Intended for healthcare professionals

Letters Eating disorders during the covid-19 pandemic

What is driving the pandemic related surge in disordered eating?

BMJ 2021; 374 doi: (Published 06 September 2021) Cite this as: BMJ 2021;374:n2175
  1. Sara J Hansen, trainee intern,
  2. David B Menkes, associate professor of psychiatry
  1. Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
  1. shan893{at}

As Feinmann points out, the effect of the covid-19 pandemic on disordered eating is striking and seems to be international.1 Reports from North America and Europe accord with our observations in New Zealand of distinct increases in both adult and paediatric patients requiring treatment.2 Identifying relevant mechanisms is crucial to guide the effective management of these disabling and potentially lethal disorders.

Feinmann’s conference report includes the suggestion that “enforced social avoidance” during lockdowns might occur at a crucial developmental stage in children and thereby cause increased disordered eating. Our experience, by contrast, is that the surge in clinical demand for adults rivals that of children, consistent with the idea that lockdown environments exert a powerful influence regardless of age.2 This fits with evidence that social disruption and altered home environments are common triggering themes.3 We propose that it is the uncontrollable disruption of social relationships, rather than isolation itself, that drives the problem. In our experience, and as described in India,1 increased (and unwelcome) social contact during lockdown also seems to have triggered serious exacerbations of disordered eating.

We saw higher numbers of “new” patient presentations in both adults and children after lockdown, indicating that an increased incidence of eating disorders might be occurring alongside exacerbations of existing disorders.245 Children are more likely to be early in their disease trajectory, but many adults we saw during this time were experiencing a first inpatient admission, consistent with the idea that the problem is being driven by social disruption rather than developmental stage.

Finally, we note that anorexia nervosa is the predominant diagnosis in our inpatients and outpatients seen during and after lockdown.2 This extends the article’s rather limited focus on binge eating and purging in adults.1 Given the mortality associated with restrictive eating disorders,6 an increased pandemic related prevalence of anorexia nervosa should be an urgent concern for clinicians, service planners, patients, and their families.


  • Competing interests: None declared.

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