For Hannah Mayderry, the COVID-19 pandemic felt like “someone pressed the pause button.”

“I’d been rushing through life, and suddenly, I had all this time on my hands,” Mayderry, a licensed mental health counselor and therapist, says in an email. “I thought it was going to be great at first, but then, old demons resurfaced.”

Mayderry, 27, has struggled in the past with disordered eating and body dysmorphia, constantly counting calories and going on multiple diets, including intermittent fasting and hormone-regulating regimens. During the pandemic, her negative thoughts returned, and old patterns again started to take form.

“The quiet moments were filled with critical thoughts about my body and analyzing everything I ate,” says Mayderry, who has dealt with these types of issues since she was 12 years old. “It's almost as if my brain was trying to find something to keep itself occupied, and this was its twisted way of doing so.”

Data indicates Mayderry was not alone in her food-related struggles during the COVID-19 crisis, with its social isolation and exacerbation of mental health issues crashing into America’s diet culture and appetite for social media. A study published last year in JAMA Pediatrics found significant increases in adolescents and young adults seeking both inpatient and outpatient care for an eating disorder after the pandemic’s onset. A separate analysis published in May by the Centers for Disease Control and Prevention showed the average number of weekly visits to an emergency room related to an eating disorder increased 55% from the fall of 2019 to the fall of 2022 among adolescents, with the number up 57% among girls and 37% among boys.

In a 2022 review of dozens of studies from various countries, researchers from Australia concluded the pandemic “likely led to an increase in eating disorders and disordered eating behaviors,” and pointed to children, adolescents and people with a history of an eating disorder as potentially vulnerable.

“Increased stress and uncertainty associated with the pandemic have potentially created a ‘perfect storm’ for eating disorder deterioration,” states the review, published by the journal Frontiers in Psychology, though authors noted their study was limited by the quality of much of the research analyzed. “Some people who have previously been in ‘recovery’ have relapsed and others at risk have developed new eating disorders.”

Unbiased and Overlooked

Eating disorders include conditions such as anorexia nervosa, bulimia nervosa, binge eating disorder and restrictive food intake disorder, and can impact individuals regardless of race, age, sexual orientation, gender identity or socioeconomic status. Some people, like Mayderry, can grapple with disordered eatingbehaviors like food avoidance and binge eating that may not rise in scope and severity to the level of an eating disorder but can still be harmful.

Research indicates 28.8 million Americans alive as of 2018-2019 will have an eating disorder at some point in their lifetime, and the toll can be devastating: Some 10,000 people are estimated to have died in association with an eating disorder in 2018-2019 alone, and sufferers can face an elevated risk of suicide.

Those in marginalized communities may face an enhanced struggle: A past study found college students of color were less likely to be diagnosed with an eating disorder than their white peers, with separate research indicating ethnic minorities were less likely to be asked about eating disorder symptoms by a doctor. A report from the American Academy of Pediatrics also notes that “increased rates of disordered eating may be found in sexual minority youth” – such as gay, lesbian or bisexual youth – and that “transgender youth may be at particular risk.”

“There are so many eating-disordered people who aren’t getting help when they need it and aren’t being diagnosed properly,” says Kimberly Gomer, a Miami-based dietitian and nutritionist. That includes those who don’t fit the traditional stereotype of a person with an eating disorder: “When you present as an overweight person, oftentimes doctors and dietitians will not ask or just assume that you don’t have an eating disorder.”

Gomer feels eating disorders are often overlooked by clinicians due to a lack of care and knowledge. “Because people have the mindset of thinner being better or healthier and are only looking at (body mass index) charts to determine health, people are often misdiagnosed, causing them to not get the treatment they need,” she says. But “we know from research that there are people who are overweight that are eating less than thinner people. Everyone has different body types and it’s important to look at people holistically.”

For Lauryn Shell of Charlotte, North Carolina, the pandemic spurred a struggle with disordered eating habits that spiraled from “counting calories and categorizing food” to “a form of extreme dieting and losing weight fast” – a departure for someone who used to love to try new restaurants and then became afraid to do so.

“I was always writing down what I ate and how many calories I consumed per day and doing that math constantly,” says Shell, 24, who eventually found help through physical activities such as running. She also worked on focusing less on caloric consumption and more on the nutritional value of food. “It had a negative effect on me because I got to a point where I was so scared to eat. When you don't look at food as energizing, or think about the nutritional value it brings, food becomes almost like an enemy.”

Weight Loss and Social Media

To be sure, such issues pre-dated the pandemic. But the COVID era fostered anxiety, depression and unhealthy eating habits along with increased use of social media, where users could find calorie-focused content or videos glorifying a low body weight.

An analysis published in 2022 by researchers at the University of Vermont found that out of 1,000 TikTok videos gleaned from popular nutrition, food and weight-related hashtags in September 2020, about 44% dealt with weight loss and some 20% showed a person’s specific weight transformation. Among videos with the “nutrition” hashtag, about half offered advice – including on what to eat to lose weight – and they overwhelmingly came from people who were not registered dietitians.

“The glorification of weight loss across many videos, and the reoccurring suggestion that if you just try hard enough you can lose weight too, undoubtedly elevate the key principles of weight normativity, and may reinforce to viewers the belief that weight is an important indicator of health status and overall self-worth,” researchers wrote.

Christine Peat, an associate professor in the University of North Carolina–Chapel Hill Department of Psychiatry and director of the UNC-based National Center of Excellence for Eating Disorders, says social media undoubtedly fueled eating disorders among youth during the pandemic, pointing to congressional testimony from Facebook whistleblower Frances Haugen. Haugen said algorithms used by the company caused teenagers to be exposed to potentially harmful eating disorder content.

Separately, a report published last year by Boston-based nonprofit FairPlay identified a pro-eating disorder “bubble” on Instagram – owned by Meta, also the parent company of Facebook – that was tied to approximately 150 accounts and roughly 90,000 users, with a reach of about 20 million unique followers.

“There is a real need for better safeguards for children and adolescents when it comes to social media,” says Peat, who also blames the rise in eating disorders during the pandemic on the normalization of extreme diet culture and an overall fixation on being thin.

“When the initial part of the pandemic happened, there were all kinds of news pieces and social media posts about avoiding ‘the quarantine 15’ in addition to folks indicating that quarantine was a great time to start a new exercise regimen,” she says in an email. “When this kind of rhetoric is part of the backdrop of everyday discussion, it becomes the norm to think about food in these ‘good and bad’ ways and engage in risky dieting behaviors.”

Social media platforms have moved to combat eating disorder content through steps such as removing potentially harmful posts. A TikTok spokesperson, for example, says 86% of videos removed due to disordered eating content violations from April to June 2023 were taken down before being reported by a user and 82% were removed within 24 hours of being posted. When users have searched for a hashtag like #anorexia, the platform also has directed them to support through resources like the National Alliance for Eating Disorders helpline.

Instagram similarly offers users a path to the alliance and says it will remove content that promotes eating disorders. And some social media users themselves who have suffered from eating disorders have sought to spread awareness in order to help others.

Still, concerns about social media led to an advisory by the U.S. surgeon general in May, warning that “extreme, inappropriate, and harmful content continues to be easily and widely accessible by children and adolescents.” Later in the year, dozens of states sued Meta, accusing the company of fostering social media addiction among youth, unlawfully collecting children’s data and recommending problematic content, including content related to eating disorders. Meta at the time said it had “introduced more than 30 tools to support teens and their families” and was “disappointed” with the approach taken by state officials.

Similar lawsuits targeting TikTok have been filed by some states, while school districts around the nation have also attempted legal action against social media giants.

Solution Attempts and Aftermath

States have moved to curb the crisis in other ways as well. Colorado lawmakers, for instance, approved a bill limiting insurers’ use of BMI measurements in assessing the need for care for a person with an eating disorder and prohibiting the sale of over-the-counter diet pills to people under 18. Lawmakers also approved the establishment of a “disordered eating prevention program” within the state’s Department of Public Health and Environment.

Legislation approved in Texas states digital service providers must “develop and implement a strategy to prevent” minors from being exposed to harmful content – including material promoting eating disorders – and create tools allowing for parental supervision. Legislation approved in Utah that’s set to take effect next year requires parental consent for a minor’s use of a social media account and creates an overnight social media curfew for kids, though a similar law requiring parental consent in Arkansas was halted by a federal judge.

Yet eating disorders are likely to remain a struggle for many in the post-pandemic world. Research based on private health insurance data showed claim lines for eating disorders rose by 39% as a percentage of all medical claim lines from 2019 to 2020, with further but smaller increases of 10% and 6% occurring in 2021 and 2022, respectively. Between 2018 and 2019, that increase was 2%.

“I believe that individuals who are already susceptible both physically and mentally to eating disorders or disordered eating will commonly react when they have added stress,” Gomer says. “Many people are still under a lot of stress due to the strain of the pandemic that either is still with them physically – through long COVID symptoms remaining – or just the reality of how they were affected by the pandemic.”

Notably, some research and anecdotal reports also indicate that symptoms tied to COVID-19 – such as sensory loss – may play a role in the development or exacerbation of an eating disorder.

Early identification, mental health care and treatment can be key to combating such conditions. For children specifically, Dr. Dina Peralta-Reich – a pediatrician and director of New York Weight Wellness Medicine – says a robust support system is “crucial.”

“It is essential to have various sources of support that address the multifaceted needs of the child,” she says. “This includes supportive parents, as well as a team of health care professionals such as therapists, nutritionists and primary care doctors.”

For Mayderry, the mental health counselor whose past struggles resurfaced during the pandemic, her “old demons” spurred her to return to therapy, a decision she says allowed her to “actively invest my time in healing rather than allowing myself to get lost in the negative chatter.”

“It’s crucial to recognize when you need help and not be afraid to seek it. Surround yourself with support, be it through therapy, loved ones or engaging in activities that bring you joy and peace,” Mayderry recommends. “There's no one-size-fits-all solution, and the journey to acceptance and healing is unique for each individual. When you feel like you are backsliding, take it as an opportunity for even deeper healing.”

Copyright 2023 U.S. News & World Report

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