Aims and Method: This is a longitudinal cohort study describing the demand and capacity for specialist inpatient treatment of patients with severe eating disorders covering a population of 3.5 million. We compared and the impact of the pandemic and the outcomes between different inpatient services.Results: Between July 2018 and 1 November 2020 there were 293 referrals. 97% were female. 93% had a diagnosis of anorexia nervosa. 19.5% of referrals were below BMI 13, and a further 40% had extreme malnutrition. Referrals and emergency admissions to acute hospitals have increased by 20% since the pandemic. Waiting times have doubled from 33 to 67 days.A novel integrated CBTE model has shown better outcomes and shorter length of stay compared to traditional eclectic treatment.Clinical Implications.The pandemic has worsened the mismatch of demand and capacity, causing increasing serious risks and this needs to be addressed as a matter of urgency.