Eating disorders surged during the pandemic – and the rise has not fully reversed

Eating disorder clinics were overwhelmed by a tidal wave of new patients during the pandemic. Alarm bells began ringing almost immediately at the adolescent eating disorder clinic Nadia Micali led in Switzerland in 2020.

“We saw almost a 100% increase in cases,” she says – a pattern echoed by colleagues across Europe.

Researchers faced a critical question: was this a short-term shock – or the beginning of a lasting shift in young people’s mental health?

“Is this something we see for a year or two, or does it persist?”

New research in the European Eating Disorders Review uses Denmark’s national health registry – one of the most detailed datasets of its kind – to track diagnosed cases from 2000 to 2022, showing that anorexia and other eating disorders including binge eating disorder – accelerated during the pandemic and remain elevated for some groups.

The trend is most pronounced among girls aged 10–14 years, particularly for anorexia nervosa, says lead author Nadia Micali, head of the Center for Eating and Feeding Disorders Research in Greater Copenhagen. The number of newly diagnosed cases rose by 35% for anorexia nervosa and 57% for other eating disorders between 2019 and 2021.

By 2022 – the latest available data – the number of new cases had still not returned to pre-pandemic levels, suggesting that the surge may have left a lasting imprint.

Such a dramatic spike in anorexia nervosa cases signals a serious public health crisisanorexia nervosa has the highest mortality rate of any mental disorder, with about one in 20 dying within four years of diagnosis. Anorexia at a young age can have lasting repercussions for growth, bone density, heart health and brain development.

Why were younger girls hit hardest?

Nadia Micali and coauthors offer several potential explanations for the pandemic’s effect on eating disorders. “Eating disorders are complex,” she says, shaped by multiple interacting factors.

“Young people saw dramatic disruption: school routines shifted, social contact shrank, and activities disappeared.”

For those already prone to stress responses, this disruption may have tipped the balance toward disorders such as anorexia nervosa.

Teens also spent more time online during the pandemic – another factor linked to negative self-image and increased eating disorder risk.

But why the outsized impact on children aged 10–14 years? “We know that the onset of puberty is a trigger, both because of biological changes and because it can be particularly stressful for those who develop anorexia,” she explains. “The puberty hypothesis might also explain why young girls were particularly affected compared with boys – this is a period when body changes and social pressures intensify.”

This reflects a broader two-decade rise: diagnoses among girls aged 10–19 in Denmark have doubled between 2005 and 2022 and trebled in boys of the same age.

More cases – or better detection?

Denmark’s data align with patterns across Europe. In Norway, diagnoses of new eating disorders among girls leapt 46% in 2021, while in Germany, 40% more girls were hospitalized for anorexia in 2023 than before the pandemic.

Part of the increase since 2000 reflects improved detection driven by clinicians and public health efforts – healthcare providers, school officials and parents are better at recognising the signs and bringing children into care who might previously have been missed. This means some of the rise reflects improved identification rather than a true increase in disease.

But improved detection alone cannot explain the full rise – and it is too early to relax.

Together, these findings suggest that the pandemic did not just trigger a temporary spike – it may have shifted the baseline risk.

Data from other countries suggest that eating disorders among boys in Denmark may still be underdiagnosed.

“Although more males are being diagnosed, the gap with females remains wider than expected,” Nadia Micali says.

What should parents look for?

Nadia Micali urges parents and guardians to watch closely for sudden changes in weight or eating habits – such as avoiding meals or, conversely, unusually large amounts of food disappearing from the house.

“Another sign might be self-esteem – an excessive focus on appearance, weight or shape,” she says. “That could also be a marker of an underlying eating disorder.”

It is important to understand that eating disorders are serious health conditions at all body sizes and weights.

Skipping meals might be correctly identified as a problem for a thin child but might be wrongly praised for a heavy child socially pressured to lose weight. As diet culture becomes increasingly normalised, some experts argue for adding a new diagnosis – orthorexia, an unhealthy obsession with clean eating and exercise that blurs the line between healthy habits and harmful restriction.

“We know that early diagnosis and treatment greatly improve recovery,” Nadia Micali says. “The longer the illness lasts, the harder it is to recover.”

The risk does not end with adolescence

Nadia Micali says that Denmark’s healthcare system has been slow to adopt ICD-11, the World Health Organization’s classification system released in 2019, which includes specific diagnostic categories for conditions such as binge eating disorder.

The researchers believe that catching up to the international community in the vocabulary Denmark’s registry uses for eating disorders will make it an even more precise tool for tracking how these conditions develop over time.

The risk does not disappear with age – and may emerge later. Eating disorders are also rising among adults – a trend also seen in Denmark, particularly women in their mid-twenties to mid-thirties. Another study by researchers from the Danish Institute for Public Health found that one in four Danish women in that age group show signs of eating disorders.

“Eating disorders have previously been seen as a youth phenomenon,” said co-author Heidi Rosendahl, a researcher at the National Institute of Public Health, in an interview with the Danish Broadcasting Corporation. “But the behaviour often persists into adulthood.”