The COVID-19 pandemic has created what a Kaiser Permanente marriage and family therapist called “the perfect storm” of risk factors that can lead to an increase in eating disorder cases. Isolation, change in routine, and heightened anxiety can contribute to the formation of an eating disorder or an increase in the severity of existing ones, such as anorexia, bulimia, and binge eating disorder.

“Eating disorders thrive in secrecy,” said Jennifer Lombardi, MFT, a manager of behavioral health for the Kaiser Permanente Sacramento Service Area and a certified eating disorder specialist. “During the pandemic when people are stressed, fearful, and disconnected from others, it’s difficult for them to use coping strategies outside of their illness.”

Lombardi said Kaiser Permanente’s North Valley Service Area has had a 30% increase in hospitalizations associated with eating disorders in 2020 compared with 2019.

“When people are stressed, fearful, and disconnected from others, it’s difficult for them to use coping strategies outside of their illness.” Jennifer Lombardi, marriage and family therapist.

Although aggregated data for Kaiser Permanente Northern California is not yet available, Stuart Buttlaire, PhD, regional director of Inpatient Psychiatry for Kaiser Permanente Northern California, said that “eating disorder cases have been high in both our inpatient and outpatient programs, as well as in our residential programs, particularly among youth, this past year.”

Lombardi explained that nearly 70% of people who have an eating disorder also suffer from anxiety or depression. For youth, the transition to online learning, a lack of socialization, and uncertainty during the pandemic have exacerbated anxieties.

This can lead to a hyper fixation on appearance, weight, severe dieting, or overeating to manage stressors and fears, Lombardi said.

Additionally, social isolation allows symptoms of an eating disorder to go unchecked by others who may usually support recovery.

Kaiser Permanente meets the moment

Like most Kaiser Permanente departments, eating disorder programs for adults and teens in Northern California have transitioned a significant portion of care to telehealth.

“As we have seen more eating disorder patients, we have added more outpatient resources to help enrich our services and make it easier for members to access care,” Dr. Buttlaire said.

A virtual mealtime is offered, in which a dietician or mental health care provider virtually attends dinner with a family of an eating disorder patient 3 times a week for 2 hours to observe, give guidance, and have conversations around food. Individual family therapy sessions, dietician consultations, and group therapy are also offered virtually.

A digital tool, Recovery Record, has been valuable to members during the pandemic. It allows patients to self-monitor eating, track coping behaviors, and connect with their clinician directly through the app. It also provides patient data and tools for timely, targeted intervention.

Dr. Buttlaire said that a “think tank” has been newly implemented, too. Mental health clinicians and physicians who specialize in eating disorders across Northern California meet weekly to consult on unique eating disorder cases, such as a patient who also suffers from drug abuse, to share best practices, resources, and solutions.

An essential component of the efficacy of a patient’s care is the collaboration among mental health care providers, nutritionists, and physicians, and is something Kaiser Permanente Northern California is great at, said Lombardi.

“We have streamlined our processes across multi-disciplinary teams to do everything we can to provide the best support to patients and their families during this challenging time.”

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