By Anna Tanner, MD, FAAP, FSAHM, CEDS
Every year, eating disorder treatment centers across the country experience a significant uptick in phone calls during summer vacation and following the holidays, from parents who are worried their child may be struggling with an eating disorder. As a pediatrician who works with children and adolescents with complicated eating disorders, and a parent of two college students, I understand why this cycle occurs year after year. Parents can more easily observe disordered eating behaviors when their children are spending more time at home.
Similarly, our current social distancing measures and shelter-in-place orders have had a disruptive impact on our everyday lives. Many parents with younger children and adolescents are spending significantly more time inside the house together. Young adults are navigating a new normal that finds themselves unexpectedly sharing a living space and spending additional time with their families.
As a healthcare provider, I believe, now more than ever, in the importance of accessing the right level of care at the right time—especially for eating disorders, which are one of the most lethal mental illnesses. Eating disorders thrive in isolation, and the stress of quarantine is exacerbating disordered eating behaviors for people across the country. It is critical for families—and healthcare providers—to work together to proactively identify worsening symptoms and take action when needed.
Collaboration between families and healthcare providers can save lives, but what does it look like in practice amidst the COVID-19 pandemic?
Bridging the COVID-19 isolation gap—together
As part of global efforts to stop the spread of COVID-19, many therapists, primary care doctors, dietitians, and other healthcare providers have transitioned to telehealth sessions with their patients. These virtual platforms offer a number of benefits beyond containment and allow us to remain connected with our patients.
That said, it is important for healthcare providers and families to understand the limitations of these platforms. Telehealth appointments are not equivalent to in-person evaluations, particularly for assessing patients with eating disorders who are also coping with the stress of isolation during the COVID-19 crisis. Therefore, there may be times when an in-person visit is required to obtain lab work, assess vitals, and/or complete a comprehensive multidisciplinary assessment.
When using telehealth, healthcare providers can rely on their ability to discern obvious physical signs of engaging in eating disorder behaviors and ask specific questions about new or worsening symptoms. However, healthcare providers and families alike should note eating disorders thrive in isolation and darkness, and make concerted efforts to notice the warning signs during this period of social distancing.
Elevating the role of family and loved ones during a crisis
During a pandemic or crisis, there is no time to wait and see if worsening eating disorders symptoms improve. It is critical for healthcare providers to take the observations and concerns of family members seriously because many patients are medically unstable and require immediate intervention. Very often, these observations and concerns indicate a need for a higher level of care.
Patients with eating disorders tend to lack insight into the severity of their behaviors. However, observations from family members and communities of support can play a vital role in early diagnosis, assessment, and referral to the appropriate level of care.
Families concerned about worsening symptoms should immediately alert healthcare providers if they notice behaviors such as a preoccupation with food or weight, an obsession with calories or nutrition, constant dieting, rapid unexplained weight loss or weight gain, use of laxatives or diet pills, compulsive exercising, making excuses to get out of eating, avoiding situations that involve food, going to the bathroom right after meals, eating alone or in secret, and hiding food or food wrappers.
It’s also important for healthcare providers to lower their threshold and understand the critical need for referring patients with eating disorders to a higher level of care at the right time. Delays in receiving the appropriate level of care can have lasting medical and physical consequences. Early intervention is critical. Eating disorders can be lethal and complications may be irreversible, particularly for children and adolescents.
Accessing a higher level of care during a pandemic
Understandably, patients and their families may have concerns about seeking treatment outside of the home right now. However, referrals to inpatient or residential eating disorder treatment programs can help patients and families potentially avoid entering a general adult or pediatric hospital. Specialized centers that have transitioned intensive outpatient and partial hospitalization programs to virtual platforms may also be a viable option, depending on the needs of the individual patient. By directing patients to a healthcare system that specializes in treating eating disorders, healthcare providers can limit potential exposure and preserve the resources hospitals need to manage COVID-19.
During these difficult times, it’s important for healthcare providers and families to support individuals struggling with or recovering from eating disorders. Healthcare providers must remember the complications of these illnesses and hold our patients to the medical standards we have worked so hard to establish. Continue to stay connected to your patients. Help them, and their families, overcome the fear and barriers that can delay life-saving treatment. Practice the same self-care behaviors you recommend to patients and their families. When you are worried, listen to your gut.
These same principles apply to family members as well. Communicate your worries with the healthcare providers on your loved one’s care team. Remember, you are not to blame. Eating disorders are not a choice and parents and family members are not to blame and can play an important role in their loved one’s recovery. There is a path to recovery for people living with eating disorders—even in a crisis—but it requires support from a team of specialized healthcare professionals. Reaching out is an act of bravery. You are not alone—and together, we are stronger.
About the Author
Anna Tanner, MD, FAAP, FSAHM, CEDS, is the Vice President of Medical Services for Veritas Collaborative, a national healthcare system for the treatment of eating disorders. She is a Board-Certified Pediatrician and Certified Eating Disorder Specialist who has spent over 20 years of her career working with complicated adolescent patients with a special emphasis on treating patients with eating disorders.