In July of 2020, a new study published by the American Academy of Pediatrics (AAP) confirmed what many already knew: Covid-19 has contributed to a mental and behavioral health crisis. With one in four parents reporting worsening mental health, and one in seven reporting an increase in behavioral challenges for their children, this is not an isolated problem.
Families everywhere are struggling right now.
But while the study focused on families with young children, in particular, additional research has pointed to the vulnerabilities adolescents are facing right now. To include an increase in post-traumatic stress, depressive and anxiety disorders.
All of which can also be associated with an increase in eating disorder behaviors.
The Mental Health Impact on Adolescents
Hina J. Talib, MD, is a board-certified adolescent medicine specialist at the Children’s Hospital at Montefiore, a top eating disorder center in New York City. Known for her popular Instagram page, TeenHealthDoc, Talib says that one of the things she has noticed since the pandemic began is teenagers experiencing a flare in previously identified mental health conditions as well as the presentation of new mental health conditions.
“In teen health, we are calling this the second-wave of the Covid-19 crisis, and it has already arrived,” Talib recently told Forbes.
She said there are a variety of circumstances contributing to this, to include the loneliness and isolation teenagers are reporting as a result of physical distancing and stay-at-home measures.
“During this time of back-to-school, anticipatory anxiety is running high for students, teachers and families. Teens, especially pre-teens, absorb this stress.”
The Risks Teenagers Face
While we don’t yet have any data connecting an increase in eating disorders to Covid-19, experts believe there is reason to be concerned.
“Eating disorders can be triggered by an attempt to gain control,” Anna M. Lutz, MPH, RD, LDN, explained. Lutz is a certified eating disorder registered dietician who co-owns a private practice in Raleigh, NC.
“Right now, all of us, but especially children, have very little control in what we can do,” Lutz said. “Sports seasons, academics as we know them, spring break trips, summer camps and important time with friends have all been canceled—all things that are very important in the lives of teens.”
She said that focusing on weight, exercise and what one allows themselves to eat can be a way of gaining control, particularly in situations where an individual may otherwise feel out of control.
As is the case for so many in the face of our current pandemic.
“Also, there has been a lot of media focus on the potential for weight gain during the Covid–19 pandemic,” Lutz explained. “This message has been directed towards children and can trigger a teen being over-controlled or restrictive with their food.”
While unhealthy, Lutz said that eating disorder behaviors can be coping tools in times of trauma and stress.
“Many people with eating disorders have a history of trauma and the current pandemic situation can trigger this trauma. Isolation, food insecurity (real or perceived), increased time with a family member who may be abusive, grief for what is being lost/missed, and fear about getting sick or your family not having enough money can all trigger an increase in eating disorder symptoms.”
Monitoring Your Teen
All families should be aware of the increased potential for mental health struggles right now, keeping an eye on their young children and teens especially. But for parents concerned about potential eating disorder behavior, Lutz said the following can be signs to look out for:
· Eating in secret
· Suddenly eating differently from the rest of the family
· Becoming extremely focused on exercise
· Refusing to take time off exercising, even when injured or sick
· Leaving large amounts of food uneaten
· Losing weight.
“These are all reasons to be concerned,” Lutz explained. “Children are supposed to be gaining weight and weight loss in children and teens needs to be further assessed.”
Talib said some things your child may be communicating can be indications of a problem as well.
You might hear a teen (or, as Talib thinks of it, the eating disorder itself) say things like:
· “I am so fat.”
· “If I gain weight I will be disgusting.”
· ”My stomach is huge.”
· “I will do an extra 200 crunches tonight.”
· “I can say no to unhealthy food even though you can’t.”
All of these should be red flags to parents right now, and anytime really.
Addressing Concerning Behaviors
If you are worried your teenager may be exhibiting eating disorder behaviors, Lutz suggested talking to them first.
“Outside of a meal time or a time when food is around, explain to them what you have been noticing and why you are concerned.”
It’s important to give adolescents a chance to reflect on their behaviors and open up about what they may be going through in a non-judgmental way. Simply let your child know you are concerned and give them a chance to respond.
Keep in mind, plenty of teenagers will try to hide their eating disorder, even when confronted. So don’t necessarily take “nothing’s wrong” as an answer. Pay attention to your child’s body language, reaction, and your own gut feeling and go from there.
“Eating disorders are great at hiding,” Talib said. “If you suspect an eating disorder or disordered eating from anxiety or depression, it is possible it has already been present for some time and it is helpful to find an experienced care team as soon as possible.”
Now is not the time to wait, she explained. “I see so many families who have lost time due to delays in access.”
But she also wants parents to ensure they are getting their children the right kind of help. Which is why she believes they should be empowered to ask providers the following questions:
· “How many eating disorder cases do you manage here at this practice?”
· “How confident are you in your diagnosis?”
· “Do you have a network of therapists, psychiatrists and dieticians that you refer to and how is your family feedback on these referrals?”
· “If our teen needs more care than we can provide at home, what are you usual next steps in this city?”
“Do not shy away from asking where the nearest specialty care center is and for your doctor to help get you there,” Talib said. “It is not uncommon to have to travel a bit to see an eating disorder team with expertise in adolescents. However the Covid–19 pandemic opening the gates of tele-health has helped this.”
Talib said that parents who are concerned should start by having a conversation with their child’s pediatrician. “Even better, find an adolescent medicine specialist or physician team that is experienced with adolescent eating disorders.”
She suggested looking to AdolescentHealth.org for the Society of Adolescent Health and Medicine’s list or The National Eating Disorder Association (NEDA) helpline (800.931.2237) if you’re having a difficult time finding a provider.
While Talib said it is always best to start with an evaluation by a professional, particularly because each situation is unique and may require tailored advice and treatment, the following resources can be helpful for families trying to better understand what they are dealing with:
If you’re worried about your child, it’s important to know there is help available. But ignoring eating disorder behavior does not make it go away. Now is the time to act. So if you’re concerned, pick up the phone and call your child’s pediatrician today.
It’s the first step to ensuring your teen will be able to have a healthy tomorrow.
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