2 Excessive Exercise among Youth with a New Diagnosis of Restrictive Eating Disorder before and during the COVID-19 Pandemic

Abstract Background During the COVID-19 pandemic, Canadian youth with anorexia nervosa (AN) and atypical anorexia nervosa (AAN) presented at higher rates with more severe illness. This trend was found to be more pronounced in Canadian jurisdictions where public health measures included full school closures and confinement. Disease severity in AN is multifactorial, however, excessive exercise can be associated with more severe illness. Due to closures, many adolescents turned to unregulated exercise regimes within their homes. The contribution of excessive exercise to the rise of new onset AN during the pandemic remains unknown. Objectives To determine the rate of excessive exercise among newly diagnosed adolescents with AN/AAN during the COVID-19 pandemic compared to the five preceding years. Design/Methods This was a secondary analysis of a prospectively collected intake registry of all new diagnoses of AN and AAN completed between January 1st, 2015, and November 30th, 2020 at two large, urban, tertiary paediatric hospitals in Quebec. Baseline demographic information and clinical assessment variables were collected based on standardized assessment forms. Excessive exercise was self-reported and defined as >10 hours per week of moderate or vigorous physical activity at the time of diagnosis. Medical hospitalization within 1 week of assessment was used as a marker of medical severity. The primary outcome of excessive exercise was compared between the period of pandemic public health preventive measures (March 2020 to November 2020) and the pre-pandemic period (January 2015 to February 2020). Variables were compared before and during the pandemic using Chi square testing. Results Overall, 817 patients with new diagnoses of AN/AAN met inclusion criteria during the study period (pre=647; during=170), with 40 patients (pre=34/647 and during =6/170) excluded due to missing data on exercise frequency. Overall, median patient age was 15.9 (IQR 13.8-16.9) years; 93% female; and 59% diagnosed with AAN. During the pandemic, mean hospitalization rate increased from 2.2 to 7.2 patients per month (p=0.001). Hospitalization within one week of diagnosis increased from 23% to 40% (136/613 vs. 65/16; p=0.001). The rate of excessive exercise did not differ before versus during the pandemic overall (27% vs. 24%; p=0.48) nor in patients requiring admission (40/136 [29%] vs. 23/65[36%]; p=0.39). Conclusion Excessive exercise in isolation does not appear to explain the increased rate and severity of new AN/AAN diagnoses since the pandemic in this cohort. Further studies are needed to better elucidate other drivers which may have contributed to the severity of eating disorders during this period.

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