207 - Trends in Eating Disorders before and during the COVID-19 Pandemic

Poster Number: 207
Publication Number: 207.400

Apryl Susi, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Madeline Dorr, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, McLean, VA, United States; Elizabeth Hisle-Gorman, Uniformed Services University, Bethesda, MD, United States; Ian S. Sorensen, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Maxwell Ebert, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Jayasree Krishnamurthy, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Cade M. Nylund, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States

Background: The COVID-19 pandemic has led to increases in negative emotions, food insecurity, social isolation/avoidance, and feeling of loss of control, all of which are factors associated with the development of eating disorders.

Objective: This study seeks to evaluate trends in the monthly rate of patient encounters for anorexia nervosa and bulimia nervosa from February 2019 to April 2021 stratified by sex and age.

Design/Methods: A retrospective trend analysis was performed using monthly cross-sectional data from the Military Health System (MHS) database. Adolescents aged 10-21 years enrolled in the MHS during a given month were included. ICD-10 codes identified inpatient or outpatient visits for anorexia nervosa and bulimia nervosa. Poisson regression evaluated overall rates and trends over the study period stratified by both sex and age.

Results: Approximately 210,000 females and 220,000 males 10-13 years, 260,000 females and 290,000 males 14-18, and 210,000 females and 330,000 males 19-21 were included monthly. Overall average monthly encounters increased for females 14-18  and females 19-21 for both anorexia (1.7% and 5.6%, p< 0.05) and bulimia (1.0% and 1.9%, p< 0.05), and for males 14-18 and 19-21 for anorexia (0.9% and 2.7% p< 0.05). Overall, both females and males 10-13 experienced a decrease in monthly encounters for anorexia (-2.9% and -5.2%, p< 0.05). Figure 1.

Monthly hospitalization rates for anorexia increased in females 14-18 and 19-21 (1.7% and 5.6%, p< 0.05) and males 19-21 (2.7%, p< 0.05). Hospitalizations decreased for females and males 10-13 (-2.9% and -5.2%, p< 0.05). Hospitalization rates for bulimia decreased in females 10-13 (-3.8%, p< 0.05) and increased in females 18-21 (3.3%, p< 0.05). Figure 2.

There was an increase in monthly outpatient visit rates for anorexia for females of all age groups, 10-13, 14-18, and 19-21 (4.3%, 2.3%, and 1.6%, p< 0.05) and for males 14-18 (3.3%, p< 0.05). Outpatient visit rates for bulimia increased for females across all age groups (6.6%, 1.9%, and 0.9%, p< 0.05). Figure 3.Conclusion(s): Rates for anorexia nervosa and bulimia nervosa were increasing in most age groups prior to the start of the pandemic and continued throughout with outpatient and inpatient visits both contributing to these trends. COVID-19 pandemic stressors may have contributed to the trends observed. The best interventions for feeding disorders are prevention and screening, so as the pandemic continues, robust screening during routine visits for eating disorders in both males and females of all ages should continue.
Figure 1: Monthly Rates of Inpatient and Outpatient Care Overall for Anorexia Nervosa and Bulimia Nervosa
Figure 2: Monthly Rates of Inpatient Encounters for Anorexia Nervosa and Bulimia Nervosa