Eating disorders and obesity (ED&O) in the COVID-19 storm

Exploring the COVID-19 pandemic's influence on eating disorders: insights from an Italian residential center

Introduction

The COVID-19 pandemic has significantly impacted global mental health, exacerbating the prevalence and severity of Eating Disorders (EDs). This study evaluates changes in the presentation and severity of EDs before and after the pandemic at the Regional Residential Center "Mariconda" in Salerno.

Methods

This retrospective cohort study analyzed records from 162 patients admitted to the center between December 2018 and December 2023. The onset of pandemic restrictions in mid-2020 divided the subjects into pre-COVID and COVID groups. Data collected included age, gender, education level, previous hospital admissions, admission diagnoses, body mass index (BMI), and comorbidity with other psychiatric conditions.

Results

Among the 162 subjects, 115 (71%) were admitted during the pandemic period. This group was significantly younger (mean age: 18.3 vs. 20.6 years, p = 0.009), had lower educational attainment (67% vs. 49% below secondary school diploma, p = 0.025), had a higher rate of prior hospitalizations (49% vs. 26%, p = 0.007), and demonstrated a higher prevalence of severe comorbidities with other mental illnesses (94% vs. 82%, p = 0.009) compared to the pre-COVID cohort. No significant differences were observed in gender distribution, initial diagnoses upon admission, or average length of hospital stay.

Conclusion

The findings indicate that the COVID-19 pandemic intensified the presentation and severity of EDs, particularly among younger individuals with lower educational backgrounds. This underscores the urgent need for targeted, integrated treatment approaches for EDs in the context of global crises, including the development of strategies to address the increased severity of comorbid conditions and higher frequency of hospital readmissions observed in this study. These results highlight the necessity of reinforcing multidisciplinary care models that integrate medical, psychological, and social support to address the heightened complexity of post-pandemic ED cases and ensure more effective, long-term treatment outcomes. Future research is essential to explore the long-term effects of the pandemic on EDs, as well as to refine treatment strategies that better support those affected.

The Impact of the COVID-19 Pandemic in the Interrelationships Among Mental Health, Nutritional Status and Lifestyle Factors of Older Adults: A Cross-Sectional Study in the Pre- and Post-Covid Periods

BACKGROUND/OBJECTIVES

The COVID-19 pandemic has led to detrimental effects on diverse aspects of the mental and physical health of the general population worldwide. The elderly are more susceptible to COVID-19 infection compared to younger age groups. In this aspect, the purpose of the current survey is to evaluate the effect of the COVID-19 pandemic on the interrelationships among the sociodemographic and anthropometric characteristics, depressive behavior, quality of life, cognition status, physical activity and nutritional status of older adults.

METHODS

The present study constitutes a comparative, cross-sectional study of 4162 older adults (mean age ± standard deviation: 72.13 ± 8.1 years and 75.22 ± 8.2 years in the pre- and post-COVID-19 periods, respectively, and a male/female ratio of almost 1:1). We used validated questionnaires to assess depression, cognition function, quality of life, physical activity and nutritional status of the elderly in the pre-Covid and post-Covid periods. Relevant questionnaires were also used for collecting sociodemographic data, while anthropometric data were measured using standard protocols.

RESULTS

The present study finds that the COVID-19 pandemic influenced, in an independent manner, residence location, smoking status, overweight/obesity and abdominal obesity, depressive behavior, quality of life, cognition behavior, physical activity levels and nutritional status of the elderly. The COVID-19 pandemic was also related to employment and living status as well as family economic status. Nevertheless, the above three relationships were insignificant in the multivariate analysis.

CONCLUSIONS

The COVID-19 pandemic exerted deleterious effects on several aspects of the mental and physical health of the elderly, which appeared to strongly persist in the post-Covid period. Future prospective population-based and well-organized surveys should be conducted to establish whether there is a causality long-term effect of the COVID-19 pandemic on diverse aspects of the mental and physical health of the elderly.

The impact of the COVID-19 pandemic on dyslipidemia in peritoneal dialysis patients

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impacted on various aspects of society, including the healthcare system and patient care. In this context, this study aimed to evaluate the impact of COVID-19 control strategies on the lipid profile and blood sugar levels of peritoneal dialysis (PD) patients in Taiwan, a crucial focus for understanding the pandemic's influence on individuals with chronic kidney disease (CKD).

METHODS

A retrospective cohort study was conducted, analyzing data from the medical records of 170 PD patients who visited the nephrology division of Taipei Veterans General Hospital in 2021. The generalized estimating equations method was used to analyze the longitudinal data and assess the changes in biomarker levels over different periods. Covariates were taken into consideration in the statistical models.

RESULTS

The study enrolled 70 (41%) males and 100 (59%) females, with an average age of 56 years old. Over 12 months in 2021, from the first period (January to April: pre-COVID-19) to the second period (May to August: COVID-19 surge), there was a notable decline in both high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels, and a significant surge in triglyceride (TG) levels. However, total cholesterol (TC) and hemoglobin (HbA1c) levels remained stable. Furthermore, the TG to HDL, TG to LDL, TC to HDL, and TC to LDL ratios were analyzed, revealing a pronounced increase during the second period.

CONCLUSION

Our findings underscore the significant impact of COVID-19 pandemic-related disruptions in the healthcare system and the subsequent management strategies on dyslipidemia in PD patients while not affecting dysglycemia. These results provide valuable insights for healthcare professionals to enhance their strategies and interventions for CKD patients undergoing PD during a pandemic.

A Brief Online Intervention Based on Dialectical Behavior Therapy for a Reduction in Binge-Eating Symptoms and Eating Pathology

Dysregulated eating behaviors, comprising subthreshold and clinical binge-eating disorder (BED) and bulimia nervosa (BN), are increasing among the general population, with a consequent negative impact on one's health and well-being. Despite the severity of these outcomes, people with BED and BN often face a delay in receiving a diagnosis or treatment, often due to difficulties in accessing care. Hence, evidence-based and sustainable interventions for eating symptomatology are needed. The present study aims to assess the effectiveness of a web-based 10-session multidisciplinary group intervention based on Dialectical Behavior Therapy (DBT) for BED and BN, aimed at reducing psychological distress and binge-eating-related symptomatology in a sample of patients with dysregulated eating behaviors and including one session of nutritional therapeutic education. A total of 65 participants (84.6% F; age M = 38.5 ± 13.2; experimental group, N = 43; treatment-as-usual group, TAU, N = 22) took part in the study. The results show, after the 9 weekly sessions, a significant reduction in binge-eating-related symptomatology and general psychopathology and an increased self-esteem and eating self-efficacy in social contexts in the experimental group compared to the treatment-as-usual group (T0 vs. T1). Improvements in the experimental group were significantly maintained after one month from the end of the intervention (T2) in terms of binge-eating symptoms, general psychopathology, and eating self-efficacy in social contexts. This study supports the effectiveness of a brief web-based multidisciplinary group intervention in reducing eating symptomatology and psychological distress and enhancing self-esteem and eating self-efficacy in a group of people with dysregulated eating behaviors. Brief web-based interventions could represent an accessible and sustainable resource to address binge-eating-related symptomatology in public clinical settings.

Preparing for the next pandemic by understanding the impact of COVID-19 mitigation measures on patients with eating Disorders: observations from an inpatient setting

OBJECTIVE

The COVID-19 pandemic overwhelmed eating disorder (ED) services worldwide. Data suggests a worsening of psychopathology and an increased request for specialised treatments. Still, the studies are mostly based on experimental protocols with underpowered short-term opportunistic experimental designs. Thus, this study aims to assess the clinical and psychological differences between patients admitted to a specialised ED Unit before and after the COVID-19 breakout.

METHODS

Consecutive patients admitted from June 2014 to February 2022 in a specialised EDs Unit were enrolled. A total sample of 498 individuals was enrolled in this retrospective study, collecting demographic and psychopathological data at admission.

RESULTS

An increase in the admission of patients with anorexia nervosa has been reported, with lower age and higher levels of specific and general psychopathology, especially linked to body uneasiness.

CONCLUSIONS

Results are put into the context of the preparation for the next pandemic that may require similar mitigation measures as COVID-19 to ensure the impact on existing and new patients. Covering an extended period with validated tools, our results might help psychiatric services to reassess their treatment pathways after the pandemic, helping clinicians to delineate future treatment interventions.KEYPOINTSAfter the COVID-19 breakdown, there was an increase in the admission of patients with anorexia nervosa to specialised services.More severe psychopathology was not accompanied by lower body mass index.Specialised eating disorders services should face sudden changes in patients' requests for treatment.Understanding the impact of the Covid-19 pandemic and the resulting mitigation measures taken can lead to better preparations for the next pandemic.

Exploring the impact of the COVID-19 pandemic on perceptual disturbances and dysfunctional eating attitudes and behaviors: A review of the literature

From the outbreak of the novel coronavirus 2019 (COVID-19) a new physical and social distancing environment has changed our lives and, more particularly, the way of perceiving oneself, as well as eating attitudes and behaviors. An increasing number of studies have highlighted a risky scenario in terms of negative perceptions of one’s body as well as disordered eating and eating disorder patterns in both clinical and general population. With regard to this postulate, this literature review posits two main concepts—perceptual disturbances and dysfunctional eating attitudes and behaviors—in the general and (sub-)clinical populations, to provide an understanding of these phenomena during the COVID-19 pandemic. The main objective of this article is to provide a comprehensive and critical review of published scientific literature about perceptual disturbances (i.e., negative body image, body image disturbances, low body esteem) and dysfunctional eating attitudes and behaviors, including disordered eating (e.g., restrictive eating, binge-eating episodes, overeating, emotional eating) and eating disorders features in community (i.e., general population) and clinical and sub-clinical samples worldwide during the COVID-19 pandemic. The PubMed, ScienceDirect, Ebsco, and Google Scholar databases were searched. The initial search produced 42 references. Scientific publications from March 2020 to April 2022 were included, and among the works compiled, only published research articles have been retained. Purely theoretical papers were also excluded. The final selection consisted of 21 studies, covering both community, clinical (i.e., eating disorder population), and sub-clinical samples. The details of the results are discussed taking into consideration the potential impact of changes in the way we perceive ourselves and interact with others (e.g., the popularity of videoconferencing and the over-use of social network sites due to social isolation) as well as changes in eating attitudes and behaviors, physical activity and exercise (e.g., as an emotional response to the insecurity generated by the pandemic context), in community and (sub-)clinical samples. The discussion sheds light on two outcomes: (1) a summary of findings with methodological considerations; (2) an intervention continuum to deal with the consequences of the COVID-19 pandemic; (3) and a final conclusion.

The COVID-19 Pandemic and Canadian Pediatric Tertiary Care Hospitalizations for Anorexia Nervosa

PURPOSE

Global studies show an increase in hospitalizations for pediatric eating disorders (EDs). No published Canadian studies have confirmed these findings in pediatric ED programs for one-year post onset of the COVID-19 pandemic. The primary objective was to examine health administrative data from two pediatric tertiary care ED programs: Alberta Children's Hospital (ACH) and Hospital for Sick Children (SickKids) to determine the number of pediatric hospitalizations with the most responsible discharge diagnosis of anorexia nervosa (AN).

METHODS

This hospital-based design explored monthly pediatric hospitalizations in seven-year-olds to 18-year-olds between March 11, 2014 and March 11, 2021 using the Discharge Abstract databases. The analysis used negative binomial regression with robust standard errors to compare hospitalization counts in the months preceding and following the World Health Organization pandemic declaration (March 11, 2020).

RESULTS

Hospitalizations due to pediatric AN increased by 63% and 132% at SickKids (p < .001) and ACH (p < .001), respectively, in the first year of the pandemic compared to the previous six years. The total number of non-ED hospitalizations decreased by 29.3% and 2.4% at SickKids and ACH, respectively.

DISCUSSION

This is the first Canadian study to show a rise in pediatric hospitalizations over one year due to AN in two tertiary care hospitals following the onset of the pandemic, confirming the impact that the pandemic has had on children and adolescents with AN in Canada.

COVID-19-related changes in eating disorder pathology, emotional and binge eating and need for care: a systematic review with frequentist and Bayesian meta-analyses

PURPOSE

The COVID-19 pandemic has been a leading cause of stress and feelings of loss of control, both of which have been related to eating disorder (ED) pathology onset and deterioration. We aim to estimate the magnitude of changes in the prevalence rates of, and indicators for, ED psychopathology in the face of the COVID-19 pandemic.

METHOD

Pre-registered systematic review with frequentist and Bayesian meta-analyses. Searches for eligible studies were performed in PubMed, Web of Science and pre-print servers until January 15 2023.

RESULTS

Our searches yielded 46 eligible studies reporting on a total of 4,688,559 subjects. These data provide strong evidence indicating increased rates of diagnosed and self-reported ED's and a concordant increased need for care in the face of the pandemic. ED symptom severity scores in patients were not elevated during the pandemic, except for those related to anorexia nervosa. On average, people in the general population report relatively high levels of emotional and binge eating during the pandemic, although the evidential strength for these associations is only anecdotal to moderate. Moderators of between-study heterogeneity were not detected.

CONCLUSIONS

Altogether, our results suggest that the COVID-19 pandemic is associated with a wide spread negative effect on ED pathology in patient samples and the general population. The development of online prevention and intervention programs for EDs during stressful times like a pandemic is encouraged. A limitation is that the results reported here may be prone to biases, amongst others, self-report bias.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

PREREGISTRATION

Prospero [ https://www.crd.york.ac.uk/prospero ] ID: CRD42022316105.

One year of COVID-19 pandemic on patients with eating disorders, healthy sisters, and community women: evidence of psychological vulnerabilities

PURPOSE

The COVID-19 pandemic has been a psychological burden worldwide, especially for individuals with eating disorders (EDs). In addition, the healthy sisters of patients with EDs are known to present specific psychological vulnerabilities. This study evaluates differences between the general population, patients with EDs, and their healthy sisters.

METHOD

A group of 233 participants (91 patients with EDs, 57 of their healthy sisters and 85 community women) was enrolled in an online survey on general and specific psychopathology 1 year after the beginning of the COVID-19 pandemic. The survey examined associations between posttraumatic symptoms and depression, anxiety, obsessive-compulsiveness, interpersonal sensitivity, and eating-related concerns.

RESULTS

Clinically relevant scores for posttraumatic disorders were found in patients with EDs. Healthy sisters scored similarly to patients for avoidance. Regression analysis showed specific associations between interpersonal sensitivity and posttraumatic symptomatology in patients and healthy sisters, but not in community women.

CONCLUSION

The psychological burden in patients with EDs is clinically relevant and linked to interpersonal sensitivity, obsessive-compulsiveness, and global symptom severity. Differences between patients, healthy sisters, and community women are discussed regarding vulnerability factors for EDs.

LEVEL OF EVIDENCE

Level III: evidence obtained from well-designed cohort or case-control analytic studies.

Review of the unprecedented impact of the COVID-19 pandemic on the occurrence of eating disorders

PURPOSE OF REVIEW

To review the recent literature on the impact of the coronavirus disease-2019 (COVID-19) pandemic on incidence and severity of symptoms of eating disorders (EDs).

RECENT FINDINGS

A worrying increase of EDs in- and outpatients has been reported since the COVID-19 pandemic began in 2019/2020. Restrictions implemented during the pandemic to protect populations against COVID-19 increased the risk for onset and for worsening of EDs by disrupting eating and exercise routines, social isolation, lack of support, and limited access to healthcare. Substantial increases since the start of the pandemic have been reported for overall incidence (15%), hospital admissions (48%) and emergency department visits (11%) for EDs, with even higher increases among women and children or adolescents with an ED. During the pandemic, ED patients reported increased severity of ED-specific symptoms and increased anxiety, depression and suicidal ideations and -attempts. Treatments shifted largely toward online methods for continuity of care, despite concerns about the quality of care provided and difficulties in self-monitoring. Our review provides preliminary evidence for a similar effectiveness of online treatment to prepandemic face-to-face treatment. In-person assessment remains essential for detecting EDs and for those requiring medical admission.

SUMMARY

Although the ongoing COVID-2019 pandemic affected mental health globally, research shows that it particularly affected individuals with an ED diagnosis or at risk for an ED, especially women, children and adolescents, and those with anorexia nervosa.

Physical, Psychological and Social Secondary Consequences of the COVID-19 Pandemic in Turkish University Students

This study aims to investigate the effect of the COVID-19 pandemic on university students and their families. A total of 274 students participated in this study. A questionnaire is developed regarding the physical, psychological, and social effects of the COVID-19 pandemic, and sent to the students via e-mail. According to the results of the study, students who contracted COVID-19 experienced significantly higher musculoskeletal pain (MSP) (p = 0.01). Students with increased propensity for harmful habits experienced significantly more MSP (p = 0.01). Anxiety levels of students who experienced MSP were significantly higher (p = 0.01). Students living in an inadequate home environment were significantly more prone to harmful habits (p = 0.01). The anxiety level of the students who experienced domestic unrest was high (p = 0.02). The home environment of students with economic difficulties was significantly inadequate (p = 0.01). The anxiety levels of the students whose participation in sports and art activities decreased, were high (p = 0.04). The home environment of the students who reported that they were positively affected by distance education was significantly inadequate (p = 0.03). The authors suggest that physiotherapy, nutrition and psychological assistance services should be provided to students, scholarship opportunities and extracurricular activities (art and sports activities) should be increased.

A cross-sectional study examining self-reported anthropometric measurements with adolescents' nutrition attitudes, obesity awareness and diet quality indices during the pandemic

PURPOSE

The purpose of this study is to evaluate the relationship between adolescents' nutritional attitudes, obesity awareness, and diet quality with their self-reported anthropometric measurements taken during the COVID-19 pandemic.

DESIGN AND METHODS

This cross-sectional type of study was conducted in a district in the south of Turkey. The research was carried out online with 907 adolescents who agreed to participate voluntarily.

RESULTS

Among the adolescents, 28.5% considered themselves overweight, and 32.1% were currently trying to lose weight. According to BMI, 16.1% were affected by overweight/obesity. Adolescents' nutritional attitudes and obesity awareness levels were moderate, while their KIDMED nutritional habits were also moderate. In this study, a negative relationship was found between the adolescents' ASHN mean scores and their body weight, waist circumference, hip circumference, neck circumference, waist/hip ratio and waist/height ratio measurements; and between their OAS mean scores and their body weight, waist circumference, waist/hip ratio and waist/height ratio measurements; and between their KIDMED index scores and their waist/height ratio measurements (p < 0.001).

CONCLUSIONS

The rate of adolescents who perceive themselves as overweight is higher than the results obtained from the measurement values. BMI levels and other anthropometric measurement values of adolescents with positive nutrition attitudes and physical activity behaviours are also positively affected.

PRACTICE IMPLICATIONS

This study may have a significant impact on the formulation and implementation of interventions to prevent obesity and increase physical activity for school health nurses. Since the pandemic is still continuing, healthcare providers must stress the risk of obesity in adolescence.

The Impact of the COVID-19 Pandemic on Patients from a Bariatric Program: A Qualitative Analysis of Their Perceptions of Health and Well-Being

Introduction: The study was conducted to explore the perceptions of patients from a bariatric program who have undergone or will undergo bariatric surgery during the ongoing COVID-19 pandemic, specifically as related to their struggles with health issues and their psychological well-being. Materials and Methods: We conducted semi-structured, in-depth interviews with nineteen pre- or post-bariatric patients to generate data on their perceptions of COVID-19. Consistent with the methods of constructivist grounded theory, we collected and analyzed data iteratively through a constant comparative process for data coding and develop themes in the transcripts. Results: We identified themes to summarize the pandemic-associated experiences of our cohort as follows: their life structure before COVID-19, the turning point with changes and adaptations, and the impact of isolation on psychological well-being. We identified grief due to loss of social contacts as well as physical and psychological health impairment as consequences of pandemic-related lifestyle changes. Most participants were not aware of overweight and obesity being major risk factors for worse outcomes of COVID-19. We developed a theme-based theory on patients’ perceptions and fears regarding the pandemic as they live through phases of grief. Discussion: Most participants shared critical perceptions about their own somatic and psychological health. These findings may inform recommendations and strategies for both patients and healthcare professionals to manage the challenges potentially presented by this vulnerable patient group in the context of the COVID-19 pandemic.

Assessment of the Impact of COVID-19 Lockdown on the Nutritional Status and Lipid Profile of Employees in a Teaching Hospital in Rome: A Retrospective Cohort Study

Background: on the 9 March 2020, the Italian government declared a state of lockdown on the entire national territory aimed at reducing the spread of SARS-CoV-2, causing strong repercussions for people’s lifestyles. The aim of the study was to analyze the impact of the lockdown on the nutritional status and lipid profile of employees of an Italian teaching hospital. Methods: an observational retrospective cohort study was carried out at the Department of Occupational Medicine of the Umberto I General Hospital of Rome, including all employees who underwent two consecutive occupational medical examinations before and after the first lockdown (9 March 2020−18 May 2020). Employee medical records were used as a data source. Results: 1014 employees were involved in the study (50.6% nurses, 31% physicians, 14.8% technical staff, 3.6% administrative staff). Post lockdown BMI, total cholesterol and LDL values increased statistically significantly compared to pre lockdown ones. Nurses showed a significant association with increased BMI (p < 0.001), while workers with heart disease were inversely associated with total cholesterol (p < 0.001) and LDL (p < 0.001). Conclusion: this study showed that lockdown had a significant impact on employees’ lifestyles. Further studies are needed to understand changes in health-related behaviors, such as diet and physical activity, of specific categories of workers over time under lockdown conditions.

The impact of the COVID-19 pandemic on eating disorders: A systematic review

OBJECTIVE

A growing body of evidence suggests that individuals with eating disorders (EDs) have experienced deteriorating symptoms, increased isolation, and an increase in hospital admissions as a result of the COVID-19 pandemic. Despite this, no systematic reviews have been conducted examining the COVID-19 and ED peer-reviewed literature. Therefore, this systematic review aimed to synthesize the impact of the COVID-19 pandemic on individuals with EDs.

METHOD

Database searches of the peer-reviewed literature were completed in the subsequent databases: CINAHL, Embase, MEDLINE, and PsycINFO (from November 2019 to October 20, 2021). All research reporting on the relationship between the COVID-19 pandemic on individuals with EDs were included.

RESULTS

Fifty-three studies met the inclusion criteria, including 36,485 individuals with EDs. The pooled hospital admissions across the studies demonstrated on average a 48% (pre = 591, post = 876, n = 10 studies) increase in admissions during the pandemic compared to previous pre-pandemic timepoints. In this review, 36% of studies (n = 19) documented increases in eating disorder symptoms during the pandemic, this increase in eating disorder symptoms were documented in AN, BED, BN, and OFSED patients. Studies also demonstrated increases in anxiety (n = 9) and depression (n = 8), however patterns of change appeared to be diagnostic and timing specific (e.g., lockdowns).

DISCUSSION

We found a large increase in the number of hospitalizations and an increase in ED symptoms, anxiety, depression, and changes to BMI in ED patients during the pandemic. However, these changes appeared to be diagnostic and timing specific. Many qualitative studies described deterioration in ED symptomatology due to decreased access to care and treatment, changes to routine and loss of structure, negative influence of the media, and social isolation. Future studies are needed to focus on pediatric populations, new ED diagnoses, and severity of illness at presentation.

PUBLIC SIGNIFICANCE

The scientific literature suggests that individuals with eating disorders have experienced deteriorating symptoms, increased isolation, and an increase in hospital admissions as a result of the COVID-19 pandemic. This study synthesized 53 articles and explored the impact of the COVID-19 pandemic on patients with eating disorders. We found increases in eating disorder symptoms during the pandemic; this increase in eating disorder symptoms was documented in patients with common eating disorders including anorexia nervosa, binge-eating disorder, bulimia nervosa, and other specified feeding and eating disorders. This review also demonstrated changes in body mass index (an index used to classify underweight, overweight, and obesity in adults) and increases in anxiety and depression during the pandemic compared to previous timepoints; patterns of change appeared to be related to timing of lockdowns. This review provides important information on the impact of COVID-19 on the physical and mental health of individuals with eating disorders.

Weight stigma in the COVID-19 pandemic: a scoping review

BACKGROUND

Weight stigma is a phenomenon associated with adverse behavioural and psychological consequences. Although experts suggest that its increase during the COVID-19 pandemic may be associated with worse health outcomes for people with obesity, a thorough analysis of the main findings and gaps is still needed when relating to this subject.

OBJECTIVE

We aim to answer three questions: (1) How does weight stigma manifest in the COVID-19 pandemic? (2) How can weight stigma affect people with overweight or obesity in times of COVID-19? (3) What are the perceptions and experiences of weight stigma during the pandemic in individuals who experience overweight or obesity?

METHODS

We conducted a scoping review of studies addressing weight stigma and the COVID-19 pandemic in electronic databases (Medline/PubMed, CINAHL, Embase, PsycInfo, BVS/Lilacs, Scopus, Web of Science, Google Scholar, and OpenGrey) published until 10th August 2021. All relevant studies were reviewed in full by two researchers. In addition, a narrative synthesis of the data was performed.

RESULTS

The results included 35 studies out of 8,090 records and identified 13 original research publications, 14 text and opinion papers, and 6 narrative reviews. The results revealed the presence of weight stigma in the media, healthcare settings, interpersonal relationships, and public campaigns during the COVID-19 pandemic. The evidence of increasing weight stigma in the COVID-19 outbreak is limited, though. Many weight discrimination consequences were described during this time, such as impairment in accessing healthcare, worst COVID-19 outcomes, and maladaptive eating. However, only maladaptive behaviours and decline in mental health outcomes were demonstrated empirically in all age groups. This effect occurred regardless of body mass index, but people with high body weight were more likely to experience weight stigma. For some people with obesity, weight stigma in the pandemic has made activities of daily routine difficult.

CONCLUSIONS

The results suggest that weight stigma in the COVID-19 pandemic occurs in several settings; moreover, although weight discrimination impacts mental health, whether before or during the pandemic, this influence between the pandemic and pre-pandemic scenario is still unclear. Therefore, more research is required in this field while the pandemic lasts, especially with people with obesity. Overall, people with overweight or obesity are more vulnerable to weight stigma than individuals without overweight. In addition, weight stigma refers to discrimination or prejudice based on a person's weight and relates to several consequences, for instance, poor healthcare treatment and mental health problems. In the COVID-19 outbreak, these weight stigma effects tend to become even more critical because they may be associated with unfavourable COVID-19 outcomes and eating disorder risks. Thus, it is crucial to investigate how weight stigma occurs during the pandemic and its impact on health, mainly for the most affected people. We investigated 35 studies published between 2019 and 2021 to map and explore how weight stigma was manifested and the related consequences for people with overweight or obesity in the COVID-19 pandemic. Only about a third of them were quantitative or qualitative, limiting the evidence of weight stigma in the COVID-19 context. The available evidence suggests that weight stigma manifests in several settings such as media, healthcare, public campaigns, and is more common in people with excess weight. However, weight discrimination experiences before or during the pandemic were associated with adverse psychological and behavioural consequences across all age groups, regardless of body weight. For some people with obesity, for instance, weight stigma made it difficult to accomplish their activities of daily routine. Nevertheless, it remains unclear whether weight stigma has increased in the pandemic, thus, more studies are required, especially about people with overweight or obesity.

Assessment of lifestyle changes during coronavirus disease 2019 pandemic in Gondar town, Northwest Ethiopia

Background

Coronavirus disease 2019 has had a global effect on people’s lifestyles. Many people have developed irregular eating patterns and become physically inactive, which leads to an aggravation of lifestyle-related diseases and unhealthier lifestyles; these, subsequently raise the severity of coronavirus disease 2019. This study aimed to assess lifestyle changes during coronavirus disease 2019 pandemic in Gondar town, North West, Ethiopia.

Method

Community-based cross-sectional study design was conducted among households at Gondar town from June to August 2021. The study participants were selected by a systematic random sampling technique from proportionally allocated kebeles. Data were collected using face-to-face interview techniques and were entered and analyzed by using a statistical package for the social sciences version 24; P-values < 0.05 were considered as statistically significant.

Result

Overall, 348 study participants were included in the study. Among those respondents, 52.3% (182) were female study participants and the mean age of the respondents was 30.95±14.4. In this study, there was a significant decrement in non-homemade food from 20.4% to 13.4% at (P = <0.001). Concerning water intake, 11.5% (40) of respondents consumed ≥8 cups/day before the coronavirus disease 2019 pandemic, and the percentage increased to 14.7% (51) during the coronavirus disease 2019 pandemic (p = 0.01). Of the participants, 46% participants were reported never engaging in any physical activity before the coronavirus pandemic, and the percentage decreased to 29.9% during the pandemic (P = 0.002). The respondents also exhibited increment tension in large from 4.9% to 22.7% before and during the coronavirus disease 2019 pandemic, respectively. Furthermore, about 6.3% of the study participants slept badly before the coronavirus disease 2019 pandemics and the effects of sleeping badly and restlessly increased to 25.9% during the coronavirus disease 2019 pandemic (P = <0.001).

Conclusion

The current study demonstrates that there is a noticeable alteration in food consumption, food choices, regular mealtime, sleeping habits, mental exhaustion, and practice of physical activity.

Help-seeking attitudes and behaviours among youth with eating disorders: a scoping review

BACKGROUND

Although early intervention is crucial in interrupting the development of eating disorders, little is currently known about help-seeking behaviours among individuals experiencing eating disorder symptoms. Given that eating disorders typically begin early in life, it is necessary to investigate the processes employed by children, adolescents, and emerging adults when seeking services for troubling symptoms. This is a growing concern as the COVID-19 pandemic has resulted in an increase in the number of individuals engaging in disordered eating behaviours. This scoping review explores the current state of the literature for evidence on how youth with eating disorder symptoms seek help, with the aim of better understanding how to identify and treat more individuals earlier.

METHODS

Using scoping review methodology, we searched seven databases for studies published from January 2000 to April 2021 that reported on help-seeking attitudes, behaviours, and healthcare utilization patterns for children and adolescents (< 18 years), emerging adults (18-25 years), and a mixture of these groups (< 25 years). Seven thousand, two hundred, and eighteen articles were identified for review. After duplicates were removed, three reviewers independently screened titles and abstracts and reviewed full-text articles. Findings related to help-seeking activity were extracted from the 62 articles that were ultimately included in this scoping review.

RESULTS

Study findings were summarized into help-seeking patterns (i.e., rates, types) as well as factors ranging from the individual level to society that influenced help-seeking behaviour. Many youth meeting eating disorder criteria were not seeking help. Notable barriers to help-seeking included poor mental health literacy, experiences with healthcare providers who failed to detect and lacked knowledge about eating disorders, minimal support from family and friends, and stigma surrounding eating disorders and help-seeking for mental health concerns.

CONCLUSIONS

The results of this scoping review can be used to inform early intervention and health promotion program development. Future research should focus on the help-seeking attitudes and activities among underrepresented groups with eating disorders (e.g., men, ethnic and gender minorities), the perspectives of family and other supporters in the help-seeking process for youth, and retrospective accounts from adults with lived experience of an eating disorder. Plain English summary Addressing and interrupting eating disorder-related thoughts and behaviours as soon as possible, with the help of a mental health professional, leads to better outcomes for youth struggling with an eating disorder. However, little is known about what prompts youth to talk about their weight, body, or eating concerns with someone-like their parent, friend, teacher, guidance counsellor, or primary care practitioner. This review explores the available published research on help-seeking patterns and preferences among youth with eating disorder concerns. Our team followed a standardized process to find 62 relevant articles for this paper. Of note, many young people who reported eating disorder concerns were not seeking help for themselves. Feeling supported by family and their primary care provider, understanding the signs of an eating disorder, and not feeling shame for reaching out for help reportedly led youth to speak up about their concerns. The findings have clinical implications for learning effective ways to help youth feel safe to speak freely about their eating disorder-related concerns, which enhances the chances of intervening early and catching symptoms before they worsen.

Abdominal obesity phenotype is associated with COVID-19 chest X-ray severity score better than BMI-based obesity

PURPOSE

Chest X-ray (CXR) severity score and BMI-based obesity are predictive risk factors for COVID-19 hospital admission. However, the relationship between abdominal obesity and CXR severity score has not yet been fully explored.

METHODS

This retrospective cohort study analyzed the association of different adiposity indexes, including waist circumference and body mass index (BMI), with CXR severity score in 215 hospitalized patients with COVID-19.

RESULTS

Patients with abdominal obesity showed significantly higher CXR severity scores and had higher rates of CXR severity scores ≥ 8 compared to those without abdominal obesity (P < 0.001; P = 0.001, respectively). By contrast, patients with normal weight, with overweight and those with BMI-based obesity showed no significant differences in either CXR severity scores or in the rates of CXR severity scores ≥ 8 (P = 0.104; P = 0.271, respectively). Waist circumference and waist-to-height ratio (WHtR) correlated more closely with CXR severity scores than BMI (r = 0.43, P < 0.001; r = 0.41, P < 0.001; r = 0.17, P = 0.012, respectively). The area under the curves (AUCs) for waist circumference and WHtR were significantly higher than that for BMI in identifying a high CXR severity score (≥ 8) (0.68 [0.60-0.75] and 0.67 [0.60-0.74] vs 0.58 [0.51-0.66], P = 0.001). A multivariate analysis indicated abdominal obesity (risk ratio: 1.75, 95% CI: 1.25-2.45, P < 0.001), bronchial asthma (risk ratio: 1.73, 95% CI: 1.07-2.81, P = 0.026) and oxygen saturation at admission (risk ratio: 0.96, 95% CI: 0.94-0.97, P < 0.001) as the only independent factors associated with high CXR severity scores.

CONCLUSION

Abdominal obesity phenotype is associated with a high CXR severity score better than BMI-based obesity in hospitalized patients with COVID-19. Therefore, when visiting the patient in a hospital setting, waist circumference should be measured, and patients with abdominal obesity should be monitored closely. Level of evidence Cross-sectional descriptive study, Level V.

The Effects of the COVID-19 Pandemic Lockdown on Eating, Body Image, and Social Media Habits Among Women With and Without Symptoms of Orthorexia Nervosa

The COVID-19 pandemic is negatively impacting people's mental health worldwide. The current study examined the effects of COVID-19 lockdown on adult women's eating, body image, and social media habits. Furthermore, we compared individuals with and without signs of orthorexia nervosa, a proposed eating disorder. Participants were 143 women, aged 17-73 years (M = 25.85, SD = 8.12), recruited during a COVID-19 lockdown in Canada from May-June 2020. Participants completed self-report questionnaires on their eating, body image, and social media habits during the pandemic. The Eating Habits Questionnaire (EHQ) assessed symptoms of orthorexia nervosa. Compared to the period prior to lockdown, women with higher total orthorexia nervosa scores reported eating a lot more than usual, feeling greater pressure to diet and lose weight, thinking about food more often than usual, experiencing greater weight gain, and perceiving more pressure from social media specifically to lose weight and to exercise, compared to their healthy counterparts. We examined associations between individual EHQ subscales and perceived changes to eating and weight. Women who scored high on EHQ-Problems reported seeing more weight loss content on their social media than those who reported fewer orthorexia nervosa symptoms. Conversely, those who scored low on EHQ-Feelings reported feeling a lot less pressure to lose weight, somewhat less or a lot less pressure to lose weight or to exercise from social media specifically, and trended toward less laxative use during lockdown, compared to those who scored higher on orthorexia nervosa. And those who scored low on EHQ-Knowledge reported feeling somewhat less or a lot less pressure to lose weight than those who reported more orthorexia nervosa symptoms. Together, the findings suggest that women with symptoms of orthorexia nervosa are experiencing an exacerbation of disordered eating thoughts and behaviors during COVID-19, and that social media may be a contributing factor.

Emotional and Behavioral Impact of the COVID-19 Epidemic in Adolescents

PURPOSE OF REVIEW

This review of the literature aims to explore the impact of the COVID-19 pandemic and the lockdown on teenagers' mental health. We distinguish two groups: adolescents who had already been diagnosed with a mental disorder and the general population of adolescents.

RECENT FINDINGS

An increase in the number of mental health-related difficulties in adolescents has already been reported in previous health crises. Accordingly, the perceived well-being of teenagers declined during the COVID-19 pandemic. Adolescents with mental disorders were significantly more affected by the lockdown than those in the general population. The effect of the COVID-19 crisis on the mental health of adolescents has been heterogeneous. The first pandemic wave was essentially associated with an increase of internalizing symptoms in adolescents, particularly anxiety, depression and eating disorders. The impact on externalizing symptoms was less clear, and seem to concern mostly adolescents with pre-existing behavioral disorders. During the second and later waves of the pandemic, an upsurge of suicidal ideation and attempts among adolescents have been reported in many countries.

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study

Background. The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. Aims. (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. Methods. The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). Results. Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. Conclusions. The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

Eating disorders during COVID-19 pandemic: the experience of Italian healthcare providers

PURPOSE

Due to COVID-19 pandemic, the Italian population lived in quarantine from March to May 2020 (lockdown phase I). Restrictions impacted individuals' psychological health, especially in those with eating disorders (ED). Healthcare providers (HCPs) treating ED provided assistance by telemedicine and/or in walk-in clinics. We hypothesize that social restrictions represented a great stressor for ED patients and HCPs, negatively impacted their therapeutic alliance, and affected the frequency of dysfunctional behaviors.

METHODS

This cross-sectional study consisted of an online survey investigating the experience of HCPs involved in ED treatment, with a specific focus on difficulties concerning the therapeutic efficacy. Questionnaire (n. 18 questions) was formulated ad hoc by our research team and sent by e-mail to Italian HCPs registered on online platforms. HCPs included ED experts specialized in psychology, nutrition or medicine. Data were collected during lockdown phase I and referred to patients with Anorexia Nervosa-(AN), Bulimia Nervosa (BN)-and Binge-Eating Disorder-(BED).

RESULTS

One-hundred questionnaires were collected; 84 and 76 were included in our qualitative and quantitative analyses, respectively. Thirty-six% of HCPs felt their therapeutic intervention was unsuccessful, 37% complained compromised therapeutic alliance. Changes in frequency of compensatory behaviors (increased in 41% AN and 49,5% BN; reduced in 14,6% AN and 21,8% BN) and binge-eating episodes (increased in 53,3% BN and 30,5% BED; reduced in 30,7% BN and 24,7% BED) were experienced and ascribed to augmented patient's anxiety. Disorders switches and variation in dysfunctional conducts frequency were both significantly related to ED category (p < 0.05 for all). Concentration techniques were recognized as useful to offset such negative outcomes.

CONCLUSION

According to HCPs, social restrictions affected the frequency of dysfunctional behaviors in ED patients and the efficacy of their therapeutic intervention. Further long-term studies are needed to confirm our data in a larger sample size.

LEVEL IV

Novel results from a cross-sectional study.

Risk and resilience factors for specific and general psychopathology worsening in people with Eating Disorders during COVID-19 pandemic: a retrospective Italian multicentre study

PURPOSE

The COVID-19 pandemic restrictions had negative impact on the psychopathology of people with Eating Disorders (EDs). Factors involved in the vulnerability to stressful events have been under-investigated in this population. We aimed to assess which factors contributed to COVID-19-induced worsening in both general and specific psychopathology.

METHODS

Three-hundred and twelve people with a clinically defined diagnosis of an ED and undergoing a specialist ED treatment in different Italian ED services before the spreading of COVID-19 pandemic filled in an online survey. ED specific and general psychopathology changes after COVID-19 quarantine were retrospectively evaluated. Factors related to COVID-19 concerns (financial condition, fear of contagion, perceived social isolation/support, satisfaction in peer, family or sentimental relationships), illness duration and treatment-related variables (type of treatment provided, type of access to care, satisfaction with therapeutic relationships) were included as predicting factors in a structural equational model, which included latent variables consisting of general and ED psychopathology items as outcomes.

RESULTS

A perceived low quality of therapeutic relationships, fear of contagion and increased isolation were positively associated with psychopathology worsening. Reduced satisfaction with family and with friends' relationships and reduced perceived social support were associated with ED and general symptoms deterioration, respectively. No significant effect emerged for intimate relationships, illness duration, economic condition and type of treatment.

CONCLUSIONS

This study provides a comprehensive evaluation of clinical variables associated with psychopathological changes during the COVID-19 lockdown period highlighting potential risk and resilience factors and, possibly, informing treatment as well as prevention strategies for EDs.

LEVEL OF EVIDENCE IV

Evidence obtained from multiple time series analysis such as case studies.

Effects of COVID-19 lockdown on eating disorders and obesity: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to examine: the pooled prevalence of symptomatic behaviours and mental health deterioration amongst individuals with eating disorders (EDs) and obesity during the COVID-19 confinement. Moreover, we examined changes in EDs and distress before and during the confinement, and the association between psychosocial factors and EDs symptoms.

METHOD

A systematic search was carried out in biomedical databases from January 2020 to January 2021. Both cross-sectional and longitudinal studies that used quantitative measures of ED symptoms and psychological distress during and after the COVID-19 confinement were included.

RESULTS

A total of 26 studies met inclusion criteria (n = 3399, 85.7% female). The pooled prevalence of symptomatic deterioration in EDs was 65% (95% CI[48,81], k = 10). The pooled prevalence of increased weight in obesity was 52% (95% CI[25,78], k = 4). More than half of the participants experienced depression and anxiety. Moreover, at least 75% of the individuals with EDs reported shape and eating concerns, and increased thinking about exercising. However, the pooled analyses of longitudinal studies showed no significant differences from pre-pandemic levels to the first lockdown phase in Body Mass Index and ED symptoms, whereas only few studies suggested increased distress, particularly among individuals with anorexia nervosa.

CONCLUSIONS

The majority of individuals with EDs and obesity reported symptomatic worsening during the lockdown. However, further longitudinal studies are needed to identify vulnerable groups, as well as the long-term consequences of COVID-19.

Eating Behavior during First-Year College Students, including Eating Disorders-RUVIC-RUNEAT-TCA Project. Protocol of an Observational Multicentric Study

(1) Introduction: Changes in eating behavior and eating disorders are especially common in young people, especially teenage and college women. The first year of college is a critical period, as students acquire freedoms that can lead to poor eating habits. During this first year, students usually gain weight. The aims of this project are to analyze the risk of developing eating disorders, the composition and dietary intake and the changes in the body composition of two groups of college students (independent from the family nucleus or still living within the family) in the first year of college. (2) Material and Methods: Multicentric prospective observational study protocol in which first-year students at the Universidad Europea del Atlántico and Universitat de Vic-Universitat Central de Catalunya voluntarily took part in the study. The students will be divided into two groups, independent and those residing in the family home, and the evolution of both groups will be compared at the beginning and at the end of the school year by performing anthropometric measurements, tests on lifestyle and eating habits (Test of Adherence to the Mediterranean Diet, MEDAS-14; Emotional Eater Questionnaire, EEQ), validated questionnaires on eating disorders (Eating Attitude Test, EAT26; Teen Figure Drawing Scales; SCOFF, Eating Behavior Test; Bulimia Investigatory Test Edinburgh, BITE) and their intake will be evaluated through 72 h dietary records. (3) Discussion: Determining the risk of suffering eating disorders of alimentary behavior, knowing eating consumption, perception of the corporal image and body composition through the first year of college will be decisive in establishing alimentary education strategies to prevent possible eating disorders in young students.

Social networks and eating disorders during the Covid-19 pandemic

OBJECTIVE

The purpose of this study is to assess the increase both in the use of the Internet and social media and in Google searches regarding eating disorders (ED) in Italy during the Covid-19 pandemic. Our aim is also to verify the possible impact of such an increase on ED, since patients treated for ED by the National Health Service (NHS) have increased in the first 6 months of 2020 as well.

METHOD

We used data from Wearesocial surveys on Internet users in the first 6 months of 2020 and the Google searches related to the query of "food disorders" and "body shaming." The first results of a project of the Italian Ministry of Health on ED have been considered too.

RESULTS

The social media users in July 2020 increased to 60% of the Italian population; a tendential increase in Google searches on these issues has emerged. Finally, new patients of NHS with ED showed a high increase in the first 6 months of 2020 (+40.9%).

CONCLUSION

Considering the contents diffused on the Internet, it is fundamental to watch over net usage in the adolescent population and those with ED, because massive access to social media can be considered almost as a risk factor.

The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond

OBJECTIVE

The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond.

METHODS

Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers.

RESULTS

Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended.

CONCLUSIONS

Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.

The impact of COVID-19 lockdown and of the following "re-opening" period on specific and general psychopathology in people with Eating Disorders: the emergent role of internalizing symptoms

BACKGROUND

We assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on specific Eating Disorder (ED) and general psychopathology in people with an ED diagnosis during the lockdown period and after the end of the related containment measures.

METHODS

People with clinically defined diagnosis and undergoing treatment for an ED completed an online survey, which included adapted questions from standardized psychometric scales. Data relative to three different time periods (before, during and after the end of lockdown) were collected. Psychopathological changes over these periods were investigated and compared through one-way analysis of variance or covariance with repeated measures.

RESULTS

Three hundred twelve people completed the survey (57.4% diagnosed with Anorexia Nervosa (AN) or atypical AN, 20.2% with Bulimia Nervosa, 15.4% with Binge Eating Disorder, 7.05% with Other Specified Feeding or Eating Disorders). The severity of both specific and general psychopathology increased during the lockdown and the rise of general symptoms persisted in the following re-opening phase, except for suicide ideation. Almost all of these findings were not affected by ED diagnosis, participants' age and illness duration.

LIMITATIONS

The retrospective nature of data collection is the main limitation of the study.

CONCLUSIONS

People with EDs showed a COVID-19 emergency-induced worsening of both general and specific psychopathology. The effect on general psychopathology persisted in the re-opening period. These findings suggest a high stress vulnerability of ED individuals with important effects on internalizing symptoms, which are worth of attention by clinicians.

Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts

BACKGROUND

A growing body of evidence is suggesting a significant association between the COVID-19 pandemic and population-level mental health. Study findings suggest that individuals with a lifetime history of disordered eating behavior may be negatively affected by COVID-19-related anxiety, and prevention measures may disrupt daily functioning and limit access to treatment. However, data describing the influence of the COVID-19 pandemic on disordered eating behaviors are limited, and most findings focus on individuals in treatment settings.

OBJECTIVE

The aim of this study is to characterize the experiences of Reddit users worldwide who post in eating disorder (ED)-related discussion forums describing the influence of the COVID-19 pandemic on their overall mental health and disordered eating behavior.

METHODS

Data were collected from popular subreddits acknowledging EDs as their primary discussion topic. Unique discussion posts dated from January 1 to May 31, 2020 that referenced the COVID-19 pandemic were extracted and evaluated using inductive, thematic data analysis.

RESULTS

Six primary themes were identified: change in ED symptoms, change in exercise routine, impact of quarantine on daily life, emotional well-being, help-seeking behavior, and associated risks and health outcomes. The majority of users reported that the COVID-19 pandemic and associated public health prevention measures negatively impacted their psychiatric health and contributed to increased disordered eating behaviors. Feelings of isolation, frustration, and anxiety were common. Many individuals used Reddit forums to share personal experiences, seek advice, and offer shared accountability.

CONCLUSIONS

Reddit discussion forums have provided a therapeutic community for individuals to share experiences and provide support for peers with ED during a period of increased psychiatric distress. Future research is needed to assess the impact of the COVID-19 pandemic on disordered eating behavior and to evaluate the role of social media discussion forums in mental health treatment, especially during periods of limited treatment access.

COVID-19 Pandemic and Eating Disorders: What Can We Learn About Psychopathology and Treatment? A Systematic Review

PURPOSE OF REVIEW

This systematic review aims to collect evidence regarding the impact of the SarsCov-2 pandemic on people affected by eating disorders (EDs) targeting the following variables: psychopathology changes, mechanisms of vulnerability or resilience, and perception of treatment modifications during the pandemic.

RECENT FINDINGS

Since the beginning of the pandemic, a mental health deterioration has been detected in the general population and especially in people affected by pre-existing psychiatric conditions. Furthermore, mental healthcare has moved toward online treatment. ED people showed a trend toward worsening of ED-specific psychopathology and impairment in general psychopathology. The most common vulnerability mechanisms were social isolation and feelings of uncertainty, while heightened self-care and reduced social pressure were resilience factors. The online treatment, although raising many concerns related to its quality, was considered the best alternative to the face-to-face approach. These findings may support the idea that stressful events contribute to the exacerbation of ED psychopathology and highlight the relevance of internalizing symptoms in EDs. The identification of putative risk and resilience variables as well as of subjective factors affecting online treatment perception may inform healthcare professionals and may promote more personalized approaches.

Eating Habits and Lifestyle during COVID-19 Lockdown in the United Arab Emirates: A Cross-Sectional Study

The coronavirus disease is still spreading in the United Arab Emirates (UAE) with subsequent lockdowns and social distancing measures being enforced by the government. The purpose of this study was to assess the effect of the lockdown on eating habits and lifestyle behaviors among residents of the UAE. A cross-sectional study among adults in the UAE was conducted using an online questionnaire between April and May 2020. A total of 1012 subjects participated in the study. During the pandemic, 31% reported weight gain and 72.2% had less than eight cups of water per day. Furthermore, the dietary habits of the participants were distanced from the Mediterranean diet principles and closer to "unhealthy" dietary patterns. Moreover, 38.5% did not engage in physical activity and 36.2% spent over five hours per day on screens for entertainment. A significantly higher percentage of participants reported physical exhaustion, emotional exhaustion, irritability, and tension "all the time" during the pandemic compared to before the pandemic (p < 0.001). Sleep disturbances were prevalent among 60.8% of the participants during the pandemic. Although lockdowns are an important safety measure to protect public health, results indicate that they might cause a variety of lifestyle changes, physical inactivity, and psychological problems among adults in the UAE.

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study

Confinement during the COVID‐19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational‐theoretical structure of the CIES. Adequate goodness‐of‐fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face‐to‐face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.

Bulimia nervosa in times of the COVID-19 pandemic-Results from an online survey of former inpatients

OBJECTIVE

The COVID-19 pandemic might pose special challenges to patients with eating disorders (EDs) by interfering with daily routines. The aim of this study was to investigate the impact of the current pandemic on patients with bulimia nervosa (BN).

METHODS

Fifty-five former inpatients with BN completed an online survey on psychological consequences of the COVID-19 pandemic as well as on changes in health care utilisation and on the use and helpfulness of different coping strategies.

RESULTS

Almost half of patients (49%) reported a deterioration of their ED symptomatology and 62% reported a reduced quality of life. The frequency of binge eating increased in 47% of patients and self-induced vomiting in 36%. Forty-six percent of patients stated a noticeable impairment of psychotherapy. Face-to-face psychotherapy decreased by 56% but videoconferencing therapy was only used by 22% of patients. Enjoyable activities, virtual social contacts with friends and mild physical activities were rated as the most helpful coping strategies among those most used.

DISCUSSION

Approximately one half to two-thirds of former inpatients with BN experienced a negative impact of the crisis on their ED symptomatology and quality of life. In challenging times when face-to-face therapy options are restricted, e-health treatments such as videoconferencing therapy should be considered to ensure continuity of care.

"Now It's Just Old Habits and Misery"-Understanding the Impact of the Covid-19 Pandemic on People With Current or Life-Time Eating Disorders: A Qualitative Study

Background: Many aspects of the Covid-19 pandemic may make living with or recovery from an eating disorder (ED) particularly challenging. Understanding the processes which underlie the psychological and behavioral responses of people with EDs during this time are key to ensure tailored support in these unprecedented circumstances. Methods: People with lifetime EDs (n = 32) were recruited through social media from May to June 2020 during a period of strict infection control measures in the United Kingdom (i.e., "lockdown," "social distancing"). They completed open-ended questions in an online anonymous questionnaire that invited them to reflect on how various aspects of their lives have been affected by the Covid-19 pandemic, including ED symptoms and coping strategies. Responses were analyzed using thematic analysis. Results: Most respondents reported that their ED worsened or resurfaced. Isolation, low mood, anxiety, lack of structure, disruption to routines, and media/social media messages around weight and exercise seemed to contribute to this. There was a clear sense that individuals struggled with which aspects of psychological distress to prioritize, i.e., mood vs. ED cognitions and behaviors, particularly as attempts to cope with one often exacerbated the other. Nonetheless, some participants reported "silver linings" of the pandemic. Conclusions: In this self-selected sample, deterioration or recurrence of ED symptoms were the norm. This has implications for the provision of treatment and care for people with EDs both in the immediate short-term and in potential future waves of the pandemic, with a significant surge of new and re-referrals expected.