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Eating disorders among Cowlitz County youth increase during pandemic

Hello Life walk

Hello Life board of directors and supporters participate in the National Eating Disorders Association walk in Portland in October 2015.

Doctors, school counselors and community agencies are raising the alarm about an increase in eating disorders among youth during the pandemic, including in Cowlitz County.

Hospitalizations among adolescents with eating disorders increased 25% compared to pre-pandemic trends, according to a national study published by Epic Health Research Network. The increase in hospital admissions was partly due to an overall increase in new eating disorder diagnoses, the study found.

“Eating disorders have been extremely prevalent in Cowlitz County for a long time … but I think it’s been an influx in people reaching out for different reasons,” said Shira Lile, executive director of Hello Life Eating Disorder Recovery Services. “It’s a mix of folks that have the time and capacity to reach out when before they couldn’t, more awareness of our services, and the pandemic really made it challenging for youth who were struggling.”

Eating disorders are serious, but treatable mental and physical illnesses that can affect anyone, according to the National Eating Disorders Association (NEDA).

Kaiser Permanente Northwest, which covers Oregon and Southwest Washington, had a 25% to 30% increase in referrals to its eating disorder program this year, said Dr. Ellen Singer, pediatrician.

The program typically sees an increase in referrals at the beginning and end of the school year, but saw a larger uptick throughout the pandemic, Singer said. Many parents told Kaiser doctors the problem started during the middle of COVID-19 while their children were at home, anxious and spending more time on social media, she said.

Since the pandemic began, Hello Life had an influx of youth, parents and schools reaching out for help, Lile said. The Longview nonprofit has nearly doubled the number of youth served last year, from about 85 to 155 so far in 2021, she said.

“It floored me,” Lile said. “The need on our side to continue to do this work has never been more critical than it is now.”

Hello Life provides free peer mentoring and support, treatment grants and referrals to people with eating disorders, as well as presentations on self-love and body positivity.

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Since the pandemic began, the organization started body positive youth groups that now always have wait lists, Lile said. There also has been an influx in community providers and schools requesting resources for students, she said.

For some youth, returning to school after remote learning for months triggered the return of eating disorders, Lile said.

Warning signs

While the exact cause of eating disorders is unknown, a growing research consensus suggests a range of biological, psychological and sociocultural factors, according to NEDA. The best-known environmental contributor is the idealization of thinness.

An eating disorder often begins with restricted eating to either feel healthy or look different, before “taking on a life of its own,” Kaiser pediatrician Singer said.

Eating disorders affect a person’s emotional and physical health and also have serious consequences that can include malnutrition, bone loss, damage to organ systems, immune suppression and other problems, according to NEDA.

Some common warning signs include changes in a child’s mood and relationship with food, wearing baggy clothes, eating or exercising in their room, as well as evidence of hidden food, discarded food or vomit, Singer said.

“This illness crosses all socioeconomic and cultural lines … it can strike in any household,” she said.

The pandemic has made it more difficult, but typically teachers, counselors and other school staff have supported youth in recovery by allowing time for appointments and supervised meals, Singer said.

Leann Couch, Toutle Lake School District counselor, said there has been a noticeable increase in students with eating disorders, especially among younger age groups.

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Pandemic-related stress on families, as well as separation from those they spend the majority of their time with was difficult for students, Couch said. Some children and teens gained weight while at home and spent more time on social media, where body shaming and other harmful messages are prevalent, she said.

Staff are “tuned in” to students who are struggling and reach out for professional resources to help, Couch said. Lile with Hello Life has worked with students struggling with their body image or eating disorders either individually or in small groups, Couch said.

“I don’t believe that there is one answer to eating disorders in our youth and young adults,” she said. “Each child is an individual and we should not compare one to another. What we should do is look at each child and build a positive relationship with her or him and work from there.”

Treatment options

For many patients, eating disorders can be managed by their primary care doctor, with referrals to a counselor and nutritionist as needed, Singer said.

Kaiser offers an eating disorder program for those under 18 which uses a family-based therapy method. Parents or guardians act as case managers and provide supervised, nutritionist-planned meals for their children in the program, Singer said. The patients also have weekly appointments with a therapist and a nutritionist.

The program doesn’t work for all families, and a Kaiser case manager also will refer patients to other outpatient or inpatient clinics in the area, Singer said. However, staff try to enroll children into the Kaiser clinic if possible because other programs have long wait lists averaging six to eight weeks, she said.

Hello Life’s services are just a piece of the treatment puzzle, and encourages youth and adults to seek professional help, Lile said. The increase in virtual services throughout the pandemic has allowed many youth to more easily connect with eating disorder professionals, she said.

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Along with making referrals, Hello Life has grants to help pay out of pocket costs not covered by insurance to allow youth and adults to access care, Lile said. There is a huge need for financial help for families who are uninsured, underinsured, or who can’t afford to bring their child to services each day in Vancouver or Portland, she said.


Lile said she hopes her small organization can expand capacity to meet the need, which is “just the tip of the iceberg.”

“If we weren’t here, I don’t know where local people would be able to turn to and that’s a scary thought,” she said.

In the past year and a half, Hello Life began offering prevention workshops at Longview Parks and Recreation after-school programs, Toutle Lake schools, Mark Morris High School and Lower Columbia College nutrition classes.

The organization plans to continue virtual services to help reach more people, Lile said.

“In a time now where some of the stigma around reaching out for support and around eating disorders has shifted, there’s more encouraging youth to reach out and be open,” she said. “I hope that continues.”

Eating disorder prevention includes modeling healthy and happy eating behaviors and using body positive language, Singer said. Parents can also monitor their child’s social media and help them manage stress through different activities, she said.

Parents should reach out to their child’s primary care doctor if they have concerns.

“It’s important to recognize that just because a kid has this illness doesn’t mean they won’t recover from it,” she said. “There is help.”


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