Referrals of young people with eating disorders for NHS treatment shot up by almost a half last year in England according to Observer analysis of government data, with doctors warning that lives are being ruined. There were 19,562 new referrals of under-18s with eating disorders to NHS-funded secondary mental health services in 2020, a rise of 46% from the 13,421 new referrals in 2019. Referrals fell by about 25% between the first two quarters of last year – a period affected by the first lockdown – but then surged from 3,313 from April-June to 6,813 in the final three months of the year. Rebecca Willgress, head of communications at the eating disorder charity Beat, told the Observer: “We’re hearing from people that lockdown has had an impact on their mental health and their eating disorder, we’ve heard from people that they’re relapsing because of lockdown. Obviously we know that children and young people have had a particularly tough time of it when it comes to lack of school, change in routine and things like that.” She said calls to Beat’s helpline rose 173% between February 2020 and January 2021. Tom Madders of youth mental health charity YoungMinds said: “It’s deeply worrying that more children and young people need support for eating disorders, and that many are waiting too long for treatment. “The factors behind eating disorders are often complex, but the pandemic has left many young people isolated, uncertain about the future and less in control. Many may also have lost access to their usual routines and coping mechanisms.” Dr Karen Street, officer for mental health at the Royal College of Paediatrics and Child Health, said many young people had had nothing to do during the first lockdown and so focused on healthy eating – which in some cases developed into an unhealthy obsession, and then into a diagnosable eating disorder. “I think it went unnoticed for the first few months in many households,” she told the Observer, “because these kids weren’t mixing with others, they weren’t back at school for people to see what was happening – and when it’s happening under your nose in the household you don’t always see somebody losing weight. “And then I think it got to the summer when people were out and about a bit more … that was when teachers were noticing, when friends and family were noticing, that we then saw this big upsurge in referrals.” The rise in referrals in 2020 marked an acceleration of an existing trend. Referrals rose 21% in 2019 and 34% in 2018. There were more than twice as many referrals in 2020 as there were in 2017, potentially due to greater awareness of eating disorders and more provision of services. However, Dr Street said that funding for NHS services was based on caseloads in 2015, when resources were last significantly increased. “There had been a really significant step forward in development of good services for these kids, but unfortunately with the year-on-year increase coupled with the surge, they’re under-resourced in terms of qualified staff, and unfortunately a lot of places are now having to operate waiting lists, which is exactly what we were trying to get away from a few years ago.” She added that cases were now rising at universities. “They’re stuck behind closed doors, nobody’s seeing them – they had a whole term like that in virtual isolation. Absolute trigger for an eating disorder. These aren’t going to go away. Once you’ve developed an eating disorder, you’ve now got an illness. It doesn’t just suddenly get better the minute lockdown’s lifted. “We really have ruined those young people’s lives for a significant period of time, and a proportion go on to develop it as a chronic illness that affects them for the rest of their lives. So there’s a huge legacy to this going forward, that’s really important that we recognise.” An NHS spokesperson said: “The pandemic turned lives upside down and hit young people particularly hard, but community eating disorder services continue to step up to treat increasing numbers that require care with 1,700 more children and young people treated since last year.”