The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond

Jennifer Couturier; Danielle Pellegrini; Catherine Miller; Neera Bhatnagar; Ahmed Boachie; Kerry Bourret; Melissa Brouwers; Jennifer S Coelho; Gina Dimitropoulos; Sheri Findlay; Catherine Ford; Josie Geller; Seena Grewal; Joanne Gusella; Leanna Isserlin; Monique Jericho; Natasha Johnson; Debra K Katzman; Melissa Kimber; Adele Lafrance; Anick Leclerc; Rachel Loewen; Techiya Loewen; Gail McVey; Mark Norris; David Pilon; Wendy Preskow; Wendy Spettigue; Cathleen Steinegger; Elizabeth Waite; Cheryl Webb

doi:10.1186/s40337-021-00394-9

The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond

J Eat Disord. 2021 Apr 16;9(1):46. doi: 10.1186/s40337-021-00394-9.

Authors

Jennifer Couturier^{1

2}, Danielle Pellegrini³, Catherine Miller⁴, Neera Bhatnagar³, Ahmed Boachie⁵, Kerry Bourret⁶, Melissa Brouwers⁷, Jennifer S Coelho⁸, Gina Dimitropoulos⁹, Sheri Findlay^{3

10}, Catherine Ford¹¹, Josie Geller⁸, Seena Grewal⁵, Joanne Gusella¹², Leanna Isserlin⁷, Monique Jericho⁹, Natasha Johnson^{3

10}, Debra K Katzman⁵, Melissa Kimber³, Adele Lafrance¹³, Anick Leclerc¹⁰, Rachel Loewen¹⁴, Techiya Loewen¹⁵, Gail McVey⁵, Mark Norris⁷, David Pilon¹², Wendy Preskow¹⁶, Wendy Spettigue⁷, Cathleen Steinegger⁵, Elizabeth Waite¹⁷, Cheryl Webb^{3

10}

Affiliations

¹ McMaster University, Hamilton, ON, Canada. coutur@mcmaster.ca.
² McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada. coutur@mcmaster.ca.
³ McMaster University, Hamilton, ON, Canada.
⁴ Canadian Mental Health Association - Waterloo Wellington, Waterloo, ON, Canada.
⁵ University of Toronto, Toronto, ON, Canada.
⁶ St. Joseph's Care Group - Thunder Bay, Thunder Bay, ON, Canada.
⁷ University of Ottawa, Ottawa, ON, Canada.
⁸ The University of British Columbia, Vancouver, BC, Canada.
⁹ University of Calgary, Calgary, AB, Canada.
¹⁰ McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.
¹¹ Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada.
¹² Dalhousie University, Halifax, NS, Canada.
¹³ Laurentian University, Sudbury, ON, Canada.
¹⁴ Patient advocate, Woodstock, ON, Canada.
¹⁵ Parent advocate, Woodstock, ON, Canada.
¹⁶ National Initiative for Eating Disorders, Toronto, ON, Canada.
¹⁷ Parent advocate, Ottawa, ON, Canada.

Abstract

Objective: The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond.

Methods: Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers.

Results: Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended.

Conclusions: Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.

Keywords: Adolescents; Anorexia nervosa; Binge eating disorder; Bulimia nervosa; COVID-19; Children; Eating disorders; Emerging adults; Guidelines; Self-help; Virtual care.