Colleen Schreyer

Objective Food anxiety and limited dietary variety often persist after intensive treatment for eating disorders (EDs) and may contribute to relapse. Prior studies demonstrate decreased meal‐related anxiety with residential or inpatient treatment, but less is known about changes in dietary variety and anxiety associated with specific foods. The current study assessed change in food anxiety and dietary variety in inpatients with EDs (anorexia nervosa and bulimia nervosa) in relation to discharge outcomes from meal‐based behavioral treatment. Method Patients ( N = 128) admitted to a specialized, hospital‐based behavioral treatment program completed measures of food anxiety, dietary variety, and ED symptoms at admission and discharge. Demographic and clinical data were abstracted from electronic medical records. A novel network community analysis identified three food anxiety groups: fruit‐veg, animal‐based, and carb‐based foods. Results High‐energy density combination foods were most anxiety‐provoking and most avoided. Food anxiety decreased, and dietary variety increased from admission to discharge. Reduction in food anxiety was associated with lower ED symptom scores and higher normative eating self‐efficacy at discharge. For animal‐based foods, increased dietary variety was associated with lower food anxiety at discharge. Neither variety nor anxiety was associated with weight restoration. Discussion Findings highlight the importance of broadening dietary variety and targeting food anxiety during the nutritional rehabilitation and weight restoration phase of ED treatment. Increasing dietary variety may contribute to reduced food anxiety, which, in turn, may increase normative eating self‐efficacy. These results may help inform nutritional guidelines for meal‐based treatment programs. Public significance Consuming a greater variety of foods during meal‐based intensive treatment may help alleviate food anxiety in patients with eating disorders.

Objective The COVID‐19 pandemic has been associated with increased hospitalization rates and worsened symptom severity in patients with eating disorders (ED), but most studies focused exclusively on adolescents. Further, research evaluating the impact of COVID‐19 on response to inpatient treatment for ED is limited. This study aimed to compare demographic characteristics, symptom severity at admission, and discharge outcomes for adult and adolescent inpatients with EDs admitted before and after onset of the COVID‐19 pandemic. We expected the post‐COVID cohort would report elevated symptomatology and poorer response to treatment compared to the pre‐COVID cohort and that this effect would be amplified for adolescents. Method Patients were consecutively hospitalized adults and adolescents treated in a specialized behavioral integrated inpatient‐partial hospitalization program for eating disorders between March 2018 and March 2022 ( N = 261). Results The effect of COVID‐19 on symptomatology was moderated by age group such that adolescents in the post‐COVID cohort, but not adults, reported higher levels of eating disorder and depressive symptoms compared to the pre‐COVID cohort. No group differences were observed for discharge outcomes (rate of weight gain, length of stay, or percent target weight). Discussion Findings with respect to elevated symptomatology in adolescents but not adults may reflect the particularly negative impact of social isolation on adolescents. Future research is needed to assess the impact of COVID‐19 on long‐term treatment outcomes including relapse at 1‐year, as well as the potential impact of COVID‐19 on treatment availability for chronically ill adults or those with public insurance. Public Significance Patients with eating disorders (ED) admitted to a specialty inpatient program after the start of the COVID‐19 pandemic were younger and more likely to be male than those admitted pre‐pandemic. Adolescents admitted post‐COVID, but not adults, reported elevated ED and depressive symptoms compared to the pre‐COVID cohort. Group differences were not observed for treatment response. Future research should evaluate the impact of COVID‐19 on relapse risk in EDs.