Background: The COVID-19 pandemic increased the incidence and burden of eating disorders (EDs) globally. First Episode Rapid Early Intervention for EDs (FREED) is a nationally implemented early intervention service model for young people (16-25 years) with EDs in England. This study evaluates the longer-term impact of the pandemic on presentations and service provision in FREED.

Methods: Data from January 2019 to September 2024 were analyzed, including three services with pre-, pandemic, and post-pandemic data (Sample 1), and 62 services with post-pandemic data (Sample 2), 32 of which also contributed data during the pandemic. Linear mixed models examined referral numbers, duration of untreated ED, diagnostic mix, average body mass index for anorexia nervosa, and wait times.

Results: In the three services with pre-, pandemic, and post-pandemic data, referrals remained significantly higher post-pandemic compared to the pre-pandemic period. Across all services, post-pandemic referrals declined compared to the pandemic period. Consistently, anorexia nervosa diagnoses decreased, and the duration of untreated ED at presentation increased post-pandemic.

Conclusions: The COVID-19 pandemic has had lasting impacts on ED service provision in England. Sustained investment and national support are essential to ensure FREED services continue to meet the needs of young people with recent-onset EDs and to reduce the duration of untreated ED.