Sobering stat incoming: Eating disorder referrals at Seattle Children's have quadrupled since the start of the pandemic. "I have never seen anything like this in over a decade as an attending physician in adolescent health," says Dr. Yolanda Evans, a clinical director at the hospital.

The uptick began almost immediately in 2020 right after schools closed, the world went remote, and binge-watching Netflix became the new extracurricular activity of choice—and the disaster cascade is only making it worse. Referrals to Children's are still on the rise into 2022.

Equally distressing is the fact that Seattle's already over-taxed health care system has had a tough time keeping up with demand. During the initial swell of referrals back in 2020, patients waited three or four months to get into the eating disorder program at Children's. Sometimes they were turned away.

The clinic has since expanded and revised its program structure to keep up; wait times are now around one to two weeks from referral to initial consult. "We might not be able to accommodate getting them that quickly for longer-term care, but we can at least give you an initial visit," Evans says.

The why and how of it all feels obvious—a once-in-a-century pandemic upends life pretty good—but it's really a combination of factors that came together in a sort of perfect storm, Evans says. One study about Covid's effects on eating disorder risks calls them "pathways for exacerbation."

Children had fewer safeguards (no more teachers or coaches keeping an eye out), were cut off from their friends and activities that provided social support, and had disrupted home lives with frazzled parents stressed to the max. On top of that kids were literally required to have more screen time, which inevitably led to additional social media consumption. And, well, TikTok and Instagram aren't exactly known for their positive body image talk. 

When things are suddenly, dramatically different, it's just human nature to want to control things as much as you can, Evans explains. For adolescents, this can manifest as regulating what or how much food you eat and how you move your body.

Despite the stereotypes, eating disorders are not just a rich white girl's problem. "Eating disorders do not discriminate based on anything," says Evans, who has seen referrals for children as young as seven and from all socioeconomic, cultural, racial, and ethnic backgrounds and gender identities. 

The biggest takeaway she wants to give parents is that it's not their fault. No one could have predicted the pandemic's toll when it first happened, but now mental health conversations are becoming much more mainstream—a good thing for increased awareness.

"Our cultural norms are around a thin ideal, and there's a very defined notion of what a body should look like or be able to do," Evans says. "I just push people to challenge that norm because health does not mean thin, thin does not equal health, and thin does not equal beautiful."

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