A spike in Kaiser Permanente Northern California eating disorder diagnoses that coincided with the start of the COVID-19 pandemic continues to affect thousands of mostly younger people in the region.
From 2018 to 2024, eating disorder diagnoses among Kaiser Permanente Northern California members soared from 2,488 to 5,527 — a 122% increase. That rise is part of a broader jump in all serious mental health disorders during the same period.
We asked Jackie Shiels, PsyD, a Kaiser Permanente Northern California behavioral health manager with an expertise in eating disorders, what is behind the increase and what are the signs, symptoms, and treatment.
To start, what is an eating disorder and what is the danger?
There are several types of eating disorders. Anorexia Nervosa is where people restrict their food intake. Some people restrict food, get hungry then binge eat, and cycle between the 2. There are also those who restrict food, binge eat, then purge.
Another diagnosis we see is atypical anorexia where people drop weight, but they are still at a normal weight or a little over. The rapid weight loss is dangerous for their health. And even though they are at a normal weight, they retain an intense fear of gaining weight and may have a false belief about how they look.
The danger of eating disorders is that the rapid weight loss can cause heart arrythmias, cardiac arrest, and death. Eating disorders are the second leading cause of death from major psychiatric disorders after opioid use.
A 122% increase is huge. What is going on?
During the COVID-19 pandemic there was a loss of daily structure, increased isolation, reduced access to activities like sports and school routines. That created a perfect storm for disordered eating behaviors to emerge and escalate. We also saw a broader rise in anxiety and depression in children and adolescents since the pandemic and that has continued. Eating disorders often co-occur with these other mental health issues. Also, increased social media exposure with its amplified body ideals and our diet culture are known risk factors.
Who is most at risk and what is the thought process of those with eating disorders?
It’s generally young women, but about one third are men or boys. It doesn’t discriminate by gender or race. The onset is mostly adolescence and teen years. There also is a hereditary component.
People who are high achieving, strong willed, harm avoidant, good kids who don’t party, and rule followers are most at risk. We also see perfectionist qualities and high levels of anxiety. These traits are sometimes transferred to food restriction.
For teen girls and women, our diet culture perpetuates thin as a positive. For boys and men, they may feel like they need to look more muscular than others.
People with anorexia are afraid to eat and gain weight. In addition to societal influences, it is shaped by their relationship to food when growing up. If they were shamed about their body size, or told to eat more or less, that can be internalized and turn into anorexia.
How does Kaiser Permanente treat eating disorders?
The gold standard is family-based treatment with a support team that includes a psychologist, pediatrician, and a registered dietitian. We teach parents to use exposure therapy at home where they serve the most feared foods and pair that with coping skills.
We also teach parents to utilize cognitive behavior therapy and dialectical behavior therapy that allow an emotional reaction and a logical reaction to food at the same time. The mom might say, ‘I know you’re scared to eat this, and this is what your body needs to recover.’ Each meal is 30 minutes max to finish. If they only eat half, we supplement with a nutritional shake.
Treatment success also depends on how honest a patient is being with their medical team about eating. We always say it’s not the person who is manipulative — it’s the disorder.
After family treatment at home, we also have intensive outpatient and inpatient care.
What are the warning signs loved ones should be aware of?
If a kid around the time of puberty has sudden weight loss, is pushing around food on a plate and not eating, or if they suddenly cut out a major food group, that is a warning sign. If you notice this, you should not wait to get help.
