The Rise of Eating Disorders During a Global Pandemic: How to Develop Nourishing Nutritional Habits

 

Many people are reporting the following nutritional challenges during this pandemic:

  • Food insecurity
  • Social isolation (no one to help with meals)
  • Chronic stress
  • Increased/Decreased appetite 
  • Unstructured eating
  • Missed meals
  • Late night eating
  • Grazing in response to stockpiles of food around
  • Eating out of boredom
  • Increase consumption of alcohol

Movement

Plus, there have also been changes in physical activity. Team sports are cancelled.  Traditional fitness classes are not happening.  But it’s not all doom and gloom with activity. Many people are getting out more than they were before, and some of my athletes are now doing even more than they were before. A basketball player I saw just the other day, was originally training 5d/week before the pandemic. She had switched to training 7days a week during the shelter in the place and was doing multiple training sessions a day – I actually had to tell her to cut back.  Too much exercise and not enough nutrition can suppress the immune system and cause other concerns such as fatigue, low heart rate, delayed growth, hormonal suppression (including low estrogen and testosterone), gastrointestinal concerns, performance declines such as poor recovery, poor muscle growth/strength, and failure to make progress.  Some exercise is immune boosting but too much without proper fueling can suppress the immune system.  Plus, there is a post-exercise immune function dip when exercise is prolonged over  > 1.5 hours/ and when intensity is moderate to high [1]. So now is not the time for your marathon training!  

Increased Risk of Eating Disorders

Concern over eating disorders and mental health appear to be on the rise during these past few months during the shelter in place orders.  In March and April 2020, the National Eating Disorders Association, or NEDA, saw a 78 percent increase of calls on their helpline compared with the year before. Similarly, there was a 75% increase in conversations around eating disorders on the Crisis Text Line, a nonprofit organization that provides mental health support by text, since March [2]. 

Food insecurity correlates with eating disorders and has been dramatically increased during the pandemic.   Likewise, eating disorders are also associated with chronic stress, and trauma, which clearly have been heightened during this time as well.  Of note, these risk factors of food insecurity, chronic stress, trauma, are all disproportionally higher in the black community and other marginalized groups, so these groups might be at an even greater risk of developing an eating disorder during the pandemic, though it’s written and spoken about it much less, if at all.

As eating disorders rise, patients, parents, coaches, trainers, clinicians have to be on the lookout for disordered symptoms (see below).  Probably one of the most important thing to know about eating disorders is that they can occur in anyone. There is no one “look.” They affect people in all sized bodies, of all ages, genders, ethnicities etc. Body size means nothing, zero, zilch, about whether a person is sick, or the degree to which a person is struggling to eat.  Clinicians must be on the lookout to be able to detect these issues in all patients.  

What to Look For:

Eating disorders may involve eating too little (restriction), eating too much (binging), vomiting or excessive exercise after eating (purging), or all of the above. For some people there is dramatic and noticeable weight loss, and for others there is no change in weight but instead there are profound medical complications associated with their eating disorder symptoms. There are several other signs as well that may be occurring which may give people a clue that something may be wrong. A person with disorder eating patterns may exhibit one or more of these signs at any given time:  

  • Increased interest in food and exercise (become a red flag when it turns into an obsession).
  • Sorting foods into “good foods and bad foods” and talking about being “scared” or “fearful” of foods.
  • Increased focus on body and shape (some of this is normal during adolescence, but a high degree of distress and preoccupation would be concerning).
  • Body checking (repeatedly touching, examining, dissecting body in mirror.)
  • Weight loss
  • Loss of menstrual cycle (*For males, testosterone levels may be suppressed and can be assessed via bloodwork by an MD).  
  • Obsessive thinking
  • Increased rigidity and lack of flexibility around food/exercise or routines
  • Lack of spontaneity around food
  • Reduction in number of foods they used to eat
  • Lack of variety in diet – a change from previous
  • Avoidance of social situations, especially where food is involved
  • Compensatory behaviors (this is defined as a behavior that is used to eliminate the calories consumed. It is a hallmark feature of Bulimia Nervosa, but is also present in other types of eating disorders as well such as Anorexia Nervosa or Binge Eating Disorder. Compensatory behaviors can be vomiting after meals, excessive exercise, misuse of laxatives, diuretics, diet pills, and teas, or it can be a period of food restriction).

 The Effect of Dieting on Eating Disorders

Despite a global pandemic going on in the background, many are very concerned about impact of their eating habits on their weight. A study conducted by the University of Missouri School of Social Work found that among a sample of almost 900 young adults, over 40% felt it would be worse to gain 25 lbs during social distancing than to be infected with Covid.

Our society riddled with fatphobia, despite a lot of evidence that people can be healthy in larger bodies.  Kids get the message quickly that “thin is good” and “fat is bad.”  Kids are obsessed w/ “6 pack abs,” “chiseled biceps” or are consumed with having a “thigh gap.”    The wt loss and dieting industry is a 72 billion market, yet 95% of diets fail. The failure of diets is part of what drives the economics of the industry’s success; people feel like they have to keep coming back for a different strategy. 

An eight year study, published in 2019 by Stice and colleagues[3], found that a primary risk factor for the development of an eating disorder is a “perceived pressure to be thin,” so this stress  is real and can life threatening should an eating disorder develop.   The National Eating Disorders Association (NEDA) states that young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers [4]. A study of nearly 17,000 children, ages 9-14, found that dieting was a significant predictor of weight gain  and led to increased rates of binge eating in both girls and boys [5].

What to Do:  

If you have concerns about the behaviors of someone you know, bring them in for a physical exam at a medical provider’s office.  A comprehensive exam is a great place to start, but remember, not all of these concerns will show up on a medical exam. The next stop might be a referral to an eating disorder specialist, like a therapist, dietitian, or both.  But don’t delay! We know the prognosis is best for eating disorders when treatment is started earlier.  

Develop Nourishing Habits 

So instead of focusing of  weight loss, or beginning the keto diet, or an intermittent fasting protocol, I ask my clients to develop sustainable nutritional habits that pull from a variety of domains – this is all preventative and protective against the development of eating disorders and disordered eating.  

This includes working on:

  • Managing emotions, stress
  • Maintaining good sleep schedules
  • Reducing screen time usage
  • Reducing alcohol consumption (for adults)
  • Including joyful movement
  • Establishing regular and consistent meal patterns that include family meals
  • Learning to eat intuitively

What is a Meal?

Establishing regularity in a meal schedule is harder is than it sounds. Meals generally look like:

  • Many different food groups paired together
  • To fill out a plate
  • To make a complete meal
  • That is both enough in volume
  • Complete in nutrition
  • And also yummy

When people actually do that, they graze less, find themselves more in tune with their appetite, and the needs of their body.

HUNGER METER

I also teach clients to use a hunger meter, a tool that teaches them to assess hunger and fullness cues. The scale goes from 1-10, where 1 is Starving and 10 is Stuffed. 

1: You can’t think clearly. Irrational. Likely to eat beyond the natural stopping place.

3-4: A great place to be when deciding to eat meals. Likely alittle twinge in your stomach.

6-7: A great place to stop. Full, but not too full. Comfortable.

9: Getting to a place of Thanksgiving day stuffed….

So before panicking and starting on a nutritional path that might be short term and also risky for the development of an eating disorder, think about what nutritional habits you might be able to tweak which would give you success over the long term.  

 

 

 

 

 

 

 

Video Clip on Instagram from Cornell Lecture May 2020

 

RESOURCES

[1] Intense Exercise Training and Immune Function.  Nestle Nutr Inst Workshop Ser. 2013;76:39-50. Epub 2013 Jul 25.

[2] https://www.nytimes.com/2020/06/05/health/eating-disorders-coronavirus.html?searchResultPosition=1

[3] Stice E, Ryzin MJV, A Prospective Test of the Temporal Sequencing of Risk Factor Emergence in the Dual Pathway Model of Eating Disorders. Journal of Abnormal Psychology Journal of Abnormal Psychology, Vol 128(2), Feb 2019, 119-128.

[4] NEDA https://www.nationaleatingdisorders.org/statistics-research-eating-disorders

[5] Relation Between Dieting and Weight Change Among Preadolescents and Adolescents.  Pediatrics  2003 Oct;112 (4):900-6.

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