Eating disorders and COVID-19: The perfect storm

The COVID-19 pandemic has created “the perfect storm” of risk factors for eating disorders, according to Jennifer Lombardi, a certified eating disorder specialist and manager of behavioral health for the Kaiser Permanente Sacramento Medical Center.

“Eating disorders thrive in secrecy,” Lombardi said. “During the pandemic, when people are stressed, fearful, and disconnected from others, it’s difficult for them to use healthy coping strategies.”

That’s led to an increase in eating disorders such as anorexia, bulimia, and binge eating disorder. One study showed that hospitalizations for eating disorders doubled in 2020. The full impact of the pandemic on unhealthy eating behaviors may not be known for some time.

Children and teens have been hit especially hard. Nicole Hinkley-Hynes, MD, a pediatrician at Kaiser Permanente in the Northwest, has seen a 25% to 30% increase in children referred to the eating disorder program. And in Southern California, Elizabeth Hamilton, licensed clinical social worker and a practice leader for regional behavioral health, has noticed an upswing in younger children needing care.

Meeting the moment with telehealth and digital tools

To meet the increased needs of patients with eating disorders, Kaiser Permanente transitioned a significant portion of care to telehealth, with many individual and family therapy sessions, dietitian consultations, and group therapy meetings conducted by video visit.

“Our patients need to be able to access care safely,” said Hamilton. “While not everything can be done virtually, we’ve discovered that our teams can work very effectively in a hybrid model, where the therapy that needs to happen in person is supplemented by virtual touchpoints.”

One touchpoint is “virtual mealtimes,” which allow a dietitian or mental health clinician to attend family dinners with a young person several times a week to observe and offer guidance.

A digital tool called Recovery Record allows patients to self-monitor their eating, track coping behaviors, and connect with their clinicians. Patients sign in to the app and enter a list of foods they ate that day, including pictures. A journal feature allows patients to document how they’re feeling, and therapists can engage by “liking” a post, encouraging a particular coping skill, or sending a supportive message.

Enhancing care through teamwork

Collaboration across care teams has long been a strength of Kaiser Permanente’s integrated model for providing health care. The pandemic has required clinicians to find creative ways to continue working together to treat patients even when they can’t be in the same physical location.

Care teams at Kaiser Permanente in Northern California implemented a weekly “think tank,” where mental health clinicians and physicians share best practices, resources, and solutions.

Southern California care teams also doubled down on their efforts to bring together key players involved in the care of patients with eating disorders, including registered dietitians, case managers, psychiatrists, addiction medicine specialists, endocrinologists, pediatricians, and adult primary care physicians.

“One of Kaiser Permanente’s greatest strengths is the way our treatment teams work together,” said Hamilton. “The pandemic has strengthened what we had in place before, so that our communication and collaboration is better than ever. It’s a great model for care for people with eating disorders.”

Learn more about Kaiser Permanente’s mental health care, including support for eating disorders.