Described by its authors as, “substantial and alarming,” a new study by the Centers for Disease Control, released in September 2021, has found marked increases in weight gain among children between 2 and 19 years old in the United States, during the COVID-19 coronavirus global pandemic — exacerbating an existing and significant health challenge.
Comparing the body mass index of more than 430,000 children from January 2018 to February 29, 2020, with data from March 1, 2020 to November 30, 2020, the study found a 22 per cent increase in the percentage of obese children versus 19 per cent prior to the pandemic.
The study authors point to, “school closures, disrupted routines, increased stress, and less opportunity for physical activity and proper nutrition,” as the main contributing factors for the increase.
In Canada, an article in The Globe and Mail reported that, “Admissions for eating disorders at the province’s five pediatric hospitals jumped to as much as 223 per cent above capacity in June as teens have struggled amid the pandemic with isolation, a lack of routine, the loss of extracurricular activities and negative social media influences.”
Among the more common eating disorders:
Characterized by abnormally low body weight. Potentially life-threatening.
Bingeing and purging. Potentially life-threatening.
Repeated and persistent regurgitation of food after eating.
Avoidant/restrictive food intake disorder
A lack of interest in eating that negatively impacts minimum daily nutrition requirements.
Registered dietitian, Alida Iacobellis has experienced a huge increase in clients, especially young adults, as well. Waiting lists to get professional help for eating disorders, has in many cases doubled in many parts of the country. Iacobellis, who is in private practice based in Toronto, is also a nutrition therapist.
Where Parents Talk spoke to Iacobellis about her practice, current trends and strategies to help parents and families navigate a potential eating disorder within their household.
What you do as a nutrition therapist?
The best way I can describe it is that I help people recover from their eating disorders. And I do this by guiding them through the process of separating their self-worth and self-identity from food choices and their physical appearance, so that we can help them build a healthier relationship with food that is as much about nutrition and meeting those needs, as it is about enjoyment and connection.
How do you define eating disorders specifically?
Eating disorders are classified as a mental disorder. So within the DSM, which is the manual that is used to diagnose all sorts of different mental health disorders, that’s where eating disorders fit under that umbrella.
When you look at trends, what are you seeing currently in this space, specifically affecting 15, to 24 year olds, before the pandemic, and now during this pandemic, what strikes you about these trends?
Pre-pandemic, I would say most of the clients I was seeing were in the 18 and older group. And during the pandemic, I’ve seen that number shift down. I’m seeing more and more younger people probably more so in the 15 to 18 group and higher than I’ve ever seen before, which is very much in line with the trends that many hospital-based programs are also experiencing. There’s been so many articles that have been circulated recently, a lot of them shared with me about various programs and hospitals seeing a huge spike in their referrals and admissions. What I’m seeing in private practice is definitely in line with that in terms of the age of the people that are coming to me and the number of them that are coming as well.
We’ve seen it being reported that the pandemic has, in many ways, been the perfect storm for fuelling eating disorders in young people. Why do you believe that this is the case?
Lots of different things have changed as a result of the pandemic. More time staying at home, lots of disruptions to school for these young people. Lack of routine is a huge contributing factor, as well as the social isolation and disconnection from peers that’s happened as a result of the wave of lockdowns. And all of this, I think has really led to not only young adults, but everyone really spending a lot more time online and possibly more time on social media as part of that.
And this increased exposure can have so many different harmful effects and influences, especially when you consider the influx of fear-based messaging around quarantine weight gain that we were seeing everywhere for a while there. So I think all of that together has resulted in a lot of uncertainty, a lot of fear, a lot of distress that can be really hard to tolerate as a young person.
And all of this contributing to maybe newly formed anxiety or depression or worsening of pre-existing anxiety or depression and, and really just increasing the need for relief from all of this stuff, which is so tough to deal with.
You’ve been in practice now for a couple of years. As somebody on the front lines, what troubles you most about what you’re seeing and what the trends are showing right now?
I think it’s just how many young people are starting to be affected by this. I mean, it’s always affected young people to a certain extent, but I think there’s definitely been an increase in that. And, if these things don’t get caught early enough or addressed early enough, there’s a huge likelihood that this could be something that follows someone through the better part of the rest of their life and can have long term negative effects in terms of physical health, like it’s definitely something that is, as we mentioned, a mental health disorder and there’s a lot of those pieces at play, but there’s also things like bone density and growth at this stage when they’re when you’re a teenager, you’re still growing. And there’s issues with energy intake and normal growth and stunting growth that can have a lot of really negative long-term effects.
Can you give us a sense of what the science shows in terms of how negative eating behaviours can be prevented before they become a disorder?
There is a lot of pretty solid research surrounding how protective the family meal can be when it comes to preventing negative eating behaviours and kind of catching those things before they do develop into something like a full-fledged eating disorder. Research has found that adolescents who reported more frequent family meals, higher priority for family meals in the home a positive atmosphere at family meals and just more structure overall, with the family meal environment, those adolescents were the ones who were less likely to engage in disordered eating. So we’re actually seeing when we look at the numbers, about 18% of girls from this study reported, who reported one to two family meals a week engaged in extreme weight control behaviours. Now this number was cut in half, as soon as we saw the number of weekly family meals increased to just three to four.
What would you say are some of the more common signs and symptoms of an eating disorder. And you know, in many families, your parents might not be used to seeing this. And this is all coming about, you know, out of the blue in many cases.
There’s a lot of things to be on the lookout for. And part of what can be hard about detecting this stuff is some of the signs and symptoms could be indicative of an eating disorder. And other times they’re not. So it’s a bit kind of hit and miss. But some of the things that you want to look out for are weight change, for example. And that could be weight change in either direction, either loss or gain. Another thing might be a sudden change in diet or dietary preferences. So an example of that would be suddenly switching to like a vegetarian or vegan type of eating, especially when no one else in the household is following that kind of pattern that may be a sign and eating and secret or finding food wrappers hidden in their rooms around the house, complaining of always being cold, that can be a sign of inadequate energy intake and the slowing down of metabolism. So even if they’re not complaining of being cold, maybe just noticing that they’re wearing a lot of layers of clothing all the time. Missing periods for girls, that is something that can also be assigned and that you’d want to follow up on. Complaints about digestive discomfort, so bloating, stomach pain, constipation, all of that can be a sign as well as a lot of body checking behaviours. So are they weighing themselves frequently daily, more than more than once daily? Are they checking the reflection a lot. And last but not least, I would say things like disappearing off to the bathroom after meals and just increased rigidity, lack of spontaneity around food, including avoiding social situations, maybe as a result of worrying that there wouldn’t be anything there for them to eat that would feel safe.
So what should a parent or caregiver do if they encounter any of these symptoms? And you’ve listed so many of them? And what point should they seek help?
I would say as soon as you’re noticing a couple or a few of the symptoms or signs that we just discussed, I would approach your child about it sooner rather than later. And do your best to just create a judgment free space for sharing and conversation, really trying to focus on listening and providing validation. And I know it can be so hard but trying to avoid the urge to go into fix it mode at first, really just appreciating that you can validate their experience without necessarily condoning if there is something troublesome going on. And I would also really caution against simplifying the issue eating disorders like all mental illnesses aren’t a choice and suggesting that they are can be really invalidating for your teen and make them possibly less willing to accept help down the road. So if you’re able to have that conversation and kind of just address it head on that’s that’s always best. But regardless, I would definitely get your child into see their general practitioner their doctor family doctor for a checkup to assess if there has been a change in weight, and the severity of that change, as well as to address medical stability. So it’s not uncommon to see abnormalities and blood work and heart rate and people of all different sizes. with eating disorders. your GP is also going to be the person who is going to be able to put a referral into eating disorder treatment programs, and like we already mentioned related to the wait times have gotten so much longer over the last year. And so it’s better to get on those lists sooner rather than later and have your name come up and not need a spot versus letting things progress and get more serious and needing a spot but not having one available.
So if and when they get referred to someone like yourself, you go about trying to help them rewire their perception of food as relates to health and diet and body image and self- worth. Can you take us through some of the broad strokes of how you go about doing that?
So that process of rewiring often starts with correcting a lot of misinformation about food and nutrition, debunking popular food trends and fat diets that have been picked up in the media and maybe taken as gospel and a lot of challenging black and white, all or nothing thought patterns that can be really unhelpful. I would say the process also really involves helping people understand the triggers for their eating disorder behaviours and the resulting chain of events that lead to those unhealthy eating behaviours. So we can clearly see the short and long term consequences as well as identify points in time where we can intervene and change the outcome for next time.
Alida, can you tell us about the more method that you use with your clients?
Over the past few years of working almost exclusively with eating disorders, I’ve definitely noticed certain patterns emerge within my clients and common areas, they’re needing support, and that are key for recovery. And I’ve turned this into a teaching framework that I call the MORE method. It’s all about learning to give yourself more nourishment, more confidence, more energy, more freedom, all of the things you have to gain through recovery from an eating disorder. And so it’s a blend of evidence-based treatment modalities for eating disorder recovery consisting of four main pillars. So the four pillars being moderation, optimization, restoration and elevation. And so the moderation part is about moderating your diet to find a realistic and enjoyable way of eating. Then we move down to optimizing your mindset to find peace and contentment with food, restoring connection with your body to optimize self-care. And then finally, attacking the body image piece of things where we elevate your self-confidence so that you can be at peace with your body.
Study: Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020 (Centers for Disease Control)