Like many mental health conditions, eating disorders likely have increased during the pandemic. "We are seeing numerous cases now that report onset in the spring, during the lockdown," says Jessica Van Huysse, Ph.D., assistant professor of psychiatry. "Our wait list is currently twice as long as usual."
The Michigan Medicine Comprehensive Eating Disorders Program treats patients ages 8-22. Their partial hospitalization treatment plan brings patients to C.S. Mott Children's Hospital every day for six hours. At least it did, until the pandemic necessitated a major decrease of in-person appointments.
In the spring, the eating disorders program went virtual.
Van Huysse has researched the effects of this dramatic change in treatment delivery on the patients. The good news is that patients seem to be doing just as well with virtual care as with in-person care. Most of the patients in the program have restricting eating disorders, like anorexia nervosa, says Van Huysse. Because these patients have generally lost a significant amount of weight prior to treatment, the program uses weight restoration as a measure of success. "Our patients in virtual care restored just as much weight as a cohort of patients in regular care," says Van Huysse. "Cases seem to be up; however, we are finding that the treatment is just as effective, once initiated."
Van Huysse says, "It actually makes sense that they did OK in virtual care." The treatment program depends largely on teaching parents how to manage the eating disorder so that they're in charge of choosing and plating their child's food. With many school buildings closed and many parents working from home, Van Huysse suspects providing daily parental supervision and support was more manageable, although she acknowledges that this small study was not designed to gather data that might prove that hunch.
In clinic, Van Huysse has noticed some challenges that the pandemic has presented for her patients. "A common symptom [of eating disorders] might be discomfort eating foods from a restaurant," she says. Usually, the program would use exposure therapy to help a patient get more comfortable with eating out, but with many restaurants closed, that hasn't been an option.
In February, Mazey Perry, then a senior in high school, was diagnosed with bulimia and went through intensive eating disorder treatment at Mott. She had struggled with eating at the beginning of the school year. "A lot of my friends were really struggling with eating, too," she says. She likens it to a support group, "but not a healthy one." The teens talked frequently about how unhappy they were with their looks and how little they had eaten each day. "I was definitely lucky enough to feel comfortable telling my mom what was going on."
Once Perry began treatment, she had doctor appointments "pretty much every day of the week," she says. She continued her treatment after stay-at-home orders went into effect, but she switched from in-person to phone appointments.
Perry's experience supports both the findings from Van Huysse's study and the problems Van Huysse noticed with her patients. Although Perry says phone appointments were harder than in-person appointments, she was able to continue working toward her goals.
"One of the main things I struggled with was eating in front of my friends," says Perry. Even staying at home, she mostly ate by herself, until her treatment team emphasized the importance of Perry's parents being with her while she ate. "It was definitely a change in my plan for recovery, not being able to have that exposure to eating in front of my friends." Despite the setback, Perry found a creative workaround: She would get takeout from restaurants that had been difficult for her in the past so that she could practice healthy eating techniques.
"I think I definitely was able to get better." She now just has an occasional check-up to make sure she's maintaining her weight. Since graduating from high school, Perry has begun her first year at Kalamazoo College, attending classes remotely from her apartment in Ann Arbor. "I've never had a college experience before, so I don't necessarily know what I'm missing," she says.