Setting a youth-focused research agenda for eating disorders during the COVID-19 pandemic

Over 80% of eating disorders (EDs) have their onset in youth (Garland et al., 2019). The peak age of onset for anorexia nervosa (AN) and bulimia nervosa is 16, with the mean illness duration of AN being approximately 10 years. The optimal period for early intervention for EDs is the first 3 years of illness i.e. age 16–19, which straddles the age-based transition from child to adult mental health services in many countries. Since about 30% of young people treated in child and adolescent ED services require further treatment in adult ED services, they have an in-built disruption in their care. Overall, less than 5% of adolescents with a mental health disorder experience a satisfactory transition between child and adult mental health services (Singh et al., 2010). Patients with AN typically do not maintain treatment progress over transition (Garland et al., 2019).

The separation between child and adult specialty ED services also undermines the development of a transformative research agenda to meet the needs of young people during the COVID-19 pandemic. The Australian National Eating Disorder Collaboration surveyed 25 ED-specific services and found that there has been a marked increase in presentations of both new and relapsing EDs, with higher acuity and severity of these presentations (https://nedc.com.au/research-and-resources/show/issue-69-the-impact-of-covid-19-on-eating-disorders). In Australia and the United Kingdom, the past year has seen an almost doubling of both urgent and routine referrals for child and adolescent ED services (Solmi et al., 2021; www.abc.net.au/news/2021-08-31/eating-disorders-regional-teens-covid-19-pandemic-/100417812). The increased ED presentations have occurred on the background of substantially higher youth mental health-related presentations to primary care settings, community mental health services, and hospitals (www.theage.com.au/national/it-s-completely-shocking-when-it-s-your-child-what-s-driving-the-youth-mental-health-crisis-20210902-p58oa5.html).