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8 ways the COVID-19 pandemic has impacted people with eating disorders

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The COVID-19 pandemic has been challenging for everyone, but even more so for people with underlying health conditions such as eating disorders.

"We can – and should – strive to learn from peoples experiences during the pandemic and work with individuals with lived experience of eating disorders to work towards improved healthcare infrastructure and technologies for the future."
Dr Dawn Branley-Bell

Disruptions to daily life including reduced access to healthcare and social isolation have exacerbated eating disorder symptoms for many, and the transition to remote healthcare has highlighted health inequalities throughout the country.

Dr Dawn Branley-Bell is a health and cyber psychologist from Northumbria University, undertaking the RHED-C project to help us understand how services can be improved for people with eating disorders in the UK.

Just two weeks after lockdown restrictions were enforced, Dr Branley-Bell began online surveys with over 120 people with eating disorders to understand how life had changed for them.

From this early research, Dr Branley-Bell found that an overwhelming majority reported that their eating disorder symptoms had worsened as a result of the pandemic, with over 30 per cent reporting that their symptoms were much worse. She uncovered eight key reasons for this:

1. Disruption to normal living situation

Changes in normal living situations were found to be a key factor for people whose eating disorders symptoms had worsened. Many people found themselves suddenly spending prolonged periods of time with partners or family members, for some individuals this led to increased stress. Reasons for this stress included feeling that they had to hide their eating disorder, facing pressure from others to eat more, and losing control of their diet.

One participant commented: “I’m trapped at home with people who don’t know I have anorexia. I am hiding and lying constantly.”

2. Increased social isolation and reduced access to usual support networks

Many people reported feeling more socially isolated due to the pandemic. For people with eating disorders, family and friends constitute an important support system for their recovery, holding them accountable and being available for eating meals together.

Comments from participants included: “Not seeing those close to me who would recognise my losing weight and deterioration has put me under less pressure to challenge my eating disorder.”

3. Changes to physical activity rates

With gyms and exercise facilities closing, many people reduced their physical activity throughout lockdown. However, Dr Branley-Bell’s survey found that over 35 per cent of people with eating disorders increased their physical activity levels, driven by worries about weight gain and inactivity. Dr Branley-Bell was involved in subsequent research which suggests that governmental emphasis and public preoccupation with weight gain during the pandemic may have helped to exacerbate this.

4. Reduced access to healthcare services

A major challenge throughout the pandemic has been reduced access to healthcare services, particularly for people with eating disorders, who reported being prematurely discharged from inpatient units, having treatment suspended or remaining on a waiting list for treatment, and receiving limited post-diagnostic support.

While remote care was utilised in some cases, it often fell short of treatment and support received in-person and was described as a ‘postcode lottery’ as to whether it was available or not at the start of the pandemic.

Remote services also raised their own, perhaps unexpected, issues. For example, some participants felt that seeing their own video during the call made them more aware and more critical of their appearance; and some were concerned about being asked to self-weigh by healthcare professionals.

5. Disruption to routine

For many, keeping to a regular routine is vital for eating disorder recovery and relapse prevention. Unfortunately, many routines were significantly impacted by lockdown, potentially creating more time to worry about weight, exercise habits, and meals.

6. Increased exposure to triggering messages

Over 80 per cent of participants reported spending more time online during the pandemic, exposing them to more triggering messaging around weight. Examples include the general public’s “fear of gaining weight” during lockdown and increased availability of “daily exercise” content such as free YouTube workouts.

Whilst public health initiatives that promote healthy eating and exercise might be beneficial for some members of the general public, Dr Branley-Bell’s subsequent research suggests that a focus on exercise and food can be triggering for people with eating disorders.

7. Changes to the individual’s relationship with food

The lockdown changed shopping habits across the population, with some having a shortage of certain foods in the house and others having excess amounts if they had stocked up.

For some people with eating disorders, the perceived scarcity of food during the early weeks of the pandemic caused then to feel guilty for eating food, saying they felt “less deserving” of food than other people, giving them a way to rationalise their food restriction.

Others felt more likely to binge-eat due to increased access to food in the household. And many reported increased levels of thought over their food intake. There were also issues related to people not being unable to purchase “safe foods”, i.e., those that they feel comfortable eating – again negatively impacting upon their recovery.

8. Positive outcomes

Despite the challenges of managing an eating disorder during the pandemic, it is important to recognise that there were also some positive outcomes. Some people reported increased use of the internet to access support groups, less comparisons with others due to social isolation, more support from family members at home, and the ability to wear more comfortable clothing. However, the majority of those surveyed about their experiences reported increased pressures and stress due to the pandemic.

Looking to the future

Ultimately, Dr Branley-Bell’s research has shown that there is a vital need for improved healthcare interventions to support people with eating disorders exacerbated by the current pandemic. There is also an important need to recognise the benefits of remote care (for example increased accessibility to support for some individuals). Remote care will continue to be important in the future, not just in relation to the pandemic.

Dr Branley-Bell’s ongoing RHED-C project will involve working with individuals with eating disorders and healthcare professionals to co-design effective remote healthcare solutions and technologies for people with eating disorders – with the aim of ensuring they are better supported to reach and maintain recovery.

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Dr Dawn Branley Bell1 Dr Dawn Branley-Bell

Dr Branley-Bell said: “The pandemic necessitated an unforeseen rapid transition to remote healthcare and support. Unfortunately in many cases, healthcare provision was not adequately advanced or prepared for this transition."

"However, we can – and should – strive to learn from peoples experiences during the pandemic and work with individuals with lived experience of eating disorders to work towards improved healthcare infrastructure and technologies for the future. This is what we aim to do during the RHED-C project”

You can find out more about the RHED-C project online or follow the project on Twitter.

If you need help and support in relation to yourself or a loved one experiencing eating disorder symptoms, please contact BEAT for information and support.