Surging demand for eating disorder support during pandemic

‘We have seen a huge increase in people reaching out for support, information and referrals regarding eating disorders and body image issues to our helpline since the beginning of COVID.’
 
That is psychologist Juliette Thomson, manager of the Butterfly Foundation’s National Helpline.
 
She told newsGP demand to the foundation’s helpline was more than 25% higher from January to June this year, compared to the previous six-month period.
 
Furthermore, demand for support via the Butterfly Foundation’s online web chat service has increased by 116% in the last year.
 
Dr Elizabeth Crouch, a GP with a special interest in eating disorders, is also seeing a surge in the number of patients with eating disorders seeking help from their GP during the pandemic.
 
‘And there have been some new cases too,’ she told newsGP.
 
The experts believe there are multitudes of reasons that may be driving this situation.
 
‘COVID has understandably increased people’s levels of stress and anxiety for lots of different reasons, and it’s also changed the way that we go about our daily lives and our habits,’ Ms Thomson said.
 
She says changes in routine can increase ‘triggers and exposures’ in patients with eating disorders that may worsen their illness.
 
Dr Crouch echoes that sentiment. Maintaining a routine before the pandemic helped patients ‘keep things under control a bit’.
 
‘So there are a lot of people who have established eating disorders that are deteriorating because they’ve lost their routine,’ she said.
 
Dr Crouch is not surprised, with a significant increase in people drinking excessively, smoking and ‘doing anything they can to feel better’.
 
‘Eating disorder behaviour will escalate in that regard as well,’ she said.
 
Research published on 24 August in Journal of Eating Disorders found similar effects in the UK. Researchers collected data from 129 individuals during the early stages of the lockdown who were currently experiencing, or in recovery from, an eating disorder.
 
It found the pandemic was having a ‘profound’ negative impact on individuals with eating disorders, with 87% of respondents saying their symptoms had worsened, and over 30% saying they were much worse.
 
That is of concern in itself, but Ms Thomson says these issues can lead to an increased mortality, as the death rate in people with eating disorders is higher than in the general population.
 
‘Suicide drives a lot of that percentage, and the other part of that percentage is the medical complications that you see from eating disorders,’ she said.
 
In fact, according to the Butterfly Foundation, suicide is 31 times more likely for people with eating disorders.
 
Ms Thomson says such a high suicide rate speaks to the complicated nature of eating disorders.
 
‘This illness is incredibly complex and it can be very protracted for people,’ she said.
 
‘It’s not easy to get help at times. There are not the services and supports that should be there perhaps, through lack of funding and awareness.
 
‘So it can be really challenging, both from the psychological illness perspective to recover from an eating disorder and from a system perspective.’


Juliette Thomson says demand to the Butterfly Foundation’s helpline was more than 25% higher from January to June this year.

Ms Thomson would like to see more education for clinicians to help improve that system perspective.
 
‘I understand that GPs have enormous pressures on them to understand a lot about a lot of things, and there’s only so many hours in the day to do further training,’ she said.
 
‘[However], eating disorders are one of those areas that really benefits your patients from investing in any extra education that you can about the area because it’s ever changing.
 
‘If you’re equipped with the best information and support, you’re really going to benefit that person who’s seeking help.’
 
Ms Thomson says the National Eating Disorders Collaboration (NEDC) is a useful resource for clinicians, and the Butterfly Foundation is helpful for patients and their loved ones.
 
Dr Crouch believes it is also important for clinicians to be aware of the increased spike in disordered eating at this time.
 
She says GPs should check in with patients and ask about eating behaviours and whether they have changed of late, saying such consultations are best conducted either in person or via video call.
 
‘When we see people face-to-face we can tell if they’ve lost weight or if they look unwell, and one of the problems about using telephone calls for telehealth is you don’t get to physically see the patient,’ Dr Crouch said.
 
‘And so with people who are at risk, I’m definitely doing video calls just so I can actually keep an eye on what they physically look like and just assessing their mental health and everything.’
 
While it is important to check in on such patients, Dr Crouch says it is also imperative to understand these patients require increased support. 
 
‘People will need nuts and bolts in support and problem solving to be able to monitor [their eating behaviours],’ she said.
 
Part of that problem solving may involve brainstorming ways to ‘get around’ some of the issues posed during the pandemic.
 
‘Eating with other people on Zoom has been one thing that’s been very helpful,’ Dr Crouch said.
 
‘One of the problems with eating disorders is they flourish in secrecy and when people don’t have anybody to be accountable to, it’s very easy for the eating disorder to overtake things.
 
‘Just like at the end of this [pandemic] we’re going to see a lot of people with drinking problems – and we already are seeing that – we’re going to be seeing a lot of people with hidden eating disorders as well.’
 
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