Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders

Staying isolated indoors means that nobody sees me": ontological (in)security and living with significant appearance concerns before, during, and 'since' COVID-19

PURPOSE

Though a worldwide period of uncertainty (COVID-19) has 'ended', there exists a legacy of maladaptive experiences among people with significant appearance concerns (SAC) that requires care and attention.

METHODS

Using Giddens' concept of ontological security, we explored how people experienced their SAC before, during and "since" COVID-19. Qualitative surveys allowed us to capture diverse perspectives from individuals transnationally, analysed with deductive reflexive thematic analysis using ontological security as our theoretical foundation.

RESULTS

Themes named "More Mirror(ed) Time" and "Locked Out, Shut Down, and Shut Out" gave a contextual grounding for the embodied experiences of this group through times of social restrictions, and the theme "Redefining Relevance" explored the continued legacy of COVID-19 - and continued global uncertainties such as economic hardship and warfare - that impact the wellbeing of people with SAC.

CONCLUSIONS

People with SAC are still 'locked out' from essential healthcare support as those providing healthcare are overworked, under-resourced and rely on efficient interactive methods such as tele-health that may be triggers for people with SAC. Care providers may consider expanding appearance concerns verbiage, look to involve trusted others in the care-seeking process, and utilize modalities beyond digital health to support people with SAC.

A qualitative analysis of college women's experiences with dieting

OBJECTIVE

Dieting is a known risk factor for disordered eating, yet many college women engage in this behavior. Given the popularity of diets, and the risks associated with dieting, it is important to enhance understanding of dieters' experiences. This study utilized a qualitative approach to investigate college women's experiences of dieting.

PARTICIPANTS

Eighty-four woman-identifying undergraduates [42% White, 24% Asian, 20% Black, 14% other; Mage = 19.18 (1.77)] who endorsed dieting were included in the study.

METHODS

Participants provided short-answer responses to open-ended questions. Data were analyzed using a thematic analysis approach.

RESULTS

The following themes were identified: A complicated relationship, variability of experiences, and social factors. Subthemes highlighted the complexity of college women's dieting behavior.

CONCLUSIONS

Results provide important insight into college women's dieting experiences and their consequences. Future qualitative research should aim to understand how to apply these findings to eating disorder prevention efforts.

"Some distance between us": a UK mixed methods study exploring experiences of remote care for eating disorders during COVID-19

Introduction

COVID-19 necessitated a rapid move from face-to-face services to remote care for eating disorders/eating distress (EDs). This study explores the advantages and challenges of remote care, identifying future implications for service provision. Remote care has been considered in the broadest of terms, including therapeutic care (e.g., Cognitive Behavioural Therapy, peer support, forums, one-to-one and group care options).

Methods

Using a mixed methods approach, data were collected from 211 people with lived experience of EDs (PWLE), with and without formal diagnosis. 27 participants took part in semi-structured interviews/workshops and a further 184 participants took part via an online survey. Participants reported on their ED status, the impact of the pandemic on symptoms, the benefits, and challenges of remote care (and type of support accessed), and any reasons for not accessing support. Participants were invited to make future care recommendations.

Results

ED symptoms were reported as worsening during the pandemic with contributing factors including isolation, lack of routine, negative emotions, and feeling like the external situation was outside of one's control. Remote care was positively attributed to increased flexibility and facilitation of social connection. Identified barriers to access included lack of awareness about support availability, digital access/literacy, and competing commitments. Further challenges included approaches being perceived as too clinical (e.g., ED information and support presented using clinical language and/or limited to support within medical care settings, without acknowledging the broader context of disordered eating), uncertainty around remote care quality, and concerns that remote platforms may facilitate masking of symptoms. Participants reported distress caused by online platforms where self-view is the default during video calls. They expressed a need for more holistic approaches to remote care, including: "real stories" of recovery, and hybrid (online and offline) options for greater flexibility and widening of access and choice. Participants also expressed a need for appropriate digital literacy training.

Discussion

Future recommendations emphasise user-centred holistic and hybrid approaches to ED remote support, with training to address digital literacy barriers and facilitate user control of platform functionalities (e.g., self-view). This study underscores the need for continued remote care with a focus on inclusivity and user empowerment.

Role of self-esteem and personal mastery on the association between social support and resilience among COVID-19 long haulers

Although the COVID-19 mortality rate is declining, the number of individuals dealing with persistent COVID-19 symptoms is increasing worldwide, making long COVID a global public health concern. People with long COVID (long haulers) often deal with physical and mental stressors. Long haulers' psychological resilience could play a key role in coping with these stressors in intercorrelation with psychosocial resources. The current study aims to test a hypothesized relationship between social support and its functions (i.e., instrumental and emotional) and the resilience of long haulers through serial mediation by personal mastery and self-esteem. A cross-sectional and self-administered online survey was conducted among 460 individuals with long COVID recruited from COVID-19 Facebook support groups in the United States. Analyzing data indicated a positive correlation between social support and the resilience of long haulers. Structural equation modeling suggested that self-esteem and personal mastery fully mediated the association between social (instrumental) support and resilience. Personal mastery also mediated the association between self-esteem and resilience in social (instrumental) support models. However, in the emotional support model, the indirect effect was non-significant for the mediation by personal mastery and self-esteem. Findings suggest that social support, mainly instrumental support, may protect long haulers by promoting their resilience through self-esteem and personal mastery. This study emphasizes the importance of including social support services in designing programs for COVID-19 long haulers.

'Chugging along, plugging in and out of it': Understanding a place-based approach for community-based support of mental health recovery

Community-based Mental Health (MH) organisations in the United Kingdom (UK) are facing challenges for sustaining in-person service delivery. Without empirical evidence that demonstrates the value of a place-based approach for MH recovery, and the types of resources needed to build nurturing spaces for peer support, community-based MH organisations will struggle to maintain their physical spaces. We present empirical insights from a case study involving interviews with 20 students accessing peer support services at the Recovery College Collective, a community-based MH organisation located in the North East of England. The interview study aims to evidence how a place-based approach can afford MH recovery. We draw from discourses on place-making and interpret our interview findings through an established framework that highlights four mechanisms through which place impacts recovery: place for doing, being, becoming and belonging. We use this framework to structure our findings and highlight key qualities of place for establishing and maintaining MH recovery. Our contribution is two-fold: we address a gap in the literature by providing empirical understandings of how place influences MH recovery, whilst extending previous research by considering the role that place plays in community-based organisations. This is timely because of the challenges faced in securing in-person service delivery post-pandemic, and a shift towards remote service provision models. We highlight key implications: (i) Accessing a physical place dedicated to MH support is vital for people who do not have anywhere else to go and are socially isolated due to their health conditions; (ii) Connecting through peer-to-peer interaction is an integral part of the recovery process, and learning from people with lived experience can inform a place-based approach that best suit their needs; and (iii) Recognising the value of place for MH support, and the resources needed for peer support delivery in the community, will help secure places that our research participants described as lifesaving.

Factors predicting long-term weight maintenance in anorexia nervosa: a systematic review

PURPOSE

Eating disorder recovery is a poorly defined concept, with large variations among researchers' definitions. Weight maintenance is a key aspect of recovery that remains relatively underexplored in the literature. Understanding the role of weight maintenance may help guide the development of treatments. This paper aims to address this by (1) investigating the factors predicting long-term weight maintenance in anorexia nervosa (AN) patients; (2) exploring differences in predictive factors between adolescent and adult populations; and (3) exploring how weight maintenance is conceptualised in the literature.

METHODS

We conducted a systematic review following PRISMA guidelines to address our research questions. Five databases were searched and filtered according to our exclusion criteria.

RESULTS

From the search, 1059 studies were yielded, and 13 studies were included for review. A range of weight, biological and psychological factors were found to predict weight maintenance among these papers. BMI at admission and discharge from inpatient treatment was the most common predictor among the papers. Few studies investigated biological factors and mixed evidence was found for psychological factors. We found no observable differences between adult and adolescent populations. Finally, weight maintenance was defined and measured differently across studies.

CONCLUSION

This review's findings can help contribute to a well-rounded understanding of weight maintenance, and ultimately, of recovery. This can help support clinicians in tailoring interventions to improve long-term outcomes in AN. Future research should aim to replicate studies to better understand the relationship between the factors identified and weight maintenance.

LEVEL I

Systematic review.

The relationship between change in routine and student mental wellbeing during a nationwide lockdown

OBJECTIVE

During March 2020, the UK entered a national lockdown, causing a sudden change in undergraduate students' routines. This study uses this event to investigate the impact routine change had on students' mental wellbeing; in particular looking at depression, anxiety, sleep disturbance, and eating behaviors.

METHOD

Participants reported their daily routine timings (waking, breakfast, lunch, evening meal and bedtime) and activities (e.g. exercise amount, time with friends, time studying, etc) on a typical Monday, Wednesday and Saturday during term time and lockdown. Additionally they completed the PROMIS measures of anxiety, depression, and sleep disturbance, and the Eating Pathology Symptom Inventory.

RESULTS

Lockdown saw small but significant shifts in routine timing (on average 1.5 h) However, there was no clear overall pattern of relationships between mental wellbeing and routine structure or magnitude of routine change. There was some evidence of changes in amount of exercise relating to reported anxiety.

DISCUSSION

These findings are consistent with the current literature reporting lockdown effects on behavior. Routine timings shifted, but this change was small and largely did not affect the mental wellbeing reported by undergraduate students. The change in amount of exercise posed by lockdown did appear to be an important factor in wellbeing, and more research should focus on the wellbeing implications of closing places for exercise.

A systematic review of COVID-19 and the presentation of avoidant/restrictive food intake disorder and avoidant/restrictive food intake disorder-like symptoms

BACKGROUND

The adverse effects of COVID-19 and the associated restrictions on eating disorder populations have been discussed in recent literature. However, little is known about the presentation of cases with avoidant/restrictive food intake disorder (ARFID) during this period.

AIMS

To explore the extent of the literature on the presentation of ARFID, and ARFID-like cases, during the COVID-19 pandemic.

METHOD

Cochrane Library, CINAHL (EBSCO), PsycINFO (EBSCO), EMBASE (Ovid) and Medline (Ovid) were searched for publications between March 2020 and May 2023. Google Scholar and reference lists were hand searched. At least two reviewers independently screened each paper. Narrative synthesis was used.

RESULTS

Seven papers were included: four case reports and three cohort studies (total ARFID sample of 46). Included papers were assessed as having high (n = 3) or moderate (n = 4) quality. Findings did not suggest an increase in ARFID cases during the COVID-19 pandemic, although it is unclear if this is because of a lack of impact or underrecognition of ARFID. A need for a multidisciplinary approach to differentiate between ARFID and organic causes of ARFID-like presentations (e.g. gastrointestinal effects of COVID-19) was highlighted.

CONCLUSIONS

Publications specifically pertaining to ARFID presentations during the COVID-19 pandemic have been few. Papers found have been of small sample sizes and lack subanalyses for ARFID within broader eating disorder samples. Continued surveillance is needed to evaluate any COVID-19-specific effects on the development, identification, treatment and outcomes of ARFID.

The implications of the COVID-19 pandemic on eating disorder features and comorbid psychopathology among adolescents with anorexia nervosa and matched controls: a comparative cohort design study

PURPOSE

To examine implications of the COVID-19 pandemic on eating disorder (ED) features and psychopathology in female adolescents with anorexia nervosa (AN).

METHOD

In total 79 females with first-onset AN (aged 12-22 years) were included and were followed up across a period of 1 year. We assessed AN participants recruited pre-pandemic (n = 49) to those recruited peri-pandemic (n = 30). Pre- (n = 37) and peri-pandemic (n = 38) age-, and education-matched typically developing (TD) girls (n = 75) were used as a reference cohort. ED features and psychopathology were assessed at baseline. After 1 year of follow-up the association between pandemic timing and clinical course was assessed. Analyses of covariance were used to examine differences in ED features and psychopathology.

RESULTS

Peri-pandemic AN participants experienced less ED symptoms at baseline compared to pre-pandemic AN participants. In particular, they were less dissatisfied with their body shape, and experienced less interpersonal insecurity. In addition, the peri-pandemic AN group met fewer DSM-IV criteria for comorbid disorders, especially anxiety disorders. In contrast, peri-pandemic AN participants had a smaller BMI increase over time. In TD girls, there were no differences at baseline in ED features and psychopathology between the pre- and peri-pandemic group.

CONCLUSION

Overall, peri-pandemic AN participants were less severely ill, compared to pre-pandemic AN participants, which may be explained by less social pressure and peer contact, and a more protective parenting style during the pandemic. Conversely, peri-pandemic AN participants had a less favorable clinical course, which may be explained by reduced access to health care facilities during the pandemic.

LEVEL OF EVIDENCE

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

Impact of the COVID-19 pandemic on care for anorexia and bulimia nervosa in US military-connected adolescents and young adults

OBJECTIVE

This study examined the impact of the COVID-19 pandemic on healthcare engagement for anorexia nervosa (AN) and bulimia nervosa (BN) in a large, geographically diverse population.

METHOD

This repeated monthly, cross-sectional study queried Military Health System records of individuals aged 10-21 before and during the pandemic (February 2019-January 2022). ICD-10 codes identified encounters for AN and BN. Monthly rates of care were modeled as the number of unique individuals with an ICD-10-identified eating disorder-related encounter per month divided by the enrolled population. Poisson regression analysis evaluated rates of care stratified by eating disorder, clinical setting, and sex.

RESULTS

In a population of 1.76 million adolescents and young adults, 1629 individuals with AN or BN received care during the pre-pandemic period; 3256 received care during the pandemic. The monthly rate of care for females with AN during the pandemic increased in inpatient settings (adjusted relative risk [aRR]: 1.31 [1.16-1.49]) and outpatient settings (aRR: 1.42 [1.37-1.47]); monthly care rates in males with AN increased in the outpatient setting (aRR: 1.46 [1.28-1.67]). Females with BN had increased engagement in outpatient settings (aRR: 1.09 [1.03-1.16]); BN care for males showed no significant monthly changes during the pandemic period in either healthcare setting.

DISCUSSION

With increased rates of AN and BN disorder-related care during the pandemic, screening for eating disorder symptomatology may allow for timely diagnosis and intervention in periods of heightened stress. Pandemic-related increases in healthcare engagement may strain limited resources, emphasizing a need to expand accessibility of clinical expertise.

PUBLIC SIGNIFICANCE

This study indicates that monthly rates of healthcare engagement during the COVID-19 pandemic for AN and BN varied based on clinical setting and sex in an adolescent and young adult population. The increased number of individuals seeking eating disorder-related care, especially outpatient care, attributed to heightened stressors necessitates accessible professionals with eating disorder clinical expertise.

A Qualitative Exploration of Prominent Factors Contributing to the Aetiology of Child and Adolescent Eating Disorder Presentations during the COVID-19 Pandemic: The Perspectives of Patients, Parents and Clinicians

AIM

The aim of this study was to explore the prominent factors that contributed to the development of child and adolescent eating disorder presentations during the COVID-19 pandemic.

METHODS

This was achieved through a qualitative analysis of interviews gathered from (1) adolescent patients diagnosed with an eating disorder (ED) during the COVID-19 pandemic (aged 13-18) (n = 4), (2) parents of patients attending an ED service (n = 7) and (3) clinicians working within a specialist child and adolescent ED support service (n = 7). Reflexive thematic analysis was used to analyse the data and establish the most prominent aetiological factors reported.

RESULTS

The most prominent aetiological factors reported were (1) the accumulation of risk factors; (2) seeking control amid increased anxiety, stress and uncertainty; (3) social isolation; (4) an increased focus on exercise and "healthy eating"; (5) increased social media use promoting unhelpful attention towards ED triggers; and (6) a lack of both awareness and support services.

CONCLUSION

During the COVID-19 pandemic, the quantity and severity of ED presentations increased. The current study uncovered six themes perceived by patients, parents and clinical staff that contributed to the aetiology of ED presentations during the COVID-19 pandemic. It is hoped that the insight gained through this research study into ED aetiology may act as a basis for further research and support ED awareness, prevention and intervention in the future.

Effects of the COVID-19 Pandemic on Depressive Symptoms, Including Clinical and Subthreshold Levels, and Eating Behaviors in First-Year University Students

Introduction

During the coronavirus disease 2019 (COVID-19) pandemic, university students experienced unusual environmental stresses, and the number of university students with depressive symptoms increased. The pandemic had a profoundly negative impact on the mental health of first-year students because they were not prepared to face academic and social stresses. The purpose of this study was to investigate the effect of the COVID-19 pandemic on depressive symptoms, eating behaviors, and stress-coping ability among first-year university students.

Methods

A total of 8,424 first-year students, 2,043 males and 1,636 females who entered university in Japan in 2021-2022 (during the pandemic) and 2,912 males and 1,833 females who entered university in Japan in 2018-2019 (before the pandemic), participated. We investigated the differences in depressive symptoms (using Beck Depression Inventory II [BDI-II]), eating behaviors (using Eating Attitudes Test-26 [EAT-26] and Bulimic Inventory Test, Edinburgh [BITE]), and stress coping (using Coping Inventory for Stressful Situations [CISS], which has three subscales) between first-year students before and during the pandemic. We divided the students into three categories (clinical, subthreshold, and nonsymptomatic) according to depressive symptoms and eating behaviors based on BDI-ll and EAT-26 scores and compared the frequencies of the three categories at two time points.

Results

First-year students during the pandemic showed a higher percentage of depressive symptoms, including clinical and subthreshold levels, than first-year students before the pandemic but did not show disordered eating behaviors. Additionally, the CISS task-oriented score was significantly lower for students with depressive symptoms, including clinical and subthreshold levels, during the pandemic than before the pandemic in females.

Conclusions

This study suggests that it may be important to provide first-year university students with more information about depressive symptom awareness, including clinical and subthreshold levels, and to provide appropriate ways for stress coping from many angles and early support in pandemic conditions.

Family body culture, disordered eating and mental health among young adult females during COVID-19

Different family interactions related to body weight and shape may co-occur and represent a broader 'family body culture'. This may be important in the context of COVID-19 due to a heightened focus on body weight/shape, and many young adults living back with their families. This study aimed to, first, explore relationships between different family body-related interactions to assess the presence of a family body culture, and second, explore relationships between aspects of family body culture, disordered eating and mental health among young adult females during the COVID-19 pandemic. Participants were 233 females aged 18-25 years who completed measures of family body culture (family fat talk; family weight concern; family weight teasing), disordered eating, anxiety and depression. Results showed all aspects of family body culture were significantly, positively related. Engaging in fat talk with family members (self fat talk) was a key correlate of disordered eating, anxiety and depression. Family concern with weight was also significantly associated with disordered eating. Findings suggest that among some families there is a more problematic family body culture with a greater importance placed on body weight and shape through various body-related interactions. Additionally, findings highlight two key aspects of family body culture related to disordered eating and wellbeing among young adult females. Specifically, vocalising critical remarks about one's own body when with family and an environment that may indirectly communicate a high importance of body weight and shape (e.g., via dieting). These should be considered in future family interventions to support healthy eating behaviours.

Assessing the factor structure of the Eating Attitude Test-26 among undergraduate students in Malaysia

The objective of this study was to assess the factor structure of the 26-item Eating Attitude Test (EAT-26) through confirmatory factor analysis (CFA) among 1,084 undergraduate students in Malaysia. The initial findings indicated a lack of support for the proposed three-factor structure. Model modifications were made due to the inadequate initial fit. The fit of the model was significantly improved by excluding items with factor loadings below 0.40 and integrating residual covariances. In conclusion, it is necessary to make contextual modifications to the EAT-26 in order to effectively utilize it among Malaysian undergraduates. This highlights the significance of cultural adaptations in psychological instruments.

Acute presentations of eating disorders among adolescents and adults before and during the COVID-19 pandemic in Ontario, Canada

BACKGROUND

Increased rates of pediatric eating disorders have been observed during the COVID-19 pandemic, but little is known about trends among adults. We aimed to evaluate rates of emergency department visits and hospital admissions for eating disorders among adolescents and adults during the pandemic.

METHODS

We conducted a population-based, repeated cross-sectional study using linked health administrative data for Ontario residents aged 10-105 years during the prepandemic (Jan. 1, 2017, to Feb. 29, 2020) and pandemic (Mar. 1, 2020, to Aug. 31, 2022) periods. We evaluated monthly rates of emergency department visits and hospital admissions for eating disorders, stratified by age.

RESULTS

Compared with expected rates derived from the prepandemic period, emergency department visits for eating disorders increased during the pandemic among adolescents aged 10-17 years (7.38 v. 3.33 per 100 000; incidence rate ratio [IRR] 2.21, 95% confidence interval [CI] 2.17-2.26), young adults aged 18-26 years (2.79 v. 2.46 per 100 000; IRR 1.13, 95% CI 1.10-1.16) and older adults aged 41-105 years (0.14 v. 0.11 per 100 000; IRR 1.15, 95% CI 1.07-1.24). Hospital admissions for eating disorders increased during the pandemic for adolescents (8.82 v. 5.74 per 100 000; IRR 1.54, 95% CI 1.54-1.54) but decreased for all adult age groups, especially older adults aged 41-105 years (0.21 v. 0.30 per 100 000; IRR 0.72, 95% CI 0.64-0.80).

INTERPRETATION

Emergency department visits for eating disorders increased among adolescents, young adults and older adults during the pandemic, but hospital admissions increased only for adolescents and decreased for all adult groups. Differential rates of acute care use for eating disorders by age have important implications for allocation of inpatient mental health resources.

Exploring the reciprocal associations between body appreciation, body image flexibility, and body acceptance by others in the context of the COVID-19 pandemic in Germany: Results from cross-lagged panel analyses among women and men

The COVID-19 pandemic provided a context associated with negative consequences for body image and eating behavior. However, little is known about what factors helped to mitigate these consequences and build a positive body image. Previous research pointed to the significance of body image flexibility and perceived body acceptance by others in predicting body appreciation. However, as most of the studies have been cross-sectional, causal relationships are poorly understood. This longitudinal study tested the reciprocal association between body appreciation, body image flexibility, and perceived body acceptance by others during the COVID-19 pandemic in Germany. We analyzed data from a large community sample consisting of 1436 women and 704 men who were invited to complete the study measures (BAS-2, BI-AAQ-5, BAOS-2) at three time points, each approximately six months apart. Latent cross-lagged panel analyses revealed that greater T1 body appreciation predicted an increase in T2 body image flexibility among both genders, while for women, we additionally observed reciprocal effects between T2 and T3. Among both genders, we further found that greater body appreciation predicted increased perceived body acceptance by others over both measurement intervals (but not vice versa). Our findings are discussed in light of pandemical constraints during the studies' assessments.

The Impact of the COVID-19 Pandemic on Childhood Obesity: A Review

The coronavirus disease 2019 (COVID-19) pandemic has changed many families' eating habits and lifestyles. The main aim of this study was to investigate the association between COVID-19 and childhood obesity across the scientific literature. Literature reviews have shown that the current COVID-19 pandemic may play a major negative role in the global fight against childhood obesity. School closures, changes in routine, loss of structure, and loss of control were negatively associated with childhood obesity during the COVID-19 period. In addition, physical inactivity, irregular sleep, increased smartphone/TV screen time, and sedentary life may have played a significant negative role in social distress among children and adolescents. It has been argued that school closures during the pandemic have the potential to increase the prevalence of childhood obesity. Finally, family violence was predicted to increase during the pandemic, putting already vulnerable children at increased risk. The pandemic caused significant morbidity and mortality, straining healthcare systems, shutting down economies, and closing school districts. Pandemic future planning should involve stakeholders, including governments, schools, and families, who should make every effort to minimize the impact of the COVID-19 outbreak on childhood obesity.

Predictors of mental well-being over the first lockdown period due to the COVID-19 pandemic in France. A repeated cross-sectional study

Introduction

Numerous studies have investigated the positive and negative effects of potential predictors of well-being during lockdowns due to COVID-19. Yet, little is known on whether these effects significantly changed with time spent in lockdown. In the current study, we described the association of mental well-being with a large number of background characteristics (e.g., socio-demographic or health-related factors), COVID-related factors, and coping strategies, over the duration of the first lockdown due to COVID-19 in France.

Methods

A nationwide online survey was conducted over 7 of the 8 weeks of the 1st lockdown in France, i.e., from 25 March 2020 to 10 May 2020. The level of mental well-being was reported using the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). We also measured various background characteristics (e.g., age, sex, education, health issues), COVID-related factors (e.g., health and economic risks, agreement with lockdown), and coping strategies. Our analytical strategy enabled us to disentangle effects aggregated over the study period from those that linearly vary with time spent in lockdown.

Results

Our final dataset included 18,957 participants. The level of mental well-being dropped gradually from the third to the eighth week of lockdown [49.7 (sd 7.9) to 45.5 (sd 10.6)]. Time in lockdown was associated with a decrease in well-being (for each additional 10 days of lockdown: B = -0.30, 95%CI: -0.62, -0.15). Factors that showed significantly negative and positive effects on well-being as time in lockdown progressed were (for each additional 10 days of lockdown): having current psychiatric problems (B = -0.37; 95%CI: -0.63, -0.04), worries about having access to personal protective equipment (B = -0.09; 95%CI: -0.18, -0.01), coping by having positive beliefs about the future of the pandemics (B = 0.29; 95%CI: 0.04, 0.62), being supported by neighbors (B = 0.24; 95%CI: 0.04, 0.44), and being involved in collective actions (B = 0.23; 95%CI: 0.04, 0.46).

Discussion

Participants from our sample saw a drop in their mental well-being throughout the first period of COVID-19 lockdown. Policymakers should be mindful of factors contributing to greater deterioration of mental well-being over time, such as having current psychiatric issues. Promoting collective actions and local support from neighbors may alleviate the deterioration of mental well-being over time.

Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response

This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.

The Impact of the First and Second Wave of the COVID-19 Pandemic on Eating Symptoms and Dysfunctional Eating Behaviours in the General Population: A Systematic Review and Meta-Analysis

BACKGROUND

The aim of this systematic review and meta-analysis was to examine the prevalence of feeding and eating disorder (FED) symptoms or dysfunctional eating behaviours (DEB) in the general population during the COVID-19 outbreak.

METHOD

We searched eligible articles in biomedical databases from 1 January 2020 to 31 March 2022. Prevalence rates of FED or DEB changes between pre-pandemic and pandemic time and correlation with psychological distress were pooled with a meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. A total of 186 studies with 406,076 participants met the inclusion criteria.

RESULTS

The more prevalent FED or DEB during the COVID-19 outbreak were: body image concerns (52%, 95% CI 0.38, 0.66), binge eating (40%, 95% CI 0.25, 0.55), and overeating (40%, 95% CI = 0.32-0.48). Pooled data of longitudinal studies (k = 8) only showed a significant difference in the prevalence of weight gain from pre-pandemic to the pandemic time. Finally, increased levels of psychological distress (k = 35) positively correlated with some ED symptoms.

CONCLUSION

This meta-analysis evidenced a negative impact of the pandemic on eating symptoms and DEB in the general population.

Locked down with my eating disorder: a retrospective study on the impact of COVID-19 lockdown on adolescents with eating disorders

BACKGROUND

Negative effects of COVID-19 lockdowns have been reported in adult patients with feeding and eating disorders (FED) whereas evidence of its impact on young clinical populations is still limited and somewhat inconsistent. The present study aims to investigate the effect of the first COVID-19 lockdown on a range of FED symptoms in children and adolescents: (a) already receiving treatment in our specialist service for FED when the pandemic hit, and (b) prospectively evaluated in our service from October 2020 to July 2021.

METHODS

Out of sixty-one eligible patients with a broad spectrum of FED invited, forty-five young patients (aged 11-18) consented to participate and were included. An ad-hoc survey, consisting of open questions, multiple choice questions, yes/no questions, and a symptoms checklist, was administered online.

RESULTS

About half of the participants (46.7%) reported a positive effect of lockdown on FED symptomatology. Patients with anorexia nervosa (AN) reported the highest rate of symptomatology worsening (58.6%). Younger patients (11-13 years) showed a greater improvement of symptoms compared to older ones (14-18 years of age). COVID-19 lockdown was identified as the precipitating factor for FED onset in 60.7% of newly evaluated patients.

CONCLUSIONS

Evidence from our investigation points out that although the COVID-19 pandemic was a precipitating factor for a FED for many active and newly referred patients, it had a positive impact on youth who were already in treatment and younger participants.

TFOS lifestyle: Impact of societal challenges on the ocular surface

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Adverse effect of lockdowns during the COVID-19 pandemic: increased incidence of pediatric crisis admissions due to eating disorders and adolescent intoxications

During the COVID-19 pandemic, countries imposed (partial) lockdowns that reduced viral transmission. However, these interventions may have unfavorable effects on emotional and psychological well-being. The aim of this study was to quantify possible adverse effects of the COVID-19 pandemic on psychological wellbeing in children and adolescents. Hospital admission data between January 2017 and September 2021 from eight general hospitals in the Netherlands was collected, comparing the incidences of sub-categorized psychological diagnoses, more specifically eating disorders, intentional intoxications, accidental intoxications, and excessive crying, before (2017-2019) and during the pandemic (2020-2021). Data was summarized per month and per year, and the years 2020 and 2021 were compared to 2017-2019. The relative increase or decrease in diagnoses since the start of the pandemic was calculated. Overall pediatric hospital admissions decreased with 28% since the start of the pandemic. Non-infectious diagnoses showed a decrease of 8%. Of these non-infectious diagnoses, overall psychosocial admissions were increased (+ 9%), mostly caused by an increase in admissions for eating disorders (+ 64%) and intoxications in adolescents (+ 24%). In addition, the proportion of admissions due to psychosocial diagnoses increased post-pandemic (6% vs 4%, p < 0.001). Overall admissions for intoxications in children (- 3%) and excessive crying (- 1%) did not increase, although peaks in incidence were found at the start of the second lockdown.

CONCLUSION

During the COVID-19 pandemic, admission rates for eating disorders and intentional intoxications showed a substantial increase, indicating a high burden of pediatric psychiatric diseases.

WHAT IS KNOWN

• The COVID-19 pandemic has had an impact on psychosocial wellbeing in children and adolescents.

WHAT IS NEW

• There was an increase in admissions due to psychosocial problems in the Netherlands in the period after the pandemic. • This was mainly caused by an increase in crisis admissions due to eating disorders and intoxications in adolescents.

"Like putting on an old pair of gloves" or "realising i am actually over it": a qualitative study exploring the impact of the COVID-19 pandemic lockdown restrictions on eating disorder recovery in the UK

The COVID-19 pandemic lockdown restrictions posed unique challenges for people living with eating disorders (EDs), particularly relating to social isolation and changes in treatment access. However, less is known about the experience of lockdown for people 'in recovery' from EDs or disordered eating (DE) (i.e., with an ED/DE history). This study explored: (i) how people with a self-reported ED/DE history responded to and managed the experience of lockdown, specifically in relation to their recovery, and (ii) coping strategies for the management of recovery. Semi-structured interviews were conducted between June and August 2020 with 20 adults with a self-reported ED/DE history living in the UK. Data were analysed using inductive thematic analysis within a critical realist framework. Three overarching themes were identified: (1) Seeking safety and stability during a pandemic, (2) Lockdown prompting realisations about recovery, and (3) Exploring self-compassion as a more adaptive approach. While most participants experienced a resurgence in ED symptoms during lockdown, many reflected on the successful management of these as reinforcing their recovery. These findings have important implications for understanding ED recovery, in addition to informing interventions to better promote recovery during the COVID-19 pandemic and beyond.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-023-04353-2.

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.

Increased General, Eating, and Body-Related Psychopathology in Inpatients in a Specialized Eating Disorders Unit after the Beginning of the COVID-19 Pandemic: A Retrospective Comparison with the Pre-Pandemic Period

The study of the effects of the COVID-19 pandemic on individuals who attended mental health services is needed to identify the specific vulnerabilities associated to this challenging period. Despite several analyses reporting the worsening of eating disorders symptomatology after the beginning of the pandemic, characterizations of adult inpatients with eating disorders are still lacking. We conducted a retrospective analysis to assess whether adult individuals who underwent hospitalization in a specialized eating disorders unit in the two years after the beginning of the COVID-19 pandemic differed in clinical presentation, psychopathological measures, and treatment outcomes from inpatients hospitalized in the two years before. In the comparison between the two groups, the individuals who began treatment after the start of the pandemic presented with more physical hyperactivity and more severe psychopathological scores in most of the areas investigated, with differences in eating symptoms still evident at discharge. Notably, body-related symptoms (i.e., body shape concerns, body checking, body avoidance) were associated with the pandemic, and also for inpatients with extreme anorexia nervosa. This retrospective analysis does not allow us to separate the impact of COVID-19 from other potentially relevant co-occurring factors; however, these findings help in understanding how the pandemic could have affected individuals that needed specialized intensive treatment.

Consulta remota a pessoas com transtornos alimentares durante a pandemia de COVID-19

RESUMO Objetivos: analisar as experiências subjetivas relacionadas à adaptação ao atendimento remoto por usuários com transtornos alimentares durante a pandemia de COVID-19. Métodos: estudo descritivo de abordagem qualitativa realizado com usuários de um ambulatório especializado em transtornos alimentares. Foi aplicada uma entrevista semiestruturada remota, utilizando-se o aplicativo Google Meet. Os dados foram submetidos à análise lexical por meio do software ALCESTE e discutidos à luz das evidências científicas. Resultados: a consulta remota é uma estratégia positiva, mas não substitutiva da modalidade presencial. Vantagens como economia financeira, maior contato com os profissionais e flexibilização de horários de atendimentos foram citadas. Dificuldade de avaliação clínica em relação ao peso, sinais vitais e pouco domínio da tecnologia foram apontados como limitações. Considerações Finais: o estudo induz a discussão sobre sistematização dos atendimentos remotos, os quais, durante a pandemia de COVID-19, foram responsáveis por fornecer maior sensação de suporte às pessoas com transtornos alimentares.

Remote consultation with people with eating disorders during the COVID-19 pandemic

ABSTRACT Objectives: to analyze subjective experiences related to adaptation to remote care by users with eating disorders during the COVID-19 pandemic. Methods: a descriptive study with a qualitative approach conducted with users of an eating disorders outpatient clinic. A semi-structured remote interview was applied using the Google Meet application. The data were submitted to lexical analysis using ALCESTE software and discussed in the light of scientific evidence. Results: the remote appointment is a positive strategy but not a substitute for the face-to-face modality. The research cited financial savings, closer contact with professionals, and flexibility of service schedules as advantages. It pointed out the difficulty in clinical evaluation concerning weight, vital signs, and poor mastery of technology as limitations. Final Considerations: the study induces discussion about the systematization of remote care, which, during the COVID-19 pandemic, were responsible for providing a greater sense of support to people with eating disorders.

The impact of COVID-19 related lockdown measures on self-reported psychopathology and health-related quality of life in German adolescents

The impact of school-closings on adolescents' mental health and well-being in the management of the ongoing COVID-19 pandemic is subject to ongoing public debate. Reliable data to inform a balanced discussion are limited. Drawing on a large ongoing multi-site project in Germany, we assessed differences in self-reported psychopathology in a matched convenience-sample of adolescents assessed pre- (November 26, 2018 to March 13, 2020; n = 324) and post the first lockdown (March 18, 2020 to August 29, 2020; n = 324) early 2020 in Germany. We found no evidence for an increase in emotional and behavioral problems, depression, thoughts of suicide or suicide attempts, eating disorder symptoms, or a decrease in general health-related quality of life. Reported suicide plans significantly decreased from 6.14 to 2.16%. Similarly, conduct problems decreased in the post-lockdown period. Family risk-factors did not moderate these findings. The influence of socioeconomic status on emotional and behavioral problems as well as depression decreased during the lockdown. Based on the present findings, the first school-closing in Germany had no immediate and severe impact on adolescents' well-being. However, caution is warranted as our data covers a fairly small, affluent sample over a limited time-span and long-term consequences cannot be ruled out.

The Effects of COVID-19 Pandemic and Lockdown on Pediatric Nutritional and Metabolic Diseases: A Narrative Review

SARS-CoV-2 was the first pathogen implied in a worldwide health emergency in the last decade. Containment measures have been adopted by various countries to try to stop infection spread. Children and adolescents have been less clinically involved by COVID-19, but the pandemic and consequent containment measures have had an important influence on the developmental ages. The COVID-19 pandemic and the subsequent lockdown periods have influenced the nutrition and lifestyles of children and adolescents, playing an epigenetic role in the development of nutrition and metabolic diseases in this delicate age group. The aim of our review is to investigate the effects of the COVID-19 pandemic on nutrition and metabolic diseases in the developmental ages. Moreover, we have analyzed the effect of different containment measures in children and adolescents. An increase in being overweight, obesity and type 2 diabetes mellitus has been detected. Concerning type 1 diabetes mellitus, although a validated mechanism possibly linking COVID-19 with new onset type 1 diabetes mellitus has not been yet demonstrated, barriers to the accessibility to healthcare services led to delayed diagnosis and more severe presentation of this disease. Further studies are needed to better investigate these relationships and to establish strategies to contain the nutritional and metabolic impact of new pandemics in the developmental ages.

Short Research Article: Do demographic, socioeconomic and clinical characteristics influence the number of psychological intervention sessions attended by young people in need of mental health care?

BACKGROUND AND METHOD

A cohort study using secondary data assessed associations between baseline characteristics and psychological sessions attended in young persons discharged from a Children and Young People's Mental Health Service in 2019.

RESULTS

There were 584 persons who attended a median of seven sessions. On multivariable regression analysis, males attended fewer sessions than females, young people from more affluent communities attended more sessions than those from poorer communities and those presenting with eating disorders and self-harm in particular attended more sessions than those with anxiety.

CONCLUSIONS

Addressing why these associations occur may improve mental health care in young persons.

The impact of COVID-19 on Black women who binge-eat: a qualitative study

BACKGROUND

Although studies have traced the impact of COVID-19 on those with eating disorders, little is known about the specific impact of the pandemic on Black American women who report disordered eating behaviors and are at risk for eating disorders. Thus, the purpose of this study is to investigate the impact of COVID-19 on Black women who binge-eat.

METHODS

We recruited a purposive sample during the first wave of COVID-19 from the southeastern United States. Participants identified as Black women, reported binge-eating episodes in the last 28 days, and agreed to participate in a semi-structured interview. Prior to the interview, participants were administered a socio-demographic survey and the Eating Disorder Examination-Questionnaire. Interviews were transcribed verbatim and analyzed independently using qualitative content analysis and open coding to identify relevant codes and themes.

RESULTS

On average, participants (N = 20) were 43.05 ± 16.2 years of age and reported 5.6 ± 5.7 binge-eating episodes in the last 28 days. We identified six themes to describe participants' experiences managing their eating behavior during COVID-19: (1) food as a coping strategy; (2) lack of control around food; (3) increased time in a triggering environment (e.g., being at home with an easy availability of food); (4) lack of structure and routine; (5) challenges with limited food availability; and (6) positive impact of the pandemic.

CONCLUSION

In this study, Black women reported challenges managing their eating behavior during COVID-19. Results could inform the development and tailoring of treatments for Black women reporting disordered eating behaviors.

LEVEL OF EVIDENCE

Level V, qualitative interviews.

The use of technology in the treatment of youth with eating disorders: A scoping review

BACKGROUND

Adolescence and young adulthood is a high-risk period for the development of eating disorders. In recent years, there has been an increase in use of technology-based interventions (TBIs) for the treatment of eating disorders. The objective of this study was to determine the types of technology used for eating disorder treatment in youth and their effectiveness.

METHODS

A scoping review was conducted according to PRISMA-ScR guidelines. Four databases were searched. Eligible articles included: (1) a TBI (2) participants with a mean age between 10- and 25-years and meeting DSM-IV or DSM-5 criteria for any eating disorder and (3) qualitative or quantitative designs. Quantitative and qualitative studies were assessed for quality.

RESULTS

The search identified 1621 articles. After screening of titles and abstracts, 130 articles were read in full and assessed for eligibility by two raters. Forty-nine (29 quantitative and 20 qualitative, observational, or mixed methods studies) met inclusion criteria. Quality ratings indicated that 78% of quantitative studies had a low risk of bias and 22% had a moderate risk. Technologies reviewed in our study included videoconference therapy, mobile applications, and online self-help. We considered interventions used both within sessions with clinicians as well as those used in between sessions by patients alone. Fifteen of 18 (83%) quantitative studies found that TBIs reduce eating disorder symptomatology, with nine of those reporting medium-to-large effect sizes. Qualitative data was of high quality and suggested that virtual interventions are acceptable in this population.

CONCLUSIONS

Although identified studies are of high quality, they are limited in number. More research is needed, particularly regarding videoconferencing and mobile applications. Nonetheless, TBIs show promise for the treatment of eating disorders in youth.

TRIAL REGISTRATION

Not applicable.

Longitudinal experiences and impact of the COVID-19 pandemic among people with past or current eating disorders in Sweden

The study aimed to document the impact of the COVID-19 pandemic on the health and well-being of individuals with past and current eating disorders (ED) in Sweden. We re-contacted participants with a known lifetime history of ED from two previous Swedish studies. Participants completed an online survey about health and functioning at baseline early in the pandemic (Wave 1 ca May/June 2020; N= 982) and six months later (Wave 2 Dec/Jan 2020/21; N= 646). Three important patterns emerged: 1) higher current ED symptoms were associated with greater anxiety, worry, and pandemic-related ED symptom increase; 2) patterns were fairly stable across time, although a concerning percentage (23%) who were symptom-free at Wave 1 reported the re-emergence of symptoms at Wave 2; and 3) only a minority of participants (<50%) with a current ED were in treatment, and of those in treatment, many reported fewer treatment sessions and decreased quality of care. The COVID-19 pandemic appears to pose serious health challenges for individuals with an ED, whether currently symptomatic or in remission. We encourage health service providers and patient advocates to be alert to the needs of individuals with ED and to take active measures to ensure access to appropriate evidence-based care both during and following the pandemic.

The emotional-behavioral state of Israeli adolescent and young adult females with anorexia nervosa during the COVID19 pandemic

BACKGROUND

During the COVID-19 pandemic in Israel, the number of patients with eating disorders (EDs) seeking treatment increased significantly. The present study sought to evaluate whether, during the pandemic (2020-21), patients with anorexia nervosa (AN) would show more ED-related, comorbid, and COVID-19-related symptoms in comparison to a naturalistic control group, and whether differences would be found between adult and adolescent patients with AN. We also examined attitudes to telemedicine use during the pandemic in patients receiving long-distance interventions.

METHODS

Using online self-report questionnaires, we assessed general and COVID-19-specific symptoms with a secure digital platform (REDCap^®) in 36 female adolescents with AN, 35 female adults with AN, and 25 female controls.

RESULTS

Compared with controls, patients with AN showed more symptoms of EDs, anxiety, depression, and post-traumatic stress disorder (PTSD), elevated suicidal ideation, more COVID-related emotional-behavioral disturbances, and lower resilience. Adult patients with AN fared worse than adolescent patients on most of these measures. Adult patients using telemedicine during the COVID-19 pandemic showed fewer positive attitudes toward this treatment than adolescents (telemedicine was offered to all, but used by 18/35 adolescents and 21/36 adults with AN). Last, elevated COVID-19-related symptomatology was correlated with more symptoms of ED, anxiety, depression and PTSD, and with lower resilience.

CONCLUSIONS

Our findings suggest that the emotional-behavioral state of Israeli females with AN, particularly adults, was worse during the COVID-19 pandemic in comparison to controls. Many patients did not use telemedicine for their treatment. Adult patients using telemedicine were less satisfied with it than adolescent patients.

Investigating engagement in maladaptive and adaptive exercise behaviors before and during COVID-19

PURPOSE

Evidence suggests that the coronavirus (COVID-19) pandemic has resulted in increased mental health concerns (e.g., anxiety) and there is ample discussion of how the pandemic has resulted in increases in weight control strategies (e.g., maladaptive exercise behaviors). It remains unclear, however, if maladaptive exercise behaviors are on the rise among non-clinical samples. The objective of this study was to examine college students' engagement in exercise behaviors (both adaptive and maladaptive) before and during COVID-19.

METHOD

This study compared reports of compulsive exercise, weight and shape exercise, and positive and healthy exercise in two separate samples recruited from a large southeastern university. Sample 1 was collected pre-COVID-19 (August 2019-February 2020) and Sample 2 was collected during COVID-19 (August 2020-April 2021). Case-control matched samples were generated for this study (N = 144; 52.1% male). Three separate analysis of covariance models tested the differences between (1) adaptive exercise; (2) compulsive exercise; and (3) weight and shape exercise in pre- and during COVID-19 samples, controlling for sex.

RESULTS

Individuals in the during COVID-19 sample reported significantly more compulsive exercise (p < .001), weight and shape exercise (p < .001), and adaptive exercise (p < .001) compared to individuals in the pre-COVID-19 sample. Effects were of medium to large sizes.

CONCLUSION

Consistent with reports from the research literature and popular press, the current study observed that both adaptive and maladaptive exercise were higher among college students during COVID-19 compared to pre-COVID-19.

LEVEL OF EVIDENCE

Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Effect of COVID-19 Italian Lockdown on Maxillofacial Trauma Related to Domestic Violence: A Retrospective Cohort Study

Background: This retrospective study aims to identify the potential reasons for the increase in maxillofacial trauma from domestic violence in the first COVID-19 lockdown and propose some strategies that could be effective in fighting it during any future pandemic events. Materials and Methods: The study was conducted on patients with maxillofacial trauma who arrived at the Maxillofacial Unit of the Magna Graecia University of Catanzaro from 9 March to 3 May 2020, who were compared with those registered in the same period in 2019. Inclusion criteria were: patients of both sexes and admission diagnosed with maxillofacial trauma with or without bone fracture. Exclusion criteria were: patients less than 7 years of age, maxillofacial trauma that occurred outside the established period, and patients unconscious or with unclear clinical history. Patients were divided into two groups according to the mechanism of injury (MOI): “domestic” and “non-domestic” trauma. Both descriptive and regressive statistical analysis was conducted using a Student’s t-test with a significance level set at p < 0.05. Results: The total number of maxillofacial fractures in 2020 was similar to 2019 (31 pcs in 2020 vs. 38 pcs in 2019). Before the lockdown, most of the trauma occurred in non-domestic settings (25% in 2020 vs. 76.67% in 2019), especially in road accidents (4.17% in 2020 vs. 20% in 2019). During the lockdown, most of the trauma occurred in a domestic setting (75% in 2020 vs. 23.33% in 2019), especially interpersonal violence (31.58% in 2020 vs. 14.28% in 2019). There were 7 cases of interpersonal violence recorded in 2020 (1 male and 6 female), compared to only one case (female) recorded in 2019, with a statistically significant p-Value (0.0475). Conclusions: The first COVID-19 lockdown has provided the opportunity to study the aetiology of domestic trauma due to interpersonal violence attributable to economic and social problems, all of which were aggravated by the impediment to requesting help due to the difficulty of contacting the services and the general slowdown in the ways out of violence. The analysis conducted and compared with data in the literature suggests the adoption of a proactive (and non-reactive) approach to combat domestic violence during pandemic events.

Users' perceptions of how an unmoderated eating disorder community may benefit or harm their recovery

BACKGROUND

While the negative and positive outcomes of pro-eating disorder groups have been well-documented, more research is needed on the effects of pro-recovery communities. In particular, a gap in knowledge remains surrounding users' feelings about their experiences in such communities. Using open-ended questions, we surveyed those involved in the recovery community on the social media site Tumblr, to determine how the community helped/did not help with recovery, and how it made them feel about recovery.

METHODS

Participants (n = 29) answered a series of Likert and open-ended questions. The open-ended questions were examined using thematic analysis to learn about users' lived experiences.

RESULTS

Themes identified included connection/acceptance, motivation/encouragement, content, and competition/comparisons. Participants overall felt that the community helped them feel connected to others and accepted for their struggles and their successes, though a minority did note that such acceptance could sometimes reinforce negative behaviors, and connection could lead to pressure to help others. Participants found both direct advice and indirect support (e.g., encouraging posts) to be motivating for their recovery. Feelings of competition and comparison were mixed; some felt that comparing to others made them feel less than, while others used such comparisons as reminders to stay strong in recovery. Participants indicated that the content within the community varies; sometimes there is a large presence of pro eating disorder posts, while at other times, posts are more positive, motivational, and encouraging.

CONCLUSIONS

Participants overall indicated that the community had many helpful aspects and made them feel better about recovery. However, the presence of triggering content and competition in particular were notable drawbacks of the community. Overall, recovery communities on unmoderated sites or social media applications may be useful tools during the recovery process, despite some important limitations.

Binge-eating behaviors in adolescents and young adults during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic and subsequent public health measures have resulted in a worsening of eating disorder symptoms and an increase in psychological distress. The present study examined symptoms and behaviors in adolescents and young adults with emotional eating, bingeing behaviors and binge eating disorder during the pandemic. Additionally, the study explored if individuals who experienced pandemic-related food availability and food affordability issues experienced increased binge-eating symptoms and negative feelings.

METHOD

Participants (n = 39) were a convenience sample who participated between November 2020 and January 2021 in a weight and lifestyle management program at an urban New England pediatric hospital. Participants completed online surveys that assessed (1) participant's exposure to COVID-19 related stress and binge-eating behaviors using the COVID-19 Exposure and Family Impact Survey-Adolescent and Young Adult Version (CEFIS-AYA) and the Binge Eating Scale (BES) respectively, (2) participants' and their families' ability to attain and afford food and its association with bingeing behaviors, and (3) the relationship between food availability and affordability and negative emotions.

RESULTS

Nearly half of all participants (48.7%) reported moderate to severe bingeing during the COVID-19 pandemic; those who experienced greater COVID-related stress reported more binge-eating behaviors (p = 0.03). There were no associations between indicators of food availability and affordability and binge eating or between food availability and affordability and negative feelings.

CONCLUSIONS

Higher pandemic-related stress was associated with more binge-eating behaviors among adolescents and young adults. These results underscore the need to monitor symptoms and provide treatment for these patients despite barriers to care imposed by the COVID-19 pandemic. Research and clinical care for adolescents and young adults with EDs must recognize and respond to pandemic effects across the weight and disordered eating spectrum.

The Covid-19 pandemic and food consumption at home and away: An exploratory study of English households

The Covid-19 pandemic has changed attitudes of English households towards food consumption at home and when eating out. Little academic research has however examined the scope and the scale of these changes, especially in the context of foodservice provision. This mixed methods study explores the effect of Covid-19 on food consumption in English households at home and away. It reveals increased frequency and variety of cooking during lockdown as a driver of household food wastage. The study demonstrates public hesitance towards eating out post-Covid-19. Foodservice providers are expected to re-design their business settings and adopt protective and preventative measures, such as frequent cleaning and routine health checks, to encourage visitation. After the pandemic, increased preference towards consuming (more) sustainable food at home, but not when eating out, is established. These insights can aid grocery and foodservice providers in offering more tailored products and services in a post-pandemic future.

Eating Disorders and Intimate Partner Violence: The Influence of Fear of Loneliness and Social Withdrawal

Eating disorders are vulnerability factors that increase the likelihood of intimate partner violence. However, the mechanisms underlying this relationship are unclear. Although eating disorders have been associated with increased perception and fear of loneliness, they have also been associated with increased social withdrawal resulting from decreased enjoyment of social situations and poorer social functioning. The purpose of the present study was to examine the mediating role of fear of loneliness in the relationship between the behavioural characteristics of eating disorders and intimate partner violence, as well as to explore the moderating role of social withdrawal in the relationship between fear of loneliness and intimate partner violence. The sample comprised 683 participants (78% female and 22% male) with a mean age of 21.14 years (SD = 2.72). The psychometric scales used were Eating Disorders Inventory (EDI 2), Emotional Dependency Questionnaire (EDQ), Coping Strategies Inventory (CSI) and the Violence Received, Exercised and Perceived in Youth and Adolescent Dating Relationships Scale (VREPS). The hypothesised model was tested by path analysis using maximum likelihood. The path analysis of the hypothesised model showed that inefficacy, fear of maturity, and impulsivity were the behavioural characteristics of eating disorders predominantly related to fear of loneliness. Fear of loneliness had no direct significant effect on any of the received violence variables. However, interaction effects indicated that there was a moderately significant effect of fear of loneliness on physical, psychological, and social violence received as a function of levels of social withdrawal. These findings show the need to take into account and work on fear of loneliness and social withdrawal among individuals with an eating disorder to decrease the likelihood of establishing violent intimate partner relationships. Improving interpersonal functioning and social support is key to recovery from eating disorders.

Increase in admission rates and symptom severity of childhood and adolescent anorexia nervosa in Europe during the COVID-19 pandemic: data from specialized eating disorder units in different European countries

BACKGROUND

The COVID-19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. An increase in hospital admission rates for juvenile anorexia nervosa (AN) has been documented in many regions of the world. However, data from Europe are scarce.

METHODS

We asked clinicians in specialized eating disorder units in hospitals of maximum care in France, Germany, Italy, Spain, Sweden, and the Netherlands to report on (i) overall (inpatient and outpatient) and (ii) inpatient admission rates for adolescents with AN during 2019 and 2020. Additionally, a modified version of the COVID Isolation Eating Scale (CIES) was used to assess the child and adolescent psychiatrists' estimations of a possible increase in symptom severity in children and adolescents with AN during the COVID-19 pandemic and to (iii) inquire about the contributing factors perceived by the caring professionals.

RESULTS

Four out of six representatives of European hospitals described a higher rate of overall admissions during the pandemic. Three hospitals out of six reported an increase in inpatient admissions, and two centres had constant high numbers of admissions of both outpatients and inpatients. The clinicians perceived a higher symptom severity in 2020 than in 2019, especially involving more frequent use of social media, longer duration of exercising, and more restrictive eating. They supposed an increase in social media consumption, a perceived "loss of control", and a lack of in-person assessments and weight controls as the main contributing factors for the deterioration in AN numbers and symptomatology.

CONCLUSIONS

The COVID-19 pandemic seems to have had a deep impact on symptom severity in AN, which is mirrored by a large increase in admission rates across Europe. An increase in exercise, social media consumption, a perceived "loss of control", and a lack of face-to-face health care seem to have contributed to this development. Further investigation is required to identify which factors may lead to the increase in incidence and deterioration of childhood and adolescent AN. Possible preventive means for the future could include educating paediatricians and health care workers about AN, regular weight assessment, and home-based treatments.

A Longitudinal and Comparative Content Analysis of Instagram Fitness Posts

Body dissatisfaction is among the most common mental health challenges experienced by women and has been identified as a risk factor for disordered eating. Research has found that exposure to social media images depicting thin, muscular bodies, often dubbed ‘fitspiration’, may contribute to body dissatisfaction. Image-centred social media platforms, such as Instagram, have rising popularity among adolescents and young adults. However, little is known about the content of images produced by different fitness-related sources, such as those from fitness brands compared with individual users, and how fitness content on social media is evolving over time. This study sought to determine whether Instagram content varied between female fitness influencers and brands and how this content changed between 2019 and 2021. A longitudinal content analysis was conducted on a sample of 400 Instagram images using a coding scheme developed specifically for this project. The scheme coded images for fit ideal body depiction, fitness focus, objectification, and sexualisation. Chi-square tests indicated that female fitness influencer content was more sexualised and portrayed more of the fit ideal, while fitness brands produced more Instagram content with a fitness focus. There were no significant overall longitudinal changes for any of the four key variables. However, when looking at longitudinal changes by account type, fitness-focused influencer content increased while fitness-focused brand content decreased over time. These findings highlight discernible differences in content produced by different Instagram account types. It points future research towards the consideration of potential moderating factors, such as account type, when exploring the impact of social media images on body image and mental health.

Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating

BACKGROUND

Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting).

OBJECTIVE

The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions.

METHODS

This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented.

RESULTS

The findings showed unique differences in the types of sensor data that were triangulated with the individuals' episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants' awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet.

CONCLUSIONS

This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population.

Changes of symptoms of eating disorders (ED) and their related psychological health issues during the COVID-19 pandemic: a systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic and its related social restrictions have profoundly affected people's mental health. It can be assumed that symptomatic behaviors and mental health of individuals with eating disorders (ED) deteriorated during this time. To get a thorough overview, we conducted a systematic review and meta-analysis with the following aims: First, to provide a comprehensive overview of symptoms of ED during the COVID-19-related confinement; second, to identify psychological mechanisms which impacted the emergence and maintenance of ED symptoms; third, to describe changes of daily routine and changes of access to healthcare in individuals with ED during confinement.

METHODS

We searched Embase, PubMed, and Scopus databases for observational studies published between January 1st, 2020, to July 1st, 2021, which investigated the symptomatology of ED during the COVID-19 pandemic.

RESULTS

After the screening, 13 studies with 7848 participants were included in the present systematic review and meta-analysis. The overall pooled prevalence of exacerbation of binge eating, food restriction, purging behaviors, and concerns about food intake in the pooled sample of 7848 was 59.65% (95% CI: 49.30%; 69.60%), and the overall prevalence of improved symptoms of ED in the pooled sample of 741 individuals was 9.37% (95% CI: 3.92%; 16.57%). Furthermore, COVID-19-related social restrictions negatively impacted the psychological health, daily routines, and physical activity of individuals with ED. More specifically, symptoms of anxiety and depression related to ED were increased significantly over time. However, there were also positive aspects to the COVID-19 pandemic. The main positive consequences included more emotional support from the family, less pressure to engage in social activities, and more flexible meal planning. Individuals with ED reported having difficulties getting access to healthcare centers and using telemedicine. They also found a hard time communicating via online sessions.

CONCLUSIONS

According to our interpretation, based on the data included in the systematic review and meta-analysis, the COVID-19 pandemic and its related social restrictions detrimentally impacted the mental health of majority of individuals with ED. Limited and impaired access to healthcare interventions appeared to have further exacerbated mental health issues of individuals with ED. Given this background, it seems that individuals with ED demand more attention during the COVID-19 crisis, and it is necessary to ensure that their course of treatment remains uninterrupted.

Are People with Obesity Attracted to Multidisciplinary Telemedicine Approach for Weight Management?

The forced isolation due to the COVID-19 pandemic interrupted the lifestyle intervention programs for people with obesity. This study aimed to assess: (1) the behaviors of subjects with obesity towards medical care during the pandemic and (2) their interest in following a remotely delivered multidisciplinary program for weight loss. An online self-made survey addressed to subjects with obesity was linked to the official website of our institute. Four hundred and six subjects completed the questionnaire (90% females, 50.2 ± 11.6 years). Forty-six percent of the subjects cancelled any scheduled clinical assessments during the pandemic, 53% of whom had chronic disease. Half of the subjects were prone to following a remotely delivered lifestyle intervention, especially with a well-known health professional. About 45% of the respondents were favorable towards participating in remote psychological support and nutritional intervention, while 60% would practice physical activity with online tools. Male subjects and the elderly were more reluctant than those female and younger, especially for online psychological support. Our survey showed an interest on the part of the subjects with obesity to join a multidisciplinary weight loss intervention remotely delivered. Male subjects and the elderly seem less attracted to this intervention, and this result highlights that, even with telemedicine, the approach to weight management should be tailored.

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.