Mall Americans are getting used to discussing how pandemic lockdowns and remote engagement have changed our lives. Conversations tend to be mechanical and superficial, like discussing the weather, and often include references to dietary changes or ‘pandemic 15’ jokes to reflect the weight gain from being overweight. sitting too much or too close to homemade bread.
But for a segment of the population, the changes in eating habits linked to the pandemic are no joke. As we and several colleagues reported in the JAMA Network Open, data from a large national health insurer has shown a substantial increase in hospitalizations among people with anorexia nervosa, bulimia nervosa and other disorders of the nervous system. ‘diet, such as binge eating disorder, from the second half of 2020. Hospitalization rates for these conditions have roughly doubled from rates in the previous two years. And people admitted to hospital tended to stay around 50% longer, suggesting the disorders were more severe.
We did not see any changes in outpatient visits or hospitalizations for other common mental health issues like depression, alcohol use, or opioid use, suggesting that the pandemic is having a particular effect on people susceptible to eating disorders.
While it’s not entirely clear to us why this happened, understanding some of the reasons can help families and clinicians recognize these issues earlier and provide appropriate services.
First, posts about the link between obesity and the severity of Covid-19 and the links between self-quarantine and weight gain have likely been difficult for those susceptible to eating disorders. These messages may have prompted some to adopt restrictive eating behaviors, such as refusing to eat certain foods or labeling foods as “good” or “bad,” which can lead to greater weight loss in people with anorexia and depression. more severe bulimia. and compensatory behaviors, such as vomiting or the use of laxatives, in people with bulimia.
Second, especially at the onset of the pandemic, grocery shopping became a more complicated and difficult task due to fears of contracting Covid-19 in public places like grocery stores, the limited availability of certain foods and household items, and rules. and strict rituals for buyers. Food shopping, an already stressful task for those prone to eating disorders, has become even more difficult.
Third, during the pandemic, many people purchased large amounts of processed, prepackaged comfort foods to minimize how often they had to shop and for fear of food shortages. Being confined to the home near these foods has likely resulted in an increase in the number of people mindlessly eating and snacking, as well as binge-prone episodes in those prone to eating disorders, especially more that people are less distracted and away from food.
Fourth, exercise was one of the few activities promoted as safe and healthy during the pandemic. For many people with eating disorders, exercise may have become a way of controlling an out of control situation or a compensatory mechanism for eating. In a 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 diet, body shape and weight; greater motivation for physical activity; and no more loneliness, sadness and inner turmoil.
Fifth, social anxiety, stress, and depressed mood often go hand in hand with eating disorders and have all worsened during this time.
These five factors likely increased the symptoms of eating disorders. But a combination of other circumstances may have made eating disorders easier to discover and, perhaps, more difficult to treat.
Home orders, distance education, and college campus closures may have helped families better identify rapid and unhealthy weight loss or binge eating, or see its psychological burdens more clearly, leading to family members to seek treatment for their loved ones. At the same time, ambulatory care facilities struggling to adapt their operations during the pandemic may not have additional capacity to see these patients when their symptoms warranted a lower level of care, thus delaying treatment and escalating the disorder. of food. Likewise, fears of contracting Covid-19 may have prompted individuals and family members to delay seeking care until symptoms were severe enough to require hospital care.
Food is a big part of life. For people with eating disorders, food and its rituals are also great sources of anxiety. Many people living with these disorders struggled even more during the pandemic. As it evolves and society adapts to a new normal, it is important to recognize the burden the pandemic continues to place on people with eating disorders. In a society where appearance is highly valued, eating disorders are often seen as less important and more in the control of those who experience them than other mental health disorders. The pandemic highlights the need to understand the particular triggers of people with eating disorders, identify symptoms, and provide appropriate and early treatment.
David A. Asch is a physician in internal medicine, principal investigator at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, and executive director of the Penn Medicine Center for Health Care Innovation. Kelly C. 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.