COVID Isolation, Anxiety 'Really Reinforce' Eating Disorders

Judi Kanne

August 13, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The COVID-19 pandemic has proved a perfect storm for eating disorders, experts say.

Lockdowns to limit the spread of infection have made Americans more isolated from one another while increasing their anxiety. Psychologists say the emotional impact of that has driven many people into binge eating and weight gain, while for some it has provoked the serious mental health conditions of bulimia and anorexia nervosa.

At least 30 million Americans suffer from some type of eating disorder, and the problem is not limited to any demographic category, according to the National Association of Anorexia Nervosa and Associated Disorders.

People with anorexia nervosa avoid food or restrict their eating so thoroughly that they get very little nutrition. They can become dangerously underweight. With bulimia nervosa, people often eat large amounts of food, then follow it up with forced vomiting, excessive use of diuretics, fasting, laxatives and even excessive exercise.

Eating disorders vary, and it's not always obvious to others that a person is suffering from such a condition. "It's one of the tricky things in the eating disorder world that weight does not necessarily indicate health and wellness," says clinical psychologist Laura McLain, director of the Renfrew Center of Atlanta, which specializes in the treatment of eating disorders.

"When we think about eating disorders — patients typically thrive in their illness often by secrecy, isolation, disconnection from others. The pandemic really reinforces these unhealthy coping skills," McLain says.

"We know that people are struggling," she says. "But there's still hope people can receive support."

She says many patients are now getting virtual therapy, which means they don't have to deal with the stress of driving to an appointment or entering an unfamiliar building.

In March and April, the National Eating Disorders Association (NEDA) saw a 78 percent increase in messages sent to its helpline compared with the same period last year.

A spokeswoman for NEDA, Chelsea Kronengold, says "social distancing and being quarantined is extra challenging for folks with eating disorders for many reasons."

She refers to a survey of about 1,000 individuals in the United States and the Netherlands. It confirmed challenges such as a lack of structure in daily life, spending more time in a triggering environment, and trouble finding privacy for teletherapy and other forms of virtual support, Kronengold says.

Stockpiling of food at home because of lockdowns can be a temptation to overeating for the average individual. But some people with eating disorders may actually avoid keeping the necessary food stocks on hand, experts say.

"Our patients tend to socially isolate anyway. They have social anxiety. Many times they're depressed," says Nancy Zucker, who directs the Duke Center for Eating Disorders in Durham, N.C.

"The very real worry about contracting the coronavirus can serve as a crutch to further isolate and restrict food,'' Zucker says in a Duke Health article. "Self-deception is such a dangerous thing on the best of days. It would be so easy to talk oneself into the fact that, 'No, it's safer for me to stay inside and not go out and get food.' "

For that reason, it's important to push for specifics about how people are living, Zucker says. If patients say they have enough food at home, Zucker and her colleagues will ask for details about what's in the refrigerator and on their cupboard shelves.

As noted in the U.S.-Dutch survey, some sort of structure in one's life is important to patients. "When someone is recovering, one of the things that protects them are schedules and routines, filling the space, and kind of suffocating out the eating disorder," Zucker says.

Dr. John Morton, medical director of bariatric surgery for Yale New Haven Health System, says he's seeing patients via telehealth who have gained up to 30 pounds recently. He says it can happen within months.

But there's more to weight gain than is reflected in the mirror. The CDC says severe obesity increases the risk of a dangerous breathing problem called acute respiratory distress syndrome (ARDS), which can be a serious complication of COVID-19.

And people with severe obesity are more likely to have other chronic diseases and health conditions that can increase the severity of COVID-19 itself. Gaining weight and becoming an obesity statistic is never a good option, experts say.

An Illness, Not a Choice

Maintaining a healthy lifestyle should be of concern to everyone, and most people can manage their weight with the proper measures. Eating disorders, however, are not a lifestyle choice, the National Institutes of Health says. They are biologically influenced illnesses.

Treatment plans for eating disorders include psychotherapy, medical care and monitoring, nutritional counseling, medication or a combination of these approaches. Goals include restoring adequate nutrition, bringing weight to a healthy level, reducing excessive exercise, and stopping binge-purge and binge-eating behaviors.

Patients struggling with a relapse during the current pandemic can build action plans for times of unusual stress. There should always be a friend to call or a therapist to consult with. Having a daily routine to follow is also helpful, many experts on eating disorders say.

If there's a silver lining in this pandemic, it's the fact that there are more virtual treatment and support options available now, "which is great for people who were previously unable to access in-person treatment," says Kronengold.

In addition to a confidential and toll-free helpline, NEDA has created a list of free or low-cost resources related to eating disorders: .

"We know isolation is already an issue in individuals with eating disorders," says McLain.

An increase in stress and anxiety prompts some type of eating disorder behavior, "whether it be restricting, binging, purging, anything that might come up as an eating disorder" may resurface, says McLain.

"Oftentimes, our patients are in survival mode. They are likely to avoid going certain places, or avoid eating around certain people, and choose to miss social situations as much as possible," she says.

"The truth is, we are not really built to deal with a pandemic in general, coupled with somebody that might already have this level of anxiety and depression. Plus an eating disorder that's been diagnosed — or even not diagnosed," states McLain.

"It just makes everything that much more distressing or overwhelming."

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.