She watched as her 16-year-old daughter worked out for an hour and a half on the elliptical in the morning and another hour in the evening, alternating with weights, running and cardio. — What else can be done? thought her mother. It was Fall 2020 and everything was put on hold. “I thought she needed exercise to relax, she was an energetic child who had been doing ballet for nine years,” Mary, Elsa’s mother, explains today, a misinterpretation that wasted precious time. Elsa, like thousands of her peers, developed anorexia during quarantine. She accidentally started treatment when she gained 47 kg and was not menstruating. “For seven months she has been fighting to gain weight and become who she was before …,” her mother tells K.

A quick search on YouTube is enough to find thousands of videos from the recent past with the headline “How to stay in shape during quarantine.” In them, “experts” and non-specialists offer their audience solutions for maintaining body weight while in isolation at home, teleworking or distance learning and without access to gyms. So, at a time when a large percentage of the population was “google” bread recipes to entertain themselves from the boredom of imprisonment and anxiety about the development of a pandemic, the same number of people – mostly teenagers – “melted” to the gym, going on debilitating diets to lose your proportions. Thus, two years after the start of the pandemic, there is an international surge of incidents across the spectrum of eating disorders.

Already at the end of the first twelve months of the pandemic, the number of hospitalizations for teens with eating disorders more than doubled, according to a Forbes article last August based on statistics from the University of Michigan School of Medicine. Based on data from 80 U.S. hospitals, the increase in adolescent patients has already increased by 25% in 2021, while the National Eating Disorders Association hotline saw 40% more calls. Greece, unfortunately, could not be an exception. The intensity of this phenomenon coincides with the opening a few days ago of the first eating disorders clinic at the National Health Service in Cismanoglio.

“During quarantine, teenagers spent too much time in front of screens, and the discussion about how to keep fit has monopolized many social networks (Instagram / TikTok),” says psychologist-psychotherapist Dr. Maria Ciaka, who has been dealing with eating disorders since 1997. in an atmosphere of general insecurity, when the main routine was lost, many felt that the only thing they could control was their body.

“Weight gain precedes psychotherapy; For psychotherapy to work, brain function must be restored.”

“At the Hellenic Center for Eating Disorders, we used to have twenty requests a month, now we have 40,” he explains. The patients, of course, had a predisposition that was “activated” by the conditions of confinement. “In addition, the average age of patients has gone down, now we have children exhibiting disease-specific behaviors at the age of ten and eleven,” she adds. The vast majority of patients are girls. The disease is associated with an increase and decrease in estrogen levels, therefore it occurs in 90% of women. 80% of patients become ill during adolescence, the rest usually during pregnancy or menopause. In men, eating disorders can occur with a decrease in testosterone levels, which is mainly associated with excessive physical exertion.

Teenagers have high energy requirements, “they need 2,200 calories a day because the brain, like the body, is under development,” recalls Dr. Tsiaka. However, by implementing “diet” programs, they end up consuming 700-800 calories a day when the brain alone needs 500 a day. “They measure what they eat every day using countless calorie counting apps.” They establish many rituals throughout the day. They wake up at a certain time, eat at a certain time at an extremely slow pace, convinced that this way they gain less weight. When they haven’t lost “enough” weight, they continue to increase their physical activity and refuse more food. “They are perfectionists and tend to avoid conflict, it’s a genetic trait.” They use reading to avoid eating. However, in order to work, they need glucose, which, due to malnutrition, they do not secrete in sufficient quantities. Thus, their life enters into a vicious circle: they read a lot, eat little (often only at the end of the day), sleep little. “Eventually they break down, their performance in school drops, they start lying.” Those who are not treated grow up with many fluctuations in health, “do not develop personally and professionally.” According to Dr. Tsiaki, among those who end up, there are those who have made themselves. “When you live like this for 25 years, you fall into a quagmire.”

Repeatedly, patients express their dissatisfaction with Dr. Ciaka: “You don’t trust me?” “I don’t trust the anorexia that determines their every step, they are seized by obsessive thoughts, but they themselves don’t realize it,” he emphasizes, “so it’s wrong to oppose them with logical arguments.”

It has been proven that malnutrition affects the functioning of the brain and thus changes the way you think and behave. “Your medicine is food, you cannot stop taking it.” Dr. Tsiaka repeats these words to his patients several times a day. “Weight gain precedes psychotherapy; for psychotherapy to work, brain function must be restored,” he concludes.

“He couldn’t even climb the stairs”

In the life of Elsa, an honor student from the northern outskirts with a closed character, there were two constants: anorexia and pan-Hellenism. In the end, the first won the second – Elsa failed the exams, because now she could not only read well, but even climb the stairs at school. “She wanted to go to law school, and she had all the necessary qualities to succeed,” notes her mother. Finally, Elsa entered a private college. “All we care about now is that she gets better,” says her mother honestly, who, after seven months of intensive treatment, now sees visible signs of improvement in Elsa’s condition.

“My daughter gradually lost weight,” says Mary today, “in just a year she lost seven kilograms, but she was under a lot of exercise stress.” The bell rings when Elsa’s period is interrupted. “The doctors then unfortunately chalked it up to stress and reading, so they put her on birth control.” Her hormonal tests are similar to a woman in menopause. However, the cure turns out to be a fatal mistake. “Due to fluid retention, she gained a kilo, and it infuriated her,” she describes, “now she became obsessed with the idea of ​​​​losing weight.” At the same time, her younger sister also strives to lose weight, and as she fails, she develops bulimia.

“We reached a dead end: I didn’t know what to cook anymore, they didn’t eat anything, I handed out whole pots of food to the neighbors’ homeless people.” At the same time, Elsa completely emotionally disconnected from her family, lost the ability to concentrate. Feels disproportionately cold, often bruised. “Twice she got out of her father’s car and was (slightly) hit by passing cars because she didn’t pay attention to where she was stepping.” In a school community dominated by competition for grades and appearance, her appearance is not an issue. “Unfortunately, she wasn’t the only one with anorexia, it’s just that other teenage girls haven’t lost control yet.”

When Mary took Elsa “almost by force” to ask for help, the 17-year-old girl ate lettuce salad a day. Her obligatory feeding begins with small portions. And her younger sister, whose condition is not considered so critical, begins psychotherapy. “I am grateful that we are lucky that we can afford all this, because the cost is unimaginable,” she answers a reasonable question about what it means to look after two children with private doctors. Seven months later, her health has partially recovered, but the fear of relapse is great. “He says, ‘You made me fat, I don’t want to be like that.'”

“My husband and I are also undergoing psychotherapy, the psychologist is trying to justify us, but we already feel that the burden of our responsibility should be removed,” she admits, “we are experiencing the greatest test of our lives.” By criticizing herself, she captures her own failures. “If I could go back in time, I wouldn’t take them to ballet, because there they became addicted to the obsession with “correct proportions” and competition with peers.” Elsa, unlike other girls her age, never showed interest in a relationship with a boy. “She wanted to stay focused on her goals for which she worked as a soldier,” recalls her mother. “Outwardly, both children look younger than their age, i.e. they don’t have breasts at all, as if they subconsciously decided not to increase, but to decrease, ”she says. “Maybe we gave them the wrong message that having sex is hard and they are trying to delay it.”

The first specialized clinic in a public hospital

With the rise of eating disorders among teenagers, the news of the opening of the first specialist clinic in the NHS was received with relief. “We have the ability to treat patients between the ages of 15 and 23,” says Katia Hatzigeorgiou, child and adolescent psychiatrist, supervisor at the Sismanoglio Amalia Fleming Hospital. Opened on July 12 by Minister of Health Thanos Plevris, Deputy Minister Mina Gaga and Deputy Minister of Mental Health Zoe Rapti, the clinic has a capacity of six beds – three already occupied. “Our team consists of an adult psychiatrist, a psychologist, a nutritionist, nurses, me, a child psychiatrist, and we are also expecting an occupational therapist.”

Hospitalization refers to cases that are considered very serious, given that 20% of patients with eating disorders end their lives. “The treatment is based on a very good nutrition program. If the patient does not respond, we give her a nutritional supplement,” he describes. “Leven (nasogastric intubation) is a last resort.” The median hospitalization is estimated at six months, with follow-up continuing for at least six more. “The ideal is to consume 2200-2500 calories per day and put on weight 800 grams per week,” explains Ms. Hatzigeorgiou, who has extensive experience. “Until now, they have been hospitalized in a pediatric psychiatric unit opened in 2009,” he explains, “but the coexistence of these patients with other psychiatric patients has been detrimental to both parties.”

Four times a week, Ms. Hatzigeorgiou and her colleagues see patients in the polyclinics. “From all over Greece, parents come and explain the situation to us so that we can make an initial assessment.”

Wishing to provide a general direction, Ms. Hatzigeorgiou recommends that caregivers “quietly monitor their child’s weight and appearance and, if something is not right, contact a specialist.” Those who wish can make an appointment by calling 213-20.58.975.