This blogpost is written by the members of Eating Disorders and Behaviours Research Group: SiennaMarisa Brown, Marie-Christine Opitz, and MacKenzie Robertson.
The University of Edinburgh’s Eating Disorders and Behaviours (EDB) research group [1] was established Autumn 2019 as an effort to consolidate postgraduate research (PGR) candidates with eating disorders and/or behaviours as a general area of interest. Principally led by the School of Health in Social Sciences’ Dr Helen Sharpe, Dr Emily Newman, and Dr Fiona Duffy, the research group now consists of approximately 15 members and, during the COVID-19 coronavirus pandemic rapidly[2] created, conducted, and published two studies—one interview- and one survey-based—on the perceived impact of COVID-19 on individuals both with and without eating disorders in the UK.
The first study, “A qualitative exploration of the impact of COVID-19 on individuals with eating disorders in the UK” (2020), was the first in depth interview approach with adults with mixed eating disorder presentations in the UK during COVID-19. The second study, “Exploring changes in body image, eating and exercise during the COVID-19 lockdown: A UK survey” (2020), used survey responses to investigate the perceived impact of the COVID-19 related lockdown in the UK on people’s eating, exercise, and body image.
An interview-based exploration of the impact of COVID-19 on individuals with eating disorders in the UK [3]
What did we find? Across all interviews, we found that three general themes were important: how participants were restricted in the way they could socialize, how they had to change their daily routines and how differently they could be supported by professionals regarding their eating disorder.
Social Life
Not being able to visit friends or family meant that participants felt lonelier and had more time to think about food. If they were living alone, they usually had less support from people they would otherwise see regularly. However, if they had a supportive partner or family, they sometimes had more support than they usually would have throughout the day. Finally, those who managed better during lockdown (despite having less support available), perceived this as an achievement for themselves.
Daily Life
Routine and structure were generally seen as helpful when dealing with disordered eating. New mealtime routines with supportive family members were perceived as beneficial. However, working from home, living alone and sudden changes in daily routines led to more disordered eating for participants who felt overwhelmed by these changes and who had less support than they usually would have at work or during leisure time activities. Not being able to leave the house much also meant that participants intensified their exercise routines to get the most out of it. In addition, participants had problems keeping their eating disorders hidden (while food shopping or when they lived with family/partners), which was perceived as highly stressful. Others used their isolation to avoid uncomfortable questions about how they were doing; avoiding these questions meant that they did not have to be confronted with their disordered eating.
Professional Support
Due to restrictions in face-to-face contact, the ways of accessing professional support had to be changed. Some participants struggled with this new format, while others appreciated the anonymity of online support. Most participants felt that they did not feel deserving of more support, especially with mental health services being overstrained.
Key points:
Overall, the lockdown period was a stressful experience for all study participants. Based on our ten interviews we further found:
- The impact of the lockdown measures was highly dependent on available resources (such as participants’ living situation, available personal support and amount of responsibilities held during this period)
- The impact of the lockdown measures was highly dependent on how severe the eating disorder was at the beginning of lockdown; more severe eating disorder symptoms were associated with more difficulties when dealing with disordered eating during lockdown
- Changes in routine, restrictions and regulations caused significant stress for people with eating disorders and will likely continue to cause significant stress beyond the lockdown period, as routines have to continuously be adapted; worries about the future and how routines will have to change (even if the spread of the virus can be contained) need to be considered in the future
Exploring changes in body image, eating and exercise during the COVID-19 lockdown: A UK survey [4]
The COVID-19 related lockdowns have had a major impact on our daily routines, including how we access food. In this study, we explored how lockdown measures might be impacting people’s relationships with their body, food, eating, and exercise. We were particularly concerned with how people with pre-existing eating difficulties, such as people with eating disorders, were coping with these changes.
We asked 264 adults in the UK to tell us about their experiences in lockdown. Initial findings suggest some people report that their relationship with their body, food, eating, and exercise either improved or worsened. Importantly, some groups appear to be more vulnerable to negative effects including women, people under 30 years old, and those with a current or past eating disorder diagnosis. These groups reported an increased concern about their appearance and more difficulties regarding food, eating, and exercise.
This is an ongoing project and future analyses will be important for increasing our confidence in these findings; however, alongside similar results from other studies, the findings suggest that women in particular may be experiencing more mental health difficulties as a result of the lockdown, including increased disordered eating. Additionally, results suggest that we might see an increase in demand for eating disorder services across the UK as current clients may experience worsening symptoms. This highlights the ongoing need for more accessible eating disorder resources and the critical examination of public health campaigns aimed at weight loss that are likely to increase weight stigma and perpetuate eating disorders.
[1] The University of Edinburgh’s Eating Disorders and Behaviours research group can be contacted via email at research.edb@ed.ac.uk.
[2] As COVID-19 is a rapidly evolving situation, the EDB group aimed to capture perceived effects in real time; thus, a ‘rapid study’.
[3] Brown, S., Opitz, M. C., Peebles, A. I., Sharpe, H., Duffy, F., & Newman, E. (2020). A qualitative exploration of the impact of COVID-19 on individuals with eating disorders in the UK. Appetite, 156. DOI: 10.1016/j.appet.2020.104977.
[4] Robertson, M., Duffy, F., Newman, E., Bravo, C. P., Ates, H. H., & Sharpe, H. (2020). Exploring changes in body image, eating and exercise during the COVID-19 lockdown: A UK survey. Appetite, 159. DOI: 10.1016/j.appet.2020.105062.
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