**Background:** The COVID-19 pandemic and associated lockdowns have had documented negative effects on adult patients with feeding and eating disorders (FED), including symptomatic deterioration, increased body shape concerns, and co-occurring anxiety and depression. However, evidence in youth is limited and inconsistent, with some studies reporting worsening of symptoms and others noting positive impacts on motivation to recover. This study aimed to investigate the effect of the first COVID-19 lockdown (Spring 2020) on FED symptoms in children and adolescents already receiving treatment and those newly referred to a specialist service in Geneva, Switzerland.
**Methods:** From September 2020 to July 2021, 61 eligible patients (aged 11–18) and their parents were invited to participate; 45 individuals (82.2% female, 75.6% aged 14–18) consented and were included. An ad-hoc online survey (via REDCap) was administered, consisting of open questions, multiple choice, yes/no questions, and a FED symptoms checklist. Participants rated the effect of the first lockdown (March 13–June 19, 2020) on 12 FED symptoms (e.g., food restriction, fear of weight gain, binge eating) on a 0–100 Likert scale (0 = much worse, 50 = no change, 100 = much better). Responses were transformed into change scores (Δ) ranging from −50 (extreme worsening) to +50 (extreme improvement). A summary score was calculated by averaging all endorsed symptoms’ Δ, then dichotomized as improvement/no change (mean Δ ≥ 0) vs. worsening (mean Δ < 0). Baseline clinical assessments included the Spielberger State-Trait Anxiety Inventory (STAI) and the Family Adaptability and Cohesion Evaluation Scale (FACES IV). Logistic regressions and cross-tabulations were used to examine associations with symptom change. FED diagnoses were made per DSM-5 criteria by a multidisciplinary team.
**Key Results:** Overall, 53.3% (n=24) of participants showed worsening of FED symptomatology, while 46.7% (n=21) reported improvement or no change. Patients with anorexia nervosa (AN) had the highest rate of worsening (58.6%, 17/29). Younger patients (11–13 years) were significantly more likely to show improvement compared to older adolescents (14–18 years) (χ²=3.97, p=0.046). Among the 28 newly evaluated patients (62.2% of the sample), the first COVID-19 lockdown was identified as a precipitating factor for FED onset in 60.7% (n=17). For patients already in treatment before the lockdown (n=17), 93.8% (n=15) rated access to care as satisfactory. No statistically significant associations were found between symptom change and state/trait anxiety, family cohesion/flexibility, COVID-19 infection, worry about health, or home/schooling arrangements. At a qualitative level, patients already in treatment showed more pronounced improvement in weight loss, night eating, and self-induced vomiting, but worsening in worry about shape/weight, physical activity, snacking, and food avoidance.
**Clinical Implications:** This study highlights the heterogeneous impact of the COVID-19 lockdown on adolescents with FED. While the lockdown served as a precipitating factor for many new cases (60.7%), it had a positive effect on roughly half of the sample, particularly younger patients and those already in treatment. The findings suggest that ongoing therapeutic support and increased meal support (e.g., meals prepared and eaten with parents) may buffer against symptom worsening. Clinicians should be aware that older adolescents and those with AN may be at higher risk for deterioration during stressful events like lockdowns. The lack of association with anxiety and family functioning underscores the need for further research to identify protective factors. Limitations include the small sample size, retrospective design, non-validated survey, and predominance of AN (64.4%), which limits generalizability across diagnostic groups.