A spike in people seeking treatment for eating disorders during the covid-19 pandemic has revealed their global nature and severity. Jane Feinmann reports from the International Conference on Eating Disorders Jane Feinmann freelance journalistThe story often starts in a positive way."At a consultation, kids tell us that when the pandemic started, they decided to eat healthier and begin exercising more," said Ellen Rome, head of adolescent medicine at Cleveland Clinic, Ohio, USA. That positive start is the prelude to a tragic turn, however. "Then an adult will pick up the story and say, 'The next thing we knew, she'd lost 10 kg'," said Rome. "Other kids tell us that without a schedule they started eating when they were stressed or bored and 'suddenly the weight balloons.'" Rome was speaking at the International Conference on Eating Disorders in June. There were first-hand accounts of the problems faced by severely ill patients during the pandemic, with the closure or restriction of in-patient services being a major factor. Carolyn, the Canadian mother of an adult with anorexia who relapsed in late 2019, described how she drove her daughter to the local emergency department over 10 times during the pandemic. "Each time, they discharged her as soon as she was stabilised," Carolyn told the conference, explaining that her daughter's relapse was continuing.And while much media coverage came from Europe and North America, the pandemic has shown that disordered eating is a global epidemic."The belief that eating disorders are confined to high income countries is a dangerous myth that perpetuates health disparities," says Cynthia Bulik, professor of eating disorders at the University of North Carolina. The picture is skewed, with the available literature coming from only a few affected countries, Ravi Rajkumar of the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, India, told the conference.