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What Results Has the Pandemic Had on People with Eating Disorders?

It’s hard to believe the world has been coping with COVID-19 for more than a year now. For many of us, it’s hard to believe it’s only been a year – it can feel like twenty years sometimes. In these times, everything has been restricted; we work differently, play differently, and importantly we eat and exercise differently. COVID-19 has affected everybody, and people with eating disorders are no exception to the rule.

So how has COVID-19 and the related lockdowns, quarantines, and general revision of how we go about our lives affected this at-risk population? Reports are starting to come out from various sources, ranging from clinical studies to articles in publications like the New York Times. As it turns out, the pandemic hasn’t exactly helped people with eating disorders manage their symptoms – and eating disorder treatment has become more difficult in several ways.

Changes in the Availability of Residential Eating Disorder Treatment

Residential treatment for eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder has always been the most effective form of treatment, and the most appropriate for more intense cases of these disorders. 24/7 care and total focus on recovery make it so – but it’s a major time and sometimes financial commitment. Since the quarantine began, eating disorder treatment centers immediately began compliance programs with the CDC-recommended COVID protocols, which of course was necessary. However, these measures slowed down the admissions process due to required quarantine periods. They also reduced the number of beds that could be filled due to social distancing requirements.

Because of the difficulties caused by these essential program changes, many people who would have opted for residential or inpatient treatment instead chose an outpatient or virtual option. Per the Times article:

“I’m seeing more clients, and I’m getting clients who are sicker when they come to me, because we cannot get them access to a higher level of treatment,”said Whitney Trotter, a registered dietitian and nurse in Memphis.

The bottleneck caused by these measures has led to increased waitlists for open beds and caused many people with eating disorders to seek a lower level of care than they need. Of course, this leaves many people more at-risk than they would have been if the pandemic had never happened. Another respondent in the Times article mentioned,

“For a patient who would previously have spent the day at a treatment center having all their meals provided for them, a virtual program requires so much more autonomy than they would have previously had,” said Lauren Muhlheim, a psychologist in private practice in Los Angeles.

These changes in residential treatment availability have hampered providers’ ability to get every patient the help they need. However, many eating disorder treatment programs quickly developed and put new virtual programs into place.

Day Treatment and Virtual Sessions Have Become More Prominent

Although it may not be the same as a full 30-day residential program, any form of treatment or therapy is better for a person with an eating disorder than none. Many programs already had a virtual group therapy program available online for graduates – alumni groups centered around aftercare have been considered an important part of eating disorder recovery for decades. Transitioning to a COVID-19-informed methodology has made these virtual meetings even more important, as well as foregrounding day treatment options.

Practicing social distancing and ensuring everyone involved, especially the front-line therapists, nutritionists, and dieticians providing treatment is properly masked and symptom-free has allowed at least a stopgap solution. Many in-person day treatment sessions before COVID would focus on meal planning and preparation with a dietician. When shifted to a virtual session, the responsibility to procure the foods and then prepare and eat them, which would be done together in a “normal” setting, falls entirely on the individual in treatment. Again, although it’s not ideal, it’s better than no treatment at all. The positive note is that since everyone has vastly increased familiarity with Zoom and other teleconferencing platforms, virtual support is a more practiced and useful tool in eating disorder recovery than it used to be.

Social Media and Online Culture Are Changing as Regards Eating Disorders and Body Image

Social media was a central part of many people’s lives before COVID, of course, but the pandemic-driven exodus away from workplaces and entertainment spots has made platforms like Facebook, Twitter, and especially Instagram even more popular. Social media is a double-edged sword; although it can provide support and community spaces for people with eating disorders, it can also expose these groups to diet culture, “fitness” specialists promoting weight loss, and even pro-eating disorder narratives, each of which can act as powerful triggers for disordered eating behaviors. This can be exacerbated by the lack of person-to-person discussion opportunities that can help people process their urges.

At a time where requests for eating disorder treatment are up, and eating disorders are more common than ever (according to one recent study on American and Dutch respondents which indicated a significant increase in restrictive eating behaviors), there has also been an increase in weight-gain fears among the general public. Many people on social media public decry and worry about the “quarantine fifteen,” or weight gain due to staying indoors more. For people with eating disorders, though, these kinds of posts on social media can be powerful triggers to resume disordered eating behaviors. Most people who don’t suffer from an eating or exercise disorder aren’t familiar with the principle of HAES (Healthy At Every Size), which has become the prevailing attitude employed by treatment professionals. This concept focuses on the idea that weight does not determine health (or for that matter, a person’s value). By mainstreaming weight-loss concerns related to lockdown, social media users may inadvertently be promoting justification for disordered eating behaviors.

In 2020 and continuing into 2021, the body positivity movement online has also picked up a head of steam, becoming more and more foregrounded on platforms like Instagram. This movement is also HAES-oriented and centers around the celebration of all body types. There is some controversy over the term since some fat activists argue that the term has been co-opted by thin or “straight-sized” people who do not face the same discrimination that larger people do. However, on the whole, the body positivity movement has served to promote public awareness of fat discrimination and helped more people dispel myths about weight that accelerate negative ideas about overweight people. This movement affects people with eating disorders directly; overcoming “fat-phobic” attitudes and embracing and celebrating a person’s natural weight and eating patterns is central to a complete, long-lasting eating disorder recovery.

What Happens Now That the Vaccine Is Here?

The COVID pandemic has been tough on everyone; as we’ve seen, people with eating disorders have faced unique challenges related to the pandemic. But there’s a shining ray of hope for us all – finally, the vaccines are being distributed and the possibility of resuming our old routines is near. With this comes the real chance of reopening residential programs or restoring them to full capacity. That shouldn’t be the end of how eating disorder treatment has changed because of COVID-19 though; many of the virtual and day treatment eating disorder treatment changes that were forced by the pandemic will serve to provide access to more people who need help than ever.

If you or a loved one is struggling with body image, exercise compulsion, or eating disorders ranging from ARFID to anorexia nervosa, don’t lose hope. The pandemic has set us all back, but there are professionals available to help, whether that’s a residential stay or even a weekly nutrition session done over Zoom. Call us at Rosewood at +1 (800) 845-2211 to find out how we can help.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.
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