eNewsletter - November 2021

The Impact of COVID-19 on Eating Disorders 
By: Megan Raupp, MS RD LDN, Lead Registered Dietitian Eating Disorder Services

 

The COVID-19 pandemic has not only impacted physical health and well-being across the globe, it has led to a secondary mental health pandemic—an increase in eating disorders (EDs).

Among the different countries and populations struggling with EDs during the pandemic, common themes have emerged. The risk and severity of ED behaviors has increased, and we as providers must modify our treatment approach to fit the specific challenges and needs of these unprecedented times.

COVID-19 and eating disorder risk factors

Stressful life events, such as the COVID-19 pandemic, are predictive of ED onset, maintenance and relapse. Studies have shown the pandemic has led to an increase in health-related distress as well as a rise in work, financial and social stressors. Additionally, the loss of loved ones to COVID-19 has further contributed to stress levels.

Many eating disorder-specific risk factors of the pandemic complicate its impact, including food insecurity, media and media messaging, the impact on physical activity and access to healthcare resources.

Food insecurity presents a specific risk factor for ED psychopathology, including binge eating, fasting and compensatory behaviors. For instance, the Minnesota Starvation Experiment found that even for those without prior psychopathology, food insecurity or access issues may result in increases in food preoccupation, rigid eating rituals, binge eating and distorted body image.

Use of social media has increased during the pandemic, leading to further exposure to already existing weight-related messaging. Fatphobic messaging also increased, highlighting the “quarantine 15,” referring to weight gain during the pandemic. Additionally, early reports connected COVID-19 risk to individuals with higher body mass index and encouraged weight control measures to mitigate that risk.

Lockdowns and physical distancing efforts associated with the pandemic led individuals with weight concerns to experience increased stress. Research shows that dysfunctional exercise, as well as walking and at-home workouts, increased.

 

The pandemic also reduced the ability for individuals to access healthcare in the same way they would in non-pandemic times, decreasing the ability to obtain treatment for ED behaviors and symptoms.

COVID-19 and eating disorders around the world

The impact of risk factors is being felt around the world, with research demonstrating increases in ED behaviors such as restricting, bingeing, purging and exercising in Australia. Italy specifically noted inefficacy of treatment, and challenges in involving patients and families during phase 1 of the pandemic lockdown. A Spanish study found that COVID-19-related confinement led to resurfacing of ED symptoms and behaviors. And in the United Kingdom, one study found that the reduction of social interaction and access to support networks had a negative effect on ED behaviors.

Innovative ED treatment approaches

The global increase in ED behavior in relation to the COVID-19 pandemic requires new treatment approaches to meet the increased severity and needs. These measures must also consider limitations related to access during potential lockdowns. While telehealth can be used to deliver evidence-based treatment, cognitive-behavioral therapy, family- or parent-based treatment, or acceptance and commitment therapy via telephone or web-conference, additional measures can be effective.

Email and text messaging with patients can complement clinical practice, streamline communication, support self-monitoring and self-regulation, and encourage emotional expression. Digital tools and mobile applications can be implemented for self-help and keeping recovery records, and online support groups may be helpful as well.

Eating disorder treatment can also be augmented with strategy development related to food shopping, storing and preparation, creating a structured daily meal plan, promoting awareness of hunger and fullness cues, limiting media consumption, and limiting isolation by finding healthy and creative ways to connect socially with others.

Finally, the pandemic has changed the potential outlook on treatment modalities. Adopting a harm-reduction treatment approach embraces the uncertainty of our current times and promotes strengths-based treatment.

Finding more resources

Linden Oaks is thrilled to announce our new outpatient location, Linden Oaks Eating Disorder Outpatient Programs in Woodridge. The site offers both partial hospitalization program (PHP) and intensive outpatient program (IOP) levels of care for enrolled patients. The site serves individuals aged 12 years and older who are struggling with an eating disorder.

Linden Oaks Eating Disorder Program has rolling admissions and offers structured programming to address eating disorder issues interfering with an individual’s daily functioning. We focus on healing a person’s relationship with food; as well as their health, wellness and nutrition-restoration.

Our eating disorder program practices an “all foods fit” model and utilizes the exchange system to provide flexible structure to each person’s meal plan and the body’s overall nutrition needs.

Through group therapy, nutrition education, expressive therapy and body image groups, we help individuals address complex psychological issues while treating physical and dietary needs. We empower our patients with knowledge about medical complications, medication management and relapse prevention to sustain recovery after discharge.

For patients who would benefit from connecting with a clinician who specializes in eating disorders, please call the Linden Oaks Help Line 24 hours a day at 630-305-2705.

  • Linden Oaks Eating Disorder Outpatient Program, 3329 75th Street, Woodridge, IL 60517
  • Hours:
    • PHP: Monday - Friday from 7:45 am - 3 pm; Saturday from 7:45 am - 2:15 pm
    • IOP: Monday - Friday from 9:30 am - 2:15 pm

References and resources:

  • Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention. Cooper, et al. July 2020.
  • Eating disorders in times of the COVID-19 pandemic- Results from an online survey of patients with anorexia nervosa. Schlegl, PhD, et al. May 2020.
  • Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: initial results from the COLLATE project. Phillipou, et al. April 2020
  • Eating disorder during COVID-19 pandemic: the experience of Italian healthcare providers. Colleluori et al. October 2020.
  • Children and adolescents with eating disorders during COVID-19 confinement: Difficulties and future challenges. Graell, et al. June 2020.
  • Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders. Branley-Bell, et al. August 2020.
  • COVID19, the pandemic which may exemplify a need for harm-reduction approaches to eating disorders: a reflection from a person living with an eating disorder. Janse van Rensburg. May 2020.