Column: Eating disorders have 'exploded' among young people during the pandemic. What one expert says parents should be doing.

Since March 2020, when lockdown orders went into effect all over the United States, the National Eating Disorders Association helpline has experienced a dramatic uptick in calls -- a 78% year-over-year increase during some months -- with teenagers accounting for up to 35% of the calls.

"It's really, really worrisome," psychologist Lisa Damour, author of "Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood," told me Thursday.

Damour wrote about the increase in eating disorders for her New York Times column on adolescence this week.

"As a psychologist who cares for adolescents I am well aware of the prevalence of eating disorders among teenagers," Damour wrote. "Even still, I am stunned by how much worse the situation has become in the pandemic."

She interviewed Erin Accurso, the clinical director of the eating disorders program at the University of California, San Francisco, who told Damour their inpatient unit has "exploded" in the past year, taking in more than twice as many adolescent patients as it did before the pandemic.

"Providers aren't taking new clients," Accurso told Damour, "or have waitlists up to six months."

Epidemiologist S. Bryn Austin, a professor at the T.H. Chan School of Public Health and research scientist in the Division of Adolescent and Young Adult Medicine at Boston Children's Hospital, told Damour the demand for eating disorder treatment "is way outstretching the capacity to address it" and he's hearing the same thing from his colleagues around the country.

I was alarmed by Damour's findings and called her to learn more, specifically what parents and other trusted grown-ups might do to address the problem.

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Columns are opinion content that reflect the views of the writers.

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Eating disorders, she said, are the deadliest psychiatric disorder, with an estimated mortality rate of about 10% for people with anorexia nervosa. They're often misunderstood as an affliction limited to white, affluent girls, but recent data shows eating disorders cut across genders, race, ethnicity and socioeconomic categories.

An October survey conducted for Well Beings and PBS NewsHour Student Reporting Labs asked teens how the pandemic was affecting their mental health and revealed an alarming truth, Damour said.

When asked to select the factors that have a negative impact on their "day to day mental well being," more teenagers selected "weight, fitness level, general health, or body image" than any other category, including social media, racial violence and associated trauma or financial struggles. Even broken down by gender, it was the No. 1 concern for girls and the No. 2 concern for boys, after social media.

The loss of predictable routines, school day rhythms, cherished after-school activities and face-to-face friendships likely fueled the eating disorder increase, with kids suffering from a mixture of boredom and isolation, combined with a desire to exert control over some area of their lives.

"I'm even observing in myself how disrupted my own relationship to food and activity and access to food has become during the loss of one's normal traffic patterns," Damour said. "It's really challenging to have one's entire routines and systems interrupted, and we know teenagers feel things more intensely than adults do."

They're also, thanks to the pandemic, spending even more of a highly suggestible developmental period in front of screens -- many of which are filled with images of unrealistic bodies and marketing that makes such physiques seem both aspirational and attainable.

"If a kid goes looking for content about bodies or fitness, TikTok picks up that algorithm and starts to feed them all of these advertisements for weight loss and diet supplements," Damour said. "Kids fall down the rabbit hole, or get pulled down the rabbit hole. They're literally being targeted."

She encourages parents to talk to their kids about TikTok, in particular.

"Are they on the goofy, dance side of TikTok or the hilarious meme side of TikTok or the weight and fitness side?" she said. "It has material impact."

She also cautions parents to be mindful of the way they talk about food and body image, particularly during a time of upheaval.

"Food is a pleasure," Damour said. "Food is how we take care of ourselves. Rather than talking about food as being good or bad or healthy or unhealthy, the goal really is to enjoy a balance of foods. Physical activity too -- it's really important, but it should also be pleasurable. Really modeling, as best we can, a positive relationship with food and a positive relationship with activity levels and a positive relationship with our own body and weight."

Parents, she said, are sometimes unaware of the lengths that diet culture has gone to in order to hook young people.

"It pervades so much of what kids are exposed to," she said. "There's so much of wellness influencers activity that is so seductive. Adults may glance at it or be vaguely aware of it, but we should not underestimate how that can saturate a kid's world."

If your family needs help, Damour recommends a few resources: The Academy for Eating Disorders; the Eating Disorders Center for Treatment and Research at University of California, San Diego; and the Eating Disorders Program at Boston Children's Hospital. She also points people to Maudsley Parents, a family-based resource created by parents who helped their own children recover from eating disorders.

"There's a powerful correlation between how long kids have been struggling and how strong their prognosis is," Damour said.

"I'm usually on the side of reassuring adults that they don't need to be so worried, that kids are usually fine," she said. "This is not usually how I think about and talk about teenagers."

That's one of the things that's always drawn me to Damour's work; she's measured and hopeful and puts great faith in kids, even as she nudges grown-ups to be mindful and intentional on their behalf.

So I take her alarm seriously on this topic. The pandemic has impacted kids in so many ways -- ways we likely aren't even aware of yet. I'm grateful for experts guiding our attention to the places we may be neglecting to look.

Join the Heidi Stevens Balancing Act Facebook group, where she continues the conversation around her columns and hosts occasional live chats.

hstevens@chicagotribune.com

Twitter @heidistevens13

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