Mental health conditions are often magnified in the face of external stressors. The COVID-19 pandemic came with a lot of uncertainty, lack of control, and isolation – factors that often play into the development and worsening of eating disorders.
MHA talked to experts Dr. Lisa Tuchman, Division Chief of Adolescent and Young Adult Medicine at Children’s National, and Dr. Mae Lynn Reyes-Rodriguez, Associate Clinical Professor in the Center of Excellence for Eating Disorders at UNC-Chapel Hill, about the pandemic, eating behaviors, and how to support yourself when struggling with disordered eating.
*Some answers have been edited for clarity.
Have rates and/or the severity of eating disorders increased during the COVID-19 pandemic?
Dr. Tuchman: National numbers are still coming in, but it is clear that eating disorder treatment programs are in high demand across the U.S. and seeing increasing numbers of young people struggling with symptoms of an eating disorder, which is undoubtedly true at Children’s National. We have seen close to double the number of referrals over the past year.
Dr. Reyes-Rodriguez: Many eating disorder clinics have noticed an increase in requests for eating disorder services during the COVID-19 pandemic. A study conducted by Termorshuizen et al. (2020) found that some symptoms in patients with anorexia nervosa and bulimia nervosa were exacerbated due to COVID-19 and quarantine. However, they also found that for some patients, the quarantine was beneficial because it allowed them to focus on their recovery process and bonding with their families.
How has the pandemic been challenging for people who struggle with an eating disorder?
Dr. Tuchman: This is very complicated. Many variables have come together to set the stage for eating disorder symptoms for those at risk. Probably the biggest catalyst was isolation – we know that isolation can amplify mental illness and stress. The regular in-person interaction with peers, coaches, and teachers who may pick up “something is not right” and intervene wasn’t happening with quarantine and online school. Many people postponed medical appointments and regular check-ups where health changes may be identified and discussed. The availability and access to food may also have led to increasing symptoms. Some may have had access to more food being home for school and work. Others may have had more difficulty accessing food because of the quarantine and related financial hardship, leading to rationing and restricting.
Dr. Reyes-Rodriguez: Changes in structure, routine, social isolation, not having access to physical activities, food insecurity, or not having the same food available for meals are some of the sources of distress that some eating disorder patients have encountered during the pandemic. The pandemic triggered symptoms of depression and anxiety due to the uncertainty, which can aggravate eating disorder symptoms. Some patients have reported that spending more time on social media, video calls, and video classes has increased body dissatisfaction and oversensitivity to physical appearance. For those who experienced eating disorder symptoms for the first time, some reported that increases in their desire to be healthy, in time to dedicate to exercise, in exposure to media, and in time spent in video meetings were contributing factors for dieting behaviors and disordered eating behaviors.
What about individuals who are experiencing new eating behaviors for the first time? How can they tell if it is a temporary stress response or if they have, or are developing, an eating disorder?
Dr. Reyes-Rodriguez: Whether the changes to eating behaviors are temporary or not, it is important to address them as soon as possible if it is a source of discomfort. Early intervention can prevent the development of a full criteria eating disorder, improve prognosis, and shorten the time in treatment.
Dr. Tuchman: The safest thing to do if you are experiencing new eating behaviors that are causing some distress or perceived as unhealthy is seek help. You can start with your regular source of medical care. The sooner you can get support and interrupt unhealthy patterns, the better the chances of re-establishing a healthy relationship with food.
There has been a lot of talk about “COVID weight” and “COVID bodies” – how can people who are sensitive to these types of comments navigate these conversations?
Dr. Tuchman: Unfortunately, this is not unique to the times. A “Health at Every Size” approach is what we endorse to help recognize that weight-related health outcomes are primarily driven by social, economic, and environmental factors. The principles are respect, critical awareness, and compassionate self-care. It also supports people of all sizes in adopting healthy behaviors. It is an inclusive movement, recognizing that our social characteristics, such as our size, race, national origin, sexuality, gender, disability status, and other attributes, are assets, which acknowledges and challenges the structural and systemic forces that impinge on living well.
Dr. Reyes-Rodriguez: Focus on what is under your control. Recognize that going through a pandemic is a unique situation – it is natural that our emotional states, as well as our bodies, have experienced changes. We need to focus on self-compassion and self-care. If you find yourself in the middle of a conversation about COVID weight/bodies you can do the following: a) re-direct the conversation to another topic; b) state your commitment to self-care and self-compassion; c) remove yourself from the situation if needed; or d) if comfortable, you can share your thoughts and feelings and ask them to change the topic.
As communities reopen and we return to a “new normal,” how can people who struggle with their body image feel more comfortable?
Dr. Tuchman: I recommend that people who struggle with their body image look at “Health at Every Size” and visit their physician to discuss any concerns they have. Check out the National Eating Disorders Association (NEDA) resource on size diversity: https://www.nationaleatingdisorders.org/size-diversity-health-every-size
Dr. Reyes-Rodriguez: Transitioning to the “new normal” is a process that could take time, patience, and self-compassion. I recommend a slow transition and tuning into your feelings and emotions during the process. Integrate activities that have been useful in the past in making you feel better. For some people, meditation, relaxation techniques, mindfulness, and connecting with a support system are some options to balance negative feelings and emotions. Everybody will be experiencing fear, anxiety, and other feelings depending on their individual situations – so you are not alone in navigating through a difficult transition. Dr. Cynthia Bulik’s Keep it Simple article captures the importance of taking your time in returning to old routines.
How can people who are experiencing an eating disorder or slipping into disordered eating behaviors help themselves during this time?
Dr. Reyes-Rodriguez: It is important to keep a daily routine with structure, but maintain some flexibility. Keeping a regular eating pattern (three separate meals and 2-3 snacks), keeping your mind busy, and doing activities that you enjoy can add balance to your life and perspective. Staying connected to friends and family can help keep you grounded on what is important in life. Try to control the “dose” of social media or any other situation that you have identified as a trigger for your body dissatisfaction and other eating disorder cognitions and behaviors. Finally, you can do a search to identify support groups or any additional resources in your community.
Dr. Tuchman: Please, seek help. If you are able to recognize disordered eating attitudes and behaviors in yourself, you have already taken the first step toward a happy, healthy, balanced way of life. Reach out to your regular provider to discuss your concerns. Early detection, initial evaluation, and effective treatment are essential steps to help move into recovery more quickly, preventing the disorder from progressing to a more severe or chronic state. NEDA’s helpline has resources to connect you to care in your geographic area.