The Evolving Needs of Children Hospitalized for Eating Disorders During the COVID-19 Pandemic

Abstract

BACKGROUND AND OBJECTIVES: Throughout the COVID-19 pandemic, there has been an increase in hospital admissions for adolescents with eating disorders (EDs). However, there is a paucity of information on how this increase has affected hospitalization courses and disposition planning. We sought to describe the changes in hospitalizations for EDs at our institution during the pandemic. METHODS: We reviewed charts of patients admitted to our academic medical center for nutritional restoration from January 1, 2017, to June 30, 2021. We report differences in patient characteristics and hospitalization courses using descriptive statistics and Poisson regression. RESULTS: We reviewed charts for 85 patients for 108 hospital admissions. Admissions increased from 1.4 per month prepandemic to 3.6 per month during the pandemic (P < .001). Most patients were female (91%), White (79%), had private insurance, (80%) and had restrictive eating behaviors (97%). During the pandemic, we found (1) an increase in the average length of stay (12.6 days vs. 18.0 days) with younger age associated with longer length of stay (P < .001); (2) more patients requiring psychotropic medication management (11% vs 31%, P = .01); and (3) fewer patients discharged from the hospital with outpatient therapy (43% vs 24%, P = .03). CONCLUSIONS: In addition to an increase in hospital admissions for ED management during the pandemic, our study highlights the evolving needs of ED patients during their hospitalizations. The implications of longer admissions with higher acuity at discharge represent areas where appropriate adaptations in inpatient management and disposition planning may improve the quality of care for ED patients.

Impact of the COVID‐19 pandemic on care for anorexia and bulimia nervosa in US military‐connected adolescents and young adults

“…Earlier pandemic studies noted higher medical acuity in patients hospitalized with ED in the first year of the pandemic as well as increased or new self‐reported restrictive symptomatology directly attributed to the pandemic and quarantine measures (Agostino et al, 2021; Asch et al, 2021; Feldman et al, 2023; Haripersad et al, 2021; Hartman‐Munick et al, 2022; Lin et al, 2021; Otto et al, 2021; Parsons et al, 2021; Shum et al, 2022). Prolonged disruption of daily routines and constraints on out‐of‐home activities, especially cessation of athletic programs and gym restrictions, may have increased weight or body image concerns, thereby negatively impacting eating, exercise, and mental resilience.…”

“…Research through the first year of the pandemic in both pediatric and adult literature reported increased rates of ED‐related encounters across healthcare environments. Concerns for worsening medical acuity of patients, especially with restrictive or compensatory behaviors like AN and BN, have been reported using encounter rates, hospitalization rates, and/or longer duration of stay as indirect markers of medical severity (Agostino et al, 2021; Asch et al, 2021; Feldman et al, 2023; Haripersad et al, 2021; Hartman‐Munick et al, 2022; Lin et al, 2021; Otto et al, 2021; Parsons et al, 2021; Shum et al, 2022).…”

The Impact of Chronic Stress Related to COVID-19 on Eating Behaviors and the Risk of Obesity in Children and Adolescents

“…Some patients and their families linked the onset of lockdown as a trigger for hospital admission. The overall increase in hospital admissions for eating disorder exacerbations and prolonged stays has resulted in an increased demand for care related to the treatment of these disorders [ 61 , 62 , 63 ].…”

Admission rates and clinical profiles of children and youth with eating disorders treated as inpatients before and during the COVID-19 pandemic in a German university hospital

“…Shortened length of stay (LOS) was found at pediatric hospitals in Israel and Italy ( 26 , 27 ), yet prolonged LOS was observed at a large pediatric hospital with a specialized ED-treatment program in North America and at some Departments of Child and Adolescent Psychiatry in European Countries ( 31 ). Most of the few available studies found an increase in co-occurring mental health disorders in children and youth with ED ( 28 , 32 , 33 ). German studies investigating the impact of the COVID-19 pandemic on ED, and especially AN, in children and youth are scarce, but mostly concur with international data, indicating an increase of youth hospitalized for ED during the COVID-19 pandemic ( 18 , 34 , 35 ).…”