Recent Studies on the Impact of COVID-19 on Eating Disorders

This article was written by Registered Nutritionist Sophie Gastman (reviewed by Registered Dietitian Maeve Hanan).

More evidence is emerging about how the pandemic has affected eating disorders (EDs). This article will summarise these recent findings.

Rates of Eating Disorders

Given the massive disruption COVID-19 caused to our daily routines – for example, isolation, food shortages, anxiety-inducing news 24 hours a day, increased messaging around exercise, etc. – it’s not surprising that the prevalence of eating disorders has skyrocketed.

Coupled with the UK’s emphasis on ‘obesity-tackling strategies’ and emphasis on the link between excess weight and worsened COVID-19 outcomes, society has almost created the ideal environment for eating disorders to thrive.

In 2020, the NHS reported that referrals to child and adolescent eating disorder services had doubled in the UK (1). 

On a more worldwide scale, a recent study published in The British Journal of Psychiatry examined the electronic health records of 5.2 million people, primarily in the United States, and discovered that eating disorder diagnoses were 15.3% higher in 2020 compared to previous years. This suggests that the pandemic almost certainly played a role in this significant increase (2). 

Hospital Admissions

A systematic review by Devoe et al. (2022) found that ED admissions increased by 48% on average during the pandemic compared to before the pandemic (3). This increase was more noticeable for child admissions (83%). 

Symptom Severity

ED symptoms, as well as anxiety and depression, were seen to increase during the pandemic; however, the results varied, with some patients’ symptoms improving during lockdown instead . For example, one study discovered that people with anorexia had better mental health and a higher BMI during lockdown (4). 

Whereas another study from earlier this year found that 60% of individuals with EDs experienced their symptoms deteriorating, whilst only 9% showed an improvement during the pandemic (5).  

In line with other research, this review emphasises how variable and individual the impact of COVID-19 has been on those with EDs.

For example, over half the studies reported increased binge eating behaviour during the pandemic, with one study finding that 40% of participants developed new bulimia symptoms; however, this same study also found that 18% of participants experienced less binge eating (6).

Other studies mention that the decrease in bingeing for some individuals was due to limited food availability, whereas those who experienced increased binge eating behaviours attribute it to being at home and preoccupied with food. In fact, 66% of participants in one study felt their ED symptoms were exacerbated by isolation because it gave them more time to overthink their problem and made it easier to conceal signs of their ED, such as weight loss (7). 

Similarly, many studies in this review found increased food restriction among those with EDs during the pandemic; however, some studies found participants experienced fewer symptoms and reported “accepting uncertainty in life” and having a “more flexible lifestyle regarding food,” as well as feelings of COVID-19 being a “wake up call.” (6).  

Healthcare Access

A common theme and contributor to these worsening ED symptoms was access to healthcare and changes to treatment. Issues involved treatment being delayed or shortened, as well as experiencing barriers to seeking professional health care (3). 

Richardson et al. (2020) conducted a study that looked at instant chat messages with the National Eating Disorder Information Centre during the pandemic and found that lack of access, worsening symptoms, feeling out of control, and needing support were major issues that arose (8). 

Media Messages

The media has been seen to play a significant role in worsening the situation for people with EDs during the pandemic (5).

A study by Vuiillier et al. explained how the pandemic was promoted online as an opportunity to exercise more and get fit, which caused people with EDs to feel more pressure and conform to ideals.

There were also triggering messages about the fear of gaining weight during lockdown, which heightened these fears in participants with EDs at a time when gyms and exercise were less accessible (9).  

Disrupted Routines

Another notable theme identified by Richardson et al. (2020) was the negative impact that changes to routine and structure had on those with EDs during the pandemic (8). This loss of structure and control, coupled with triggering messages on mainstream and social media and feelings of loneliness, anxiety and depression exacerbated by lockdown measures was particularly challenging for many people with EDs. 

Free Time

Despite the fact that the pandemic had such a negative impact on those with EDs, some individuals experienced some positives from this. Seven studies found that lockdown measures actually helped some people use their free time for self-care, self-reflection, and avoiding previous triggers, with some also reporting an increase in support from their social networks (3).

Conclusion

According to the latest evidence, it is clear that for the majority, symptoms of ED have been worsened by the pandemic, with key reasons attributed to changes in daily routines as a result of lockdown measures and access to healthcare, messages from the media, as well as general uncertainty and increased anxiety. However, the consequences of COVID-19 on those with EDs are highly diverse, and a minority even experienced some benefits due to the additional time they had to focus on self-care and recovery. 

Overall, it’s important to be aware of just how damaging the COVID-19 pandemic has been for most people with an eating disorder.

If you are looking for support with an Eating Disorder or Disordered Eating, you can find out about our support services here.

References 

1. England.nhs.uk. 2022. Statistics » Children and Young People with an Eating Disorder Waiting Times. [online] Available at: <https://www.england.nhs.uk/statistics/statistical-work-areas/cyped-waiting-times/> [Accessed 19 May 2022].
2. Taquet, M., Geddes, J. R., Luciano, S. and Harrison, P. J. (2022) “Incidence and outcomes of eating disorders during the COVID-19 pandemic,” The British Journal of Psychiatry, Cambridge University Press, 220(5), pp. 262–264.
3. J. Devoe, D., Han, A., Anderson, A., Katzman, D. K., Patten, S. B., Soumbasis, A., Flanagan, J., Paslakis, G., Vyver, E., Marcoux, G., & Dimitropoulos, G. (2022). The impact of the COVID-19 pandemic on eating disorders: A systematic review. International Journal of Eating Disorders, 1– 21.
4. Castellini, G., Cassioli, E., Rossi, E., Innocenti, M., Gironi, V., Sanfilippo, G., Felciai, F., Monteleone, A. and Ricca, V., 2020. The impact of <scp>COVID</scp> ‐19 epidemic on eating disorders: A longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls. International Journal of Eating Disorders, 53(11), pp.1855-1862.
5. Haghshomar, M., Shobeiri, P., Brand, S., Rossell, S., Akhavan Malayeri, A. and Rezaei, N., 2022. Changes of symptoms of eating disorders (ED) and their related psychological health issues during the COVID-19 pandemic: a systematic review and meta-analysis. Journal of Eating Disorders, 10(1).
6. Schlegl, S., Meule, A., Favreau, M. and Voderholzer, U., 2020. Bulimia nervosa in times of the COVID-19 pandemic—Results from an online survey of former inpatients. European Eating Disorders Review, 28(6), pp.847-854.
7. McCombie, C., Austin, A., Dalton, B., Lawrence, V. and Schmidt, U., 2020. “Now It’s Just Old Habits and Misery”–Understanding the Impact of the Covid-19 Pandemic on People With Current or Life-Time Eating Disorders: A Qualitative Study. Frontiers in Psychiatry, 11.
8. Richardson, C., Patton, M., Phillips, S. and Paslakis, G., 2020. The impact of the COVID-19 pandemic on help-seeking behaviors in individuals suffering from eating disorders and their caregivers. General Hospital Psychiatry, 67, pp.136-140.
9. Vuillier, L., May, L., Greville-Harris, M., Surman, R. and Moseley, R., 2021. The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences. Journal of Eating Disorders, 9(1).