How has the COVID-19 pandemic impacted our relationships with food?
Dr Kate Corrigan, Dr Róisín McManus, and Dr Aileen Murtagh from our Willow Grove Adolescent Unit look at the impact of the COVID-19 pandemic on our relationships with food, some common symptoms of eating disorders, and some ways we can support someone who we think might be developing or living with an eating disorder.
Since the beginning of the pandemic, our lives have been completely upended in ways we never could have imagined. People have found themselves under immense stress, with our lives often unrecognisable from how they were prior to the arrival of this terrible disease.
Impact of COVID-19 on eating disorders
We are still unsure of the long-term effects on mental health from COVID-19, but the general expectation among professionals is that they will be profound and far-reaching. There are indicators that the rates and severity of mental health difficulties are increasing across all clinical settings during the pandemic.
The global pandemic has created the perfect storm for triggering eating disorders or exacerbating pre-existing disorders. The Royal College of Pediatrics and Child Health issued an alert in December 2020 to families and carers to be vigilant for signs of an eating disorder among young people amid reports of a rise in cases across the United Kingdom (UK). A 66% increase in Irish paediatric hospital admissions due to eating disorders in 2020 compared to 2019 has also been reported.
Factors contributing to the rise in eating disorders
There are several factors likely contributing to the surge of eating disorders that we are experiencing. A prominent factor is almost certainly the psychological stress we are all collectively experiencing.
The sources of stress arising from the pandemic are multiple and individualised, including worries about contracting coronavirus, concern for family members, or even the loss of a loved one to the virus. Financial concerns and general uncertainty for the future can also contribute.
Public health restrictions, whilst prudent, meant reduced social supports and social isolation and, therefore, people’s capacity to tolerate stress becomes compromised. Some people may focus on controlling a variable under their personal control - such as food, weight or shape - to manage this stress and anxiety. With all this angst and uncertainty, it is no surprise that people are struggling with their mental health and that cases of eating disorders are on the rise.
This pandemic has been a difficult time for people with a pre-existing eating disorder or who struggle to maintain normal eating habits. The government advice to limit trips to the grocery store, in some cases, led to stockpiling of food in households, which can be overwhelming for people who struggle with binge eating. Equally, anxiety surrounding food availability may have triggered restrictive or starvation behaviours. For some people, limited availability of “safe foods” or specific food items in their meal plan in the supermarkets could induce intense anxiety.
Social media allows for connectivity and shared experience that brings us together, especially at times we are asked to stay apart, but these platforms can often feature unhelpful advice telling us to exercise at home and avoid the “quarantine 15” or “corona-stone”. Such messages can be extremely triggering for someone who is struggling to maintain normal eating habits. For example, an increasing, obsessive focus on exercise can occur. For other people, staying at home and restricting movements can feel lazy and unproductive with excessive control of food utilised to counteract these feelings.
Possible signs of an eating disorder
Some signs or behaviours to look out for if you are concerned about someone or suspect that they may be living with an eating disorder include:
- Change in behaviour, such as skipping meals, excessive discussions around food and related irritability or mood swings
- New, self-imposed rituals or routines around eating or meals
- Eating disordered behaviour, such as playing with food, pushing food around the plate and cutting up food in excessively small pieces
- Increased fluid intake to supress appetite
- Secretive disposal of food (spitting food into a napkin, hiding under cushions or in pockets and so on)
- Frequent weight checks
- Weight loss or gain
- Body checking or viewing reflection in reflective surfaces, such as mirrors and windows, excessively
- Wearing baggy clothes to hide weight loss
- Changes to eating habits, such as cutting out certain food groups, eating in secret, calorie counting, switching to a vegetarian/vegan diet and so on
- Involvement in food preparation but not eating the products themselves; a focus on feeding others (including pets) and not themselves
- Excessive exercise
- Using the bathroom immediately after meals (for self-induced vomiting)
- Excessive interest in online or social media resources on recipes and/or weight loss tips
- Frequent purchasing of laxatives or discovering empty packets
- Physical symptoms, such as cold intolerance, dizziness, low energy, constipation, loss of periods.
Support for someone with an eating disorder
If you are worried that a loved one may be living with an eating disorder, it is important to approach them in an open, non-judgmental manner. Listen to their story and try to understand it. It is important not to invalidate their experience or to comment on their body shape or size. You may find that they are relieved to talk to someone about their struggles.
If you feel that you or a loved one might be struggling with an ED, it is important to get support. Help is available and eating disorders are treatable. Early intervention is important and is associated with faster recovery. Contact your GP who will do a physical and psychological assessment and decide if you need onward referral. Treatment is available in outpatient, day patient and inpatient settings depending on the severity of the illness.
Dr Kate Corrigan and Dr Roisin McManus are Registrars in Willow Grove Adolescent Unit and Dr Aileen Murtagh is our Assistant Medical Director with Special Responsibility for Adolescent Mental Health Services.
Learn more about eating disorders
Click on the arrow beside each question below for more information.
-
What is an eating disorder?
Eating disorders are potentially life-threatening mental health disorders that can affect all aspects of a persons’ life and wellbeing. People with eating disorders may use control of their food and weight as a way to cope with emotional distress. People of all ages and all backgrounds can be affected by an eating disorder, but it is particularly common in young females and adolescents. The table below describes some eating disorders, including Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder and Avoidant Restrictive Food Intake Disorder. Orthorexia is a relatively recently introduced term, but lacks formal diagnostic criteria in current manuals.
A persistent reduction in food intake leading a person to become significantly underweight. This is associated with an intense fear of gaining weight or becoming fat. The person does not recognise that their low body weight is dangerous. They over-value their body shape and weight to the point that they neglect other aspect of their life such as relationships or school work.
Repeated bouts of eating large amounts of food in one sitting (binging) associated with a sense of lack of control. Inappropriate compensatory efforts to avoid weight gain such as purging via vomiting, laxative use, or excessive exercise. Over-valuing body shape and weight.
Repeated bouts of binge eating associated with a sense of lack of control. There is no purging to avoid weight gain. The binge eating is a coping mechanism for difficult emotions. The person typically binges high-calorie food quickly alone and in secret. They will often feel ashamed or disgusted in themselves afterwards. The person may trial multiple diets however often it leads to weight gain.
Avoidant Restrictive Food Intake Disorder
This is a relatively new diagnosis. It is similar to anorexia in that there is a persistent reduction in food intake, leading to a person becoming significantly underweight. However, there is no associated fear of gaining weight or distress about body shape or size.
Orthorexia
This is a relatively new term that does not yet have formal diagnostic criteria; however, general awareness has increased. It involves an unhealthy obsession with eating only ‘clean’ or ‘pure’ foods. As with other eating disorders, the eating behaviour is used to cope with negative thoughts and feelings. Individuals can feel extremely anxious after eating food considered ‘impure’. It is associated with cutting out increasing amounts of food groups (meat, carbs, sugar, dairy and so on). This obsession with healthy diet can impact negatively on work or relationships. Their emotional wellbeing can be overly dependent on their healthy diet.
-
What are the consequences of having an eating disorder?
Eating disorders affect people physically and emotionally. They have the highest mortality and morbidity of any mental health problem. They are potentially life-threatening and can affect all the body systems.
Physical complications include heart problems, such as abnormal heart rhythms or dangerously low blood pressure and heart rate, and they can lead to sudden death. There is also a risk of:
- fertility problems
- fractures
- dry skin
- hair loss
- growth of soft downy hair on the face
- a slowing down of the digestive system, leading to stomach pain and constipation.
Emotionally, eating disorders can make it hard for people to socialise and function normally in their daily lives (school, work, hobbies and so on). Eating disorders negatively affect:
- sleep
- concentration
- self-esteem
- mood
- enjoyment of life.
They are associated with other mental health conditions, including anxiety and depression.
-
How are eating disorders treated during a global pandemic?
Healthcare providers have had to evolve rapidly to continue to provide care to people struggling with an eating disorders, and the pace of change has been remarkable.
There has been inevitable disruption to services during this change, which can be a source of stress for service users.
Changes to service delivery include a shift towards remote working, with many appointments delivered by telephone or video. The use of tele-appointments can interrupt the therapeutic rapport, recognised as crucial to recovery from an eating disorder. People with eating disorders can struggle with their visual image on the screen, avoid video consultations or switch the camera off, prohibiting a visual assessment of their physical health. However, services have adapted quickly to meet these challenges and increased demand, with a focus on compassion and empathy to put the service user at ease.
-
Are people with eating disorders more likely to get COVID-19?
Fortunately, young people infected with COVID-19 tend not to acquire severe disease. However, people with compromised immune systems and medical comorbidities, seen in severe malnutrition, are more likely to become unwell with COVID-19, highlighting the need to protect and treat this group.
Find more information and support
You can learn more about eating disorders here.
You can also find information on eating disorders from the Health Service Executive (HSE), which also provides the HSE Clinical Programme for Eating Disorders App.
Bodywhys is the eating disorder association of Ireland: you can find out more about Bodywhys here. It has a resource for parents on supporting someone with an eating disorder, which you may find helpful.
Further information is also available from the College of Psychiatrists in Ireland, or the Royal College of Psychiatrists in the UK.
Continue to…
Being mindful of mindfulness: a service user’s practice