Over the past 2 years, the COVID-19 pandemic has caused many physical and emotional challenges. But has it also adversely affected people’s eating patterns and increased the prevalence of disordered eating?
Although not listed as a diagnosable condition in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), disordered eating can cause symptoms similar to an eating disorder, including restrictive or compulsive food consumption.
Moreover, anxiety, emotional distress, and changes in routine — some of the same stressors many people experienced during the COVID-19 pandemic — may trigger or intensify these symptoms.
Early in the pandemic,
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In this Special Feature, we spoke with two experts to help determine the relationship between disordered eating and the COVID-19 pandemic.
Disordered eating can be challenging to define as it encompasses a wide range of eating patterns. However, in general, people with a disordered eating pattern may eat for reasons other than hunger.
In addition, they might also change their eating patterns in response to internal or external stimuli, such as stress, boredom, or emotional dysregulation.
People with disordered eating patterns may have symptoms similar to those with an eating disorder. These symptoms may include:
- fasting or skipping meals
- binge eating
- avoidance of specific food groups or types of food
- purging or laxative misuse
- an unhealthy preoccupation with body image or weight
However, these symptoms might not occur as frequently or with the same intensity experienced by someone with a clinically diagnosed eating disorder.
Although disordered eating is not the same as an eating disorder, it could be considered pre-clinical eating disorder behavior, according to Dr. Jillian Lampert, the chief strategy officer of The Emily Program and Veritas Collaborative, who spoke with Medical News Today.
Dr. Lampert told MNT:
“[Disordered eating] is likely to progress to an eating disorder but [it does] not meet […] diagnostic criteria for an eating disorder yet. It may involve dieting, binge eating, purging, overexercising, [misuse of] diet pills or other supplements, laxative abuse, obsession with food and/or activity, restricting foods or food groups, among others.”
MNT also spoke with Dr. Allison Chase, the regional clinical director of the Eating Recovery Center. She noted that:
“In our current culture and with the constant influx of messaging on social media and other news venues, it can be challenging to decipher ‘normal’ eating from disordered eating. However, it is very important to recognize just how distorted and misguided nutrition information can be. Often, the promoted diet culture we see is actually more characteristic of disordered eating than healthfulness.”
Although the line between the two situations can be ambiguous, determining the difference between an eating disorder and disordered eating typically involves examining three factors:
- Behaviors: People with eating disorders may frequently engage in multiple behaviors concerning food. In contrast, people with disordered eating patterns may only engage in one behavior or experience behaviors less frequently.
- Obsessive thoughts: Individuals experiencing an eating disorder may continuously think about food or food-related topics, including body image. Conversely, people experiencing disordered eating may not think about these concerns as often.
- Functionality: The eating patterns of someone with an eating disorder can cause significant challenges with daily functioning, whereas people with disordered eating may not experience this to the same degree.
Evidence suggests that pandemic-related lockdowns and social distancing protocols may have contributed to an increase in disordered eating.
For example, according to a qualitative analysis of social media posts among Reddit users, most users reported that the COVID-19 pandemic and associated public health prevention measures adversely impacted their mental health and contributed to increased disordered eating behaviors.
Other research assessing the impact of pandemic-related lockdowns revealed similar findings. For instance, scientists in Italy sent questionnaires to self-selected participants via the internet to determine the pandemic’s effect on food consumption.
They found that around 46.1% of respondents reported eating more in confinement, and 19.5% reported gaining weight. In addition, 42.7% of respondents attributed their increased food consumption to higher anxiety levels.
Dr. Chase said:
“We have definitely seen a rise in the need for eating disorder care since the beginning of the pandemic. Early in the pandemic, the National Eating Disorders Association saw a 74% increase in calls to its helpline compared to the year prior. On our part, since the beginning of this year, we’ve received 89% more new patient calls compared to the same period last year.”
Research suggests several factors may play a role in pandemic-related disordered eating.
These factors include:
- higher levels of stress
- increased pandemic-induced mental health conditions
- changes to routines
- concern about possible food restriction due to reduced access
- increased use of social media and exposure to stigmatizing weight and body image posts
- new or increased preoccupation with food and eating, body 2, and perceived pressure to lose weight.
“The COVID-19 pandemic has impacted people very significantly. Isolation, anxiety, and strong social messages about weight, appearance, eating, and activity intensified significantly during this time, leading people to struggle with eating disorder [specific] thoughts and behaviors.”
— Dr. Jillian Lampert
Additionally, Dr. Chase suggests that “early in the pandemic, stress and anxiety from isolation and social distancing played a factor with those struggling with eating disorders.”
She pointed out that “[e]ating disorders thrive in isolation and secrecy, so the pandemic could have exacerbated that in some people.”
“In the beginning, the panic around grocery stores running out of various items was a potential trigger for people with eating disorders or who are in recovery, as they might rely on a routine and specific foods to help keep them on their recovery track. And then add in fear of getting sick if you go out to seek treatment; that could be really detrimental for someone who needs professional support for their eating disorder,” she added.
Dr. Chase also noted:
“As the length of the pandemic has increased, so has the uncertainty and confusion. For those more predisposed with an anxious temperament, as we see in those [experiencing] eating disorders, it makes sense that emotional discomfort is intensifying, resulting in an increase in eating disorders.”
According to Dr. Lampert, signs of disordered eating may include:
- changes in eating or activity levels
- mood changes
- isolation or eating alone
- special food requests or avoidance of certain foods
- expressing concern about body image or weight.
“Among the signs of disordered eating is the use of rules, judgments, and restriction of food and food groups,” Dr. Chase adds.
People with disordered eating patterns can learn to address them successfully. However, if a person is concerned that they may have an eating disorder, it is best to consult with a health professional for possible diagnosis and treatment.
To help manage disordered eating, Dr. Lampert advises:
“Get support. Asking and getting help shines a light on the eating disorder or disordered eating and helps to shift behaviors, thoughts, and feelings that lead to real change. Talk with your doctor, a therapist, a dietitian, particularly a specialist in eating disorders.”
“Learning to manage disordered eating is not only learning about healthy and balanced nutrition, but it’s also about recognizing and managing one’s emotions,” Dr. Chase said.
She added: “Don’t set rigid rules for yourself regarding food consumption. Recognize when you are putting judgments on certain foods. Instead of labeling a certain food as good or bad, label it in a neutral way.”
“It is equally important to learn healthful ways to manage uncomfortable feelings and reset expectations about ourselves,” Dr. Chase explained. “Tracking one’s thoughts and feelings can be helpful in identifying when one is utilizing food and unhealthy behaviors as an unhealthy coping strategy.”
Furthermore, she noted that “[a]nother significant and powerful strategy is to shift one’s emphasis and time spent on social media, namely sites and accounts with unhealthy messaging.”
“Change your social media feed so that you’re following body-positive, supportive people and accounts,” she urged.
“Similar to the social media shift, it is important to prioritize surrounding oneself with friends and family who promote healthy and positive messages.”
— Dr. Allison Chase
Despite the negative impact COVID-19 has had on eating patterns, Dr. Chase suggested that one positive has emerged: more widespread virtual treatment options.
“At Eating Recovery Center, we actually launched Virtual Intensive Outpatient in 2017 in three states,” she told MNT. “When the pandemic began, and insurance and state regulations were relaxed, we were poised to make Virtual Intensive Outpatient much more widely available. We’re now offering it in 34 states.”
“[N]ot only did this help those who might have been unable to come to in-person care because of COVID-19, it’s opened up treatment options to people without access in general, such as those who live further away from cities with treatment centers,” she pointed out.
Although the reasons behind this phenomenon are not yet fully understood, research findings and experts suggest that the COVID-19 pandemic has contributed to an increase in disordered eating.
Still, due to improved awareness and better access to treatment options, there is hope that people experiencing pandemic-related disordered eating can successfully navigate their way back to a healthy relationship with food.
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