing eating disorders experienced a worsening of symptoms as a result of the pandemic. One European study reported an increase in hospital admissions and symptom severity, particularly in patients with anorexia nervosa. The impact of the pandemic varied by cultural context and disorder subtype, with regional differences in psychological and eating behavioural problems.

The COVID-19 pandemic has highlighted the importance of optimising early diagnosis and access to treatment for eating disorders. Delays in diagnosis and treatment are often due to complex care pathways and lack of awareness among patients and healthcare providers. Research shows that early intervention and streamlined care pathways can significantly improve outcomes. Healthcare costs could be reduced by more than half by incorporating three elements into the care pathway for eating disorders: reducing waiting times for outpatient treatment at specialist centers, ensuring that patients see a specialist center after their first contact with a provider, and providing support for transition through treatment after the first contact with a provider.

In conclusion, the COVID-19 pandemic has had a significant impact on the prevalence and treatment of eating disorders, requiring a re-evaluation of current health care approaches to effectively address these challenges.