Typically, August would always be a little bit quiet and then we’d get a raft of referrals in September,” says Dr Tara Porter. “[But] this year, all through the summer, the referrals did not stop. They’re just coming, coming, coming.”
Porter is acting lead clinical psychologist at the Royal Free Hospital in London. She specialises in treating young people with eating disorders and she is concerned by what she is currently seeing: the number of referrals her team have been receiving for eating disorder treatment has increased since the start of the Covid-19 pandemic.
Porter is not the only one to have spotted this trend. The eating disorder charity Beat saw a 78 per cent increase in the number of people contacting it for help in September 2020 compared with February.
“We’ve noticed a huge jump in people reaching out for help since the start of the pandemic,” says Rebecca Willgress, Beat's head of communications.
So, what is it about the Covid-19 pandemic that is causing eating disorder numbers to rise? And how worried should teachers and school leaders be about the increase?
Coronavirus: Why are eating disorders on the rise?
Jemma Michelson, a teacher at the Royal Free Hospital Children’s School, who works with students undergoing intensive treatment for eating disorders, believes one reason for the rise in referral numbers is that problems are now being picked up later as a result of young people being physically away from school during the recent period of national lockdown.
Whereas at school, students will be surrounded by people – from teachers and friends, to the school nurse or the canteen worker – any one of whom might notice them growing thinner, the same gradual changes in weight may initially be missed at home by parents who see their children day in and day out.
“School is an extra safeguard, isn’t it? It’s the daily eyes. That whole safeguard of seeing it, noticing, communicating with the young person and the parents was lost in Covid,” Michelson says.
“You have these young people in their baggy pyjamas all day on their screens. Baggy pyjamas, on their screens, in their rooms, on their online classroom. And you don’t attune to what’s going on here when you’re like this all day,” she adds.
Students being out of school has meant that disorders are getting picked up later, which, in turn, has meant that some young people are being referred to child and adolescent mental health services weighing a lot less than is usual at the point of referral.
“We’ve had a number of young people recently come in incredibly thin. Thinner than we’ve seen before,” Porter says.
The impact of lockdown on mental health
The practicalities of lockdown has caused issues, then. But it is also important to consider the psychological impact of the pandemic, which has left many young people feeling anxious and out of control.
This point is key, Porter says, because when everything feels out of control, people will fixate on the aspects of their lives that they can control — and for a teenager, the options here are limited.
“What do you have control of as a young person at that point from 12 to say 17? What you eat, and school,” Michelson points out.
In the past year, the combination of lockdown and cancelled exams has meant that many young people will have felt less in control of their schooling. It therefore makes sense that a teenager desperately seeking to regain some kind of control over their lives might focus on what they eat.
Of course, it is too simplistic to say that eating disorders are caused by a lack of control alone; multiple factors are likely to contribute, and there is a growing body of research to suggest that genetics and brain structure have a role to play here.
However, the stress of the pandemic is undoubtedly taking its toll.
“People with eating disorders have had to cope with extreme changes to their daily routine and treatment programmes, along with worries about being isolated or unable to see their support network,” says Willgress. “This has the potential to be extremely triggering to anyone affected, and it is not surprising to see such a large increase. We’d like to reassure anyone worried about their health that we’re here to support them whenever they need us.”
What can teachers do?
But how concerned should teachers be about this? After all, these problems will only affect a small minority of the pupils that they teach, and, ultimately, healthcare services will be responsible for treating the worst cases.
That might be true, but that doesn’t mean it is a problem to be ignored, as the rise in eating disorders is indicative of broader issues around mental health that could touch any child, Porter suggests.
“I think it’s about control in this output-driven, perfectionistic culture, where the whole thing is about 'Are you going to get your qualifications?'” she says. “It’s this relentless pressure and the only sense of self-esteem is around what your output is.”
Michelson agrees with this. She believes that putting too much pressure on students to achieve exam results, especially at this difficult time, is giving young people the wrong idea about what truly matters in life.
“Mocks and exams are ramping up, but, first and foremost, your physical and your mental health is number one,” she says. “So let’s just get that under control, and that’s the key message here.”
However, Michelson points out that many schools are already well aware of the problems here, and are doing what she refers to as “incredible” work around creating a whole-school culture to support wellbeing.
“More than ever, mental health is on the agenda, more than I’ve ever seen. And that goes from primary to secondary. It is a culture that is shifting,” she says.
So, while schools have little control over how the pandemic is progressing, or the restrictions they are required to apply, they are able to make decisions about the messages they send to their students around what matters most – and they are able to continue to play the vital role of being the “daily eyes” that can be the first to spot a problem before it gets out of hand.
“It’s exactly what Jemma says: teachers noticing,” says Porter. “They’re so important in young people’s lives. A teacher can really make a difference.”