As we and several colleagues reported in JAMA Network Open, data from a large national health insurer showed substantial increases in hospitalizations among people with anorexia nervosa, bulimia nervosa, and other eating disorders, such as binge-eating disorder, starting in the second half of 2020.We saw no changes in outpatient visits or hospitalizations for other common mental health conditions like depression, alcohol use, or opioid use, suggesting that the pandemic is having a particular effect on people susceptible to eating disorders.First, messaging about the link between obesity and the severity of Covid-19 and on connections between self-quarantine and weight gain have likely been hard on people susceptible to eating disorders.
These messages may have prompted some to engage in restrictive eating behaviors, such as refusing to eat certain foods or labeling foods as “good” or “bad,” which can lead to more severe weight loss in those with anorexia and to more severe binge eating and compensatory behaviors, such as vomiting or laxative use, among those with bulimia.
Food shopping, an already anxiety-provoking task for individuals prone to eating disorders, became even more difficult.
Being confined at home in close proximity to these foods likely led to increases in mindless eating and snacking for many people, as well as bingeing episodes for those prone to eating disorders, particularly since people had fewer distractions and distance from food.
In one recent study, a majority of patients with anorexia who had participated in treatment in 2019 reported during the pandemic that they had increased concerns about eating, body shape and weight; a higher drive for physical activity; and more loneliness, sadness, and inner restlessness.These five factors likely increased eating disorder symptoms.Stay-at-home orders, remote schooling, and the closure of college campuses may have helped families better identify unhealthy rapid weight loss or binge eating, or more clearly see its psychological burdens, leading family members to seek treatment for their loved ones
In a society where appearance is highly prized, eating disorders are often considered less important and more under the control of those who experience them than other mental health disorders
The pandemic highlights the need to understand the particular triggers for individuals with eating disorders, identify the symptoms, and provide appropriate and early treatment
Allison is a psychologist and professor in the Department of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and director of Penn’s Center for Weight and Eating Disorders
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