507 - Eating disorders occur in all sizes: trends in percent median BMI among adolescents with eating disorders

Research has shown that significant psychological and physical symptom burden occurs in individuals with eating disorders (EDs) who have normal to higher body weight.^1,2,3 Studies have shown an increase in EDs among adolescents following the onset of the COVID-19 pandemic.^4,5 Limited data, however, exists comparing the number of adolescents with EDs who have greater than 90 percent median BMI before and after the onset of the COVID-19 pandemic.

Objective:

1. To examine degree of malnutrition using percent median BMI among adolescents ages 9 to 18 with an ED.

2. To compare the rate of adolescent ED encounters by percent median BMI before and after onset of COVID-19.

Design/Methods:

Retrospective review of the electronic record system at the University of Kentucky was performed, and the following data were extracted: inpatient and ambulatory encounters associated with an ED diagnosis in patients aged 9 to 18 from January 15, 2019 through June 1, 2021, with encounters occurring prior to March 1, 2020 considered pre-COVID-onset and those occurring March 1, 2020 or later considered post-COVID-onset. The following diagnoses were included: anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder (OSFED), and unspecified feeding or eating disorder. Percent median BMI (%mBMI) was used as a measure of nutritional status (ranges outlined in Table 1).⁶ Frequency distributions summarized encounters by disorder and %mBMI group. Incidence rate ratios with corresponding 95% confidence intervals and p-values evaluated changes in the rate of encounters pre- and post-COVID-onset, adjusting for the number of encounters within each time frame. An alpha level of .05 was used for statistical significance.

Results:

Percent median BMI was greater than 90 in 78% of all 2750 examined encounters across all ED diagnoses. There was a 77% increase in the rate of encounters for those with %mBMI greater than 90 following COVID onset, compared to the pre-COVID-onset subset (p< .001), and significant decreases in those with %mBMI 80-90 (IRR = 0.74, p= .001) and 70-79 (IRR = 0.56, p = .006).

Conclusion(s):

In our sample, the majority of adolescents across all ED diagnoses had %mBMI greater than 90 and thus did not meet the defined criteria for malnutrition. Following COVID-19 onset, there was an increase in the rate of ED encounters among adolescents with greater than 90% median BMI. Clinicians should be aware that EDs occur across various body weights, particularly in the COVID-19 era, and should provide appropriate management to all patients based on physical and psychologic symptomatology.