The NHS has experienced a rise in eating disorder cases since the pandemic

Trigger warning: eating disorders

“I was drinking two meal replacement shakes so my calorie intake was around the 500 mark,” says Ella Thomas, a patient who turned to the Child and Adolescent Mental Health Services (CAMHS) in 2020 when she was 17-years-old, after developing disordered eating behaviours in the first covid-19 lockdown.

For most of us, the Covid-19 pandemic consisted of fear, confusion, and restrictions. However, for some the isolation and heightened anxiety also created possible triggers for disordered eating.

A report published last year by NHS England found that more young people than ever are receiving treatment for eating disorders.

Eating disorders include bulimia, binge eating disorder, avoidant/restrictive food intake disorder (ARFID), other specified feeding or eating disorder (OSFED), and anorexia. And there’s no one-size-fits-all policy, every eating disorder is different and requires its own assessment, treatment and recovery journey.

This is a journey that often starts with the NHS, and for young people in particular, one of the CAMHS. These are local NHS services around the UK made up of a team of nurses, therapists, and child and adolescent psychiatrists who provide specialist support for emotional, behavioural or mental health difficulties, including disordered eating.

Within the CAMHS, patients are referred by a GP and assessed before a treatment plan is set out. In 2020, there were an extra 500 referrals made to the CAMHS – 44 per cent more than 2019 and pre-pandemic numbers.

When the lockdowns were in place, Thomas’ eating patterns and behaviours changed dramatically.

“I probably lost around three stone before I admitted that it was a real issue,” says Thomas, who had never used the CAMHS or experienced disordered eating before the pandemic.

Besides exercise, Thomas also blames social media for exacerbating her mental health issues. Social media usage increased significantly during the pandemic as people were forced to turn towards different ways of communicating and engaging with each other, relying on Zoom, TikTok, WhatsApp, Facebook and Instagram to stay connected.

During the height of lockdown, UK adults were spending “more than a quarter of their waking day online”, finding temporary relief from the anxiety and abnormality of lockdown life.

Video-sharing and content creation passed the time for many but Thomas describes how the overuse of social media to punctuate the anxiety she felt about the pandemic actually made her mental health decline.

“My for you page was filled with either the latest trends like the viral vodka pasta or videos on weight loss or self-improvement,” she says.

She describes how being isolated from normality caused her to turn towards social media for entertainment. At-home workout videos from influencers like Courtney Black and Joe Wicks became hugely popular with the hashtag, #homeworkout, hitting 5.2 million uses, and body transformation videos on platforms like TikTok showing what others were doing in lockdown.

Watching these videos exacerbated the beginnings of Thomas’ eating disorder: “It made me feel like, unless I was making the most of the lockdown and using it to lose weight or better myself, then I was failing.”

Losing weight gave Thomas a sense of achievement. “You train your brain to enjoy the feeling of hunger. Before an eating disorder, you hate the feeling of hunger because it literally hurts, but when you’re in one, the feeling of hunger gets associated with weight loss and weight loss gives you dopamine.

“It’s a form of self harm: teaching yourself to enjoy a feeling that your body previously recognised as pain,” says Thomas.

Convincing the brain to enjoy harmful practices was also an issue for Lauren Sanderson, now 20-years-old, whose previous struggles with body dysmorphia became exacerbated in the pandemic due to the influx of social media videos on body transformations and weight loss. Turning towards behaviours like skipping meals meant that Sanderson began experiencing dizziness and fatigue on a day-to-day basis. As a result, her disorder warranted medical intervention.

“I was given an initial assessment but due to massive oversubscription all they could offer me was a course of online Cognitive Behavioural Therapy,” says Sanderson. “I’d say this was offered to me around four months after I was referred, and I had to chase them up numerous times.”

While recovery is possible without specialist treatment, for many young people, intervention, support, and recovery plans are needed to change their harmful and restrictive behavioural patterns.

NHS data from Q1 of 2019/2020 shows that 80 per cent of urgent eating disorder cases referred to CAMHS began treatment within one week – for routine cases, 84 per cent were within four weeks of the referral date.

However, for the same period two years later, those percentages have dropped to 63 and 66 per cent respectively. This means that 863 young people with eating disorders that needed urgent treatment were not seen in the target one week wait time and 3.5 per cent had to wait over 12 weeks to start their treatment.

“Many more children and young people have started NHS eating disorder treatment in comparison to before the pandemic, which is a testament to the incredible work of NHS staff,” says Tom Quinn, the Director of External Affairs for the eating disorder charity, Beat. “But demand for treatment has been increasing and NHS services are struggling to keep up.”

“It’s so concerning that children and young people in England are not getting the support they need quickly enough,” says Quinn. “Delays to treatment can lead to people becoming more severely unwell and in need of hospital treatment.”

In-patient treatment, or ‘being sectioned’, happens when doctors believe a patients behaviour is dangerous to themselves or people around them; the doctors will admit a patient for urgent care even if you disagree with the decision. While the four month delay that Sanderson experienced did not result in her needing in-patient treatment, she believes that her disorder was considered less severe than other patients and therefore, not a priority, made her condition worse.

“The feeling that I was not ‘ill enough’ to be taken more seriously or be perceived as deserving of serious intervention had a negative impact on my self image and general well-being,” says Sanderson.

As one of the extra 500 referrals made to the CAMHS in 2020 on top of normal figures, both Thomas’ and Sanderson’s cases experienced delayed referral times while more severe cases that required in-patient care were prioritised.

Eventually, Sanderson’s parents paid for her to see a private therapist, which Lauren explains, would not have been an option without her parents' financial support.

Turning towards private treatment is a route that many young people and families can’t afford so it is crucial for CAMHS to decrease their waiting times and be given more support to cope with the influx of post-pandemic patents.

Tom Quinn says that the shortfall in staff can be addressed by Government funding as well as more training provided to non-clinical staff who can provide treatment for less severe cases.

“We urge the Government to create a fully-funded plan to help ensure every person with an eating disorder can access the support they need. As part of this, NHS staff must be supported with a long-term strategy to address gaps in the workforce,” he explains.

While the Government’s NHS Long Term Plan allocated more funding to children’s mental health services in 2019, Quinn says that an accelerated commitment to supporting CAMHS is needed to make an impact on sufferers.

“It’s also crucial that the Government holds local NHS leaders to account to ensure that funding pledged for eating disorders is reaching the frontline.”