Story By Julia Masters
Graphics By Valentina Arismendi
Isolation, uncertainty and stress: all exacerbated by the pandemic and all triggers of an eating disorder.
Every 52 minutes, someone in the world dies of an eating disorder, making it the second deadliest mental illness, and an alarmingly common one—as a minimum of 9 percent of the world’s population suffers from them.
College students are at heightened risk of eating disorders. Between 10 and 20 percent of college women and between 4 and 10 percent of college men will have one, according to the National Eating Disorders Association.
“Eating disorders and disordered eating are more likely to occur at times when your physical body is changing in some ways because there’s a readjustment that has to occur,” said Dr. Rachel Rodgers, associate professor of applied psychology at Northeastern University and director of the Applied Psychology Program for Appearance and Eating Research. “College is also for many a time when they first leave home and so they are establishing independent patterns and that kind of increases anxiety.”
Beyond this, the focus on appearance on a college campus can be toxic and may help eating disorders develop.
“It seems like part of the culture to talk about wanting to lose weight or being on some kind of diet, trying to avoid the ‘freshman 15,’” said Dr. Christine Peat, a clinical associate professor in the Center of Excellence for Eating Disorders at UNC-Chapel Hill and the director of the National Center of Excellence for Eating Disorders. “We know that that might kind of tip the scales in the balance of developing an eating disorder for individuals.”
Impacts of the pandemic
These pressures were increased last year when COVID-19 changed all aspects of everyday life.
When COVID-19-related restrictions were put in place, 62 percent of people with anorexia in the U.S. said their symptoms worsened, and many with a binge-eating disorder reported an increase in episodes, according to a survey by the International Journal of Eating Disorders.
The UNC Center of Excellence for Eating Disorders had a 30 percent increase in referrals soon after stay-at-home orders were enforced last March.
“Eating disorders thrive in isolation, and the public health measures that were/are absolutely necessary to contain the pandemic, created isolation for many individuals — perfect conditions for eating disorders to flourish and even for relapses in individuals who had recovered,” said Dr. Cynthia Bulik, founding director of the UNC Center of Excellence for Eating Disorders.
Dr. Stephanie Zerwas, an associate professor of psychiatry at UNC-Chapel Hill and founder of Flourish Chapel Hill, said that the pandemic increased three main eating disorder triggers: uncertainty, transition and isolation.
Anxiety and stress are two other factors that may trigger eating disorder behaviors, restriction for some and binging and purging for others.
“There have been increases in anxiety, loneliness and depression and at the same time, many people have been deprived of the things that generally help them to regulate such emotions,” Rodgers said.
For many college students, the pandemic changed their living situations. Those who did stay on campuses had to figure out how to find food that would fit in with their recovery meal plan and how they could stay on track during the new normal, Bulik said. The pandemic led college students on campus to stockpile foods that for people with binge-type eating disorders, are considered trigger foods—power bars and cereal, for example.
“For students who ended up back at home with their parents, it was also challenging because they may have already had a taste of living on their own and being in charge of their own recovery, and going back home can mean falling back into old patterns,” Bulik said, adding that a lack of privacy for virtual therapy sessions while at home was also a problem.
When dormitories shut down many students moved to apartments, often for the first time. This means they went from having meals ready at dining halls to having to plan, prepare and stock their own food and pantries. The resulting increase in food-related thought could be a trigger for someone with an eating disorder, Zerwas said.
According to the survey by the International Journal of Eating Disorders, 26 percent of U.S. respondents said that they had binged on food stockpiled for quarantine once or twice, 29 percent said frequently, and 19 percent said once a day or more.
Similarly, 22 percent said that COVID-19 related factors caused them to practice compensatory behaviors—self-induced vomiting, excessive exercise, misuse of laxatives, etc.—once or twice, 20 percent said frequently and 15 percent said daily.
Another major influence in eating disorder and disordered eating behavior is social media, which often creates issues with body image and promotes unrealistic diet cultures.
Peat said that social media may make college students feel pressured to look a certain way and maintain the images of their peers.
A Harris Poll conducted in 2020 found that 51 percent of respondents said they were using social media more since the pandemic hit—60 percent of poll participants were ages 18 to 34.
“Because people are only showing this very edited version of themselves online, you’re not necessarily seeing how they would look in real life,” Zerwas said. “Not only that, so many people follow actresses and actors and models and Instagram influencers whose whole job is to present their body in a certain way.”
Focusing on these curated images online coupled with more time to dwell on food and unstructured time to exercise has led to unhealthy and worsened habits, Zerwas said.
Online classes, virtual meetings and remote jobs force people to see themselves in camera more often than before and may lead to an increased concern of how they and their image are perceived by others, Rodgers said.
How to Help
The signs that someone is struggling with an eating disorder or disordered eating vary from something subtle like not wanting to eat out to more dramatic signs like rapid weight loss.
Changes in mood such as increased irritability, detachment and less willingness to engage socially could be non-physical signs of a developing eating disorder.
“Those kind of subtle things are really important to keep in mind, because again, eating disorders are conditions that people really oftentimes want to keep secret. They want to hide it,” Peat said.
Obsession with diets and clean eating, avoidance of meals especially in social settings and increased negative comments about body image are more behavioral clues that someone is struggling.
It is also important to recognize that eating disorders can occur in people with bodies of all shapes and sizes and that you cannot accurately assess a person’s health just by the way they look from the outside, Rodgers said.
The way that we talk about ourselves, appearance, food and exercise and the things we normalize in our social circles can have tremendous effects on people struggling with eating disorders or disordered eating.
On college campuses, discussions about skipping meals to look better at a party and ‘saving calories for later’ and fat talk are often daily occurrences.
As people see friends they haven’t seen for a while, it is important to avoid appearance based comments, even positive ones, as it could enforce unhealthy behaviors, Peat said.
“Those comments are really harmful because it reinforces this idea that what’s important about you is the way that you look,” Peat said. She added that it is crucial for friends to not try and out-do each other in terms of exercise and diets.
In this unprecedented time, it is imperative to not let isolation fuel one’s eating disorder, Bulik said. She said that staying connected to support circles, treatment teams and plans, and taking advantage of online resources like ‘Morningside Chats in the Living Room’ should be a priority.
“I think that it’s important that overall we recognize that the pandemic has been incredibly difficult for people with mental health,” Peat said. “It is really important that we collectively start to think about how we address some of the mental health effects of a pandemic, and that’s no short order. That’s something that we’re going to have to deal with for years to come. The more we openly talk about that, the more that we can encourage people to seek professional help when they need it.”
This is a fantastic article – very informative with clear action to support those in our community who may struggle with this.