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“It is not a choice,” how Yale New Haven Children’s Hospital is addressing the eating disorder surge and what to do while waiting for care

Eating disorders among children and teens have surged nationwide during the COVID-19 pandemic, increasing the pressure on our healthcare system and leaving families scrambling for appropriate care. Pushing past the pop culture narratives to gain an accurate picture of who is impacted and what drives these afflictions is essential to supporting people experiencing eating disorders and those close to them.

Rebecca Kamody PhD, pediatric psychologist at Yale New Haven Children’s Hospital and assistant professor at the Yale Child Study Center, who conducts research on eating disorders and works clinically with families and patients, and Jaspreet Loyal MD, medical director of Inpatient Units and division chief for Pediatric Hospital Medicine, Yale New Haven Children’s Hospital, challenge false narratives surrounding eating disorders, discuss how Yale New Haven Health is addressing the surge in hospitalizations and share what people can do while waiting for care.

Eating disorders don’t discriminate

Many of the protections against eating disorders such as social connections, hobbies, and community involvement have been upended during the pandemic, creating fertile ground for these diseases to take hold.

While treating patients, Dr. Loyal noticed every stereotype about who has an eating disorder: thin, wealthy, Caucasian girls battling for control – shattering.

“We are seeing socioeconomic backgrounds, body types, gender identities and races across the spectrum needing medical attention for eating disorders,” said Dr. Loyal. “It has been eye opening for our team that this condition doesn’t just impact one segment of the population.”

What we wish people knew

Dr. Kamody did not originally set out to treat eating disorders. Passionate about pediatric obesity, Dr. Kamody was embedded in a pediatric endocrine program during her graduate training. While there, she was exposed to the complexity of eating and weight disorders which pulled her focus to culturally-responsive treatment for a range of eating and weight disorders.

“Eating disorders are psychiatric illnesses, that can present in a variety of ways that involve some disruption in the relationship with food that impacts functioning,” said Dr. Kamody.

Eating disorders have the second-highest mortality rate of any psychiatric diagnosis – outranked only by opioid use disorder, and yet, Dr. Kamody explains there is “a belief in society that this is a choice and people can will themselves out of it. It is quite difficult without support and that is why we need appropriate treatments in place.”

Experiencing an eating disorder can be described as having a separate mindset. The person is still there, but the eating disorder mindset can often take control. When this happens, one can potentially be robbed of their ability to relax, be social, and concentrate on things that interest them due to the emotional and physical resources the eating disorder demands. It can be difficult for someone with an eating disorder to view their disorder as an issue they want to change, as anxiety and obsessive thoughts can crowd out big-picture reasoning.

The exact trigger of an eating disorder is not always clear. They are often derived from multiple genetic, cultural, environmental, and neurobiological components.

“There can often be more overlap between eating disorders and other psychiatric illnesses than within the different eating disorders themselves, given the disparate presentations, such as the distinction between eating disorders with over-control versus loss-of-control,” said Dr. Kamody.

Having an eating disorder is not a choice and weight isn’t necessarily the best marker of where someone is in their recovery.

Coming together amid the mental health crisis

Dr. Loyal, who oversees the hospital’s nutritional restoration protocol and admission criteria, spent her first five years at the hospital honing her skills in the newborn nursery. When she was tapped to lead a team caring for adolescents with eating disorders, it seemed far out of her comfort zone, but a welcomed opportunity to fill an urgent need.

Over the last three years, Dr. Loyal has led the collaboration of a multi-disciplinary inpatient team which includes child psychiatrists, social workers, dieticians, nursing staff, child-life specialists along with pediatric hospitalists to treat patients with eating disorders.

The goal of hospitalization includes safe nutritional restoration along with individualized behavioral therapy led by the child psychiatry team in collaboration with families and outpatient primary care and adolescent clinicians. These teams work together to create the best strategy to help each child move to their next phase of recovery. Additionally, each family is assigned a continuity hospitalist to serve as a central point of contact for the duration of the hospital stay.

The team also formed partnerships with pediatricians to map out discharge plans where Dr. Loyal says much of the hard work occurs.

“What the surge and the pandemic helped me realize is that you can add the calories, but to get patients to think past their disordered eating and make real progress often entails a lot of family work after discharge,” said Dr. Loyal.

Hurdling the waitlist

One of the challenges that can come with seeking eating disorder treatment is being waitlisted.

“We want people to access eating disorder specific support and are advocating for national systemic change that will increase access to care including training more providers,” said Dr. Kamody. “However there are some things people can focus on while waiting for care.”

Dr. Kamody says bridging care while waiting for help can include:

  • Regular check-ins with a primary care provider, communicate concerns and ask for referrals
  • Fight the urge to isolate by reaching out to friends and family
  • Practice self-forgiveness and compassion
  • Get on waitlists for specialty mental health supports
  • Engage in therapeutic activities like art and other creative outlets
  • Engender body acceptance
  • Discover and build up the parts of yourself that you value outside of your appearance
  • Approach food as fuel and unconnected to any set of morals. “Good and bad food is so ingrained in our language, instead – focusing on what it does for us can be protective,” said Dr. Kamody.

“When I first started this work, it was easy to feel helpless,” said Dr. Loyal. “Over time I have learned from some of our own physicians and nursing staff who have gone through eating disorders themselves and are now thriving – I have developed a respect for the opportunity we have to be a part of these kids’ journey towards recovery.”