Nearly a year into the coronavirus pandemic, another harrowing surge is seeing steep increases: eating disorders.
Over the past 10 months, eating disorders have increased dramatically nationwide, with the National Eating Disorders Association reporting a 78% increase to its helpline since March.
Locally, too, clinicians and programs are seeing unprecedented spikes. At UCSF, the number of those hospitalized has doubled since the pandemic began, and across the Bay Area, psychotherapists and other clinicians are struggling to keep up with a mounting need.
Eating disorders are illnesses that severely disrupt eating behaviors, and usually involve preoccupation with food and body weight. Without treatment, they can result in malnutrition, heart problems and other potentially fatal conditions.
Experts say the unique and highly disruptive circumstances of the coronavirus pandemic — including isolation, stockpiling, stress and bombardment from social media — have exacerbated what had already become its own epidemic.
"I feel like all of this … is the perfect storm," said Dr. Sara Buckelew, director of the UCSF Eating Disorders Program. "There's isolation, there's social media, there's difference in family dynamics, there's loss of peer groups, there's so much."
Back in March, when coronavirus cases were starting to climb, Bay Area residents coped with the uncertainty by stockpiling and hunkering down in isolation. Restaurants closed, pantries were stocked to the brim with canned foods, delivery apps surged in popularity, and in a few swift moments, most of life moved online.
The chaos of early spring actually created a lull in referrals for treatment at the beginning of quarantine, said Dr. Jason Nagata, an assistant professor of pediatrics at UCSF who is also an expert in eating disorders. But a couple of months later, the numbers of those seeking help started to rise, and patients — most of them teenagers and young adults — began to come in.
Some had severe presentations of their illness, perhaps in part because they had either been delaying care or were unable to receive it (many support groups had to shut down because of COVID-19). Food, restriction and fitness became some of the major coping mechanisms for people who were struggling with the incredible loss of control brought on by the pandemic.
"Since then it's been pretty steadily high," Nagata said. "(It's) a new normal of many more hospitalizations."
Experts say teenagers and young adults have been hit the hardest, as COVID-19 stunted so much of their burgeoning independence. Thousands of students were forced to return from college, live at home again and forgo the adventures of young adulthood indefinitely.
One recent UCSF patient was a 13-year-old girl who became obsessed with dieting and exercise shortly after the lockdown, Nagata said. She had been exercising after every meal, totaling four hours a day. She was eventually hospitalized after a regular checkup with her pediatrician, who noticed her heart rate was dangerously low, at around 30.
"I don't think we can predict what it's like to lose these milestones," said Dr. Debra Safer, a psychiatrist, professor and co-director of the Stanford Adult Eating and Weight Disorders Program. "The pressures on normal development … things that they looked forward to as the capstones … it's so much we're asking people to go through."
Amrita, an intensive outpatient program for eating disorders in San Rafael, has been inundated with calls for treatment. Founder and program director Carol Normandi said she's seen clients who dropped 20 pounds in just a few months because the wait times for help are so long, and clients have even fewer distractions and outlets than they did before the pandemic.
"The weight loss is more intensive and quicker because they're not engaged in their normal life," Normandi said. "COVID has just complicated the fuel on the fire with eating disorders because it's something you can do and control within the confines of your own home."
The remote lifestyle has upended normal routines of mobility and eating in community, and can be an environment conducive to binge, restrict or overexercise.
But that's not the only thing exacerbating the issue. The larger collective isolation experience online — with fitness videos and challenges galore — has created even more shaming and comparison around weight gain, clinicians say.
Early discussions around obesity as a strong risk factor for COVID-19 may have fueled even more anxiety, they added.
With quarantine has come an intense online focus on bodies — whether it's people sharing their elaborate fitness and meal routines, spending hours looking into what is essentially a mirror on Zoom, influencers peddling products to lose weight, or people struggling to accept the weight they might have gained over quarantine (which some are calling the "quarantine 15" or "COVID 19").
That attention has been magnified as people spend an increasing amount of time on social media. The result has been an even more triggering environment for those who were already fixating unhealthily on their bodies, said Leora Fulvio, a San Francisco therapist who specializes in eating disorders.
"Those images of appearance, of weight loss, of dieting, that inundation they're experiencing is rewiring their minds," said Normandi, the program director at Amrita. "It's brainwashing them in a way that's tipped the scale."
Several studies have found that increased social media use can have disastrous effects on eating disorders, and Fulvio said she has seen many of her clients worsen during quarantine.
"Eating disorders thrive in secrecy," said Beth Bernstein, a therapist in Oakland who specializes in eating disorders. She added that for her clients who were already struggling, it's almost like they've been left in seclusion with their eating disorders, as the infrastructure of life was stripped bare.
The popular view of eating disorders can often be superficial, she said. It's not simply about bodies or a desire to be thin.
"I think about (eating disorders) as a deep-seated anxiety about your self-worth," Bernstein said. "It's about worth, fitting in, control, power, lovability, but the body becomes shorthand for, 'Where do you lie in the order of things? In the human caste system, where are you?'"
Sometimes the scales — literal or psychological — can provide those illusory answers. Bernstein said she's heard stories of people who ride their Peloton bikes for hours because they don't know what else to do with their anxiety. Their relational alternatives — what therapists would normally recommend to help stave off those impulses — are severely limited while observing pandemic safety measures like social distancing.
But several helpful resources are still available for those who are struggling or know someone who might be:
• Talk to your physician first. If you're struggling with disordered eating patterns or think you have an eating disorder, Normandi recommends reaching out to a medical professional first so they can make sure you are physically stable, help assess the issue and tailor recommendations based on where you are. The Eat-26 test , a short standardized self-report measure of symptoms and concerns, can also be one way to gauge your level.
• Consider reaching out to a clinician. Numerous clinicians in the Bay Area specialize in eating disorders, including psychotherapists, nutritionists and dieticians. Psychology Today is a helpful online database that can assist with the process of finding support. You may also try finding one through your medical provider.
• Reach out to your local community. Eating disorders thrive in isolation. It can be a real source of support to talk to friends or family members, especially if they have gone through something similar. Though many support groups have had their physical spaces shut down due to COVID-19, many still meet online. Project Heal has some great resources for accessing treatment and finding support.
• Be mindful of what you're consuming online, and how much. A lot of social media can set off thought spirals of comparison and measurement, and it might be best to unplug from that as much as you can, clinicians say. At the same time, there are still social pages that encourage body positivity and intuitive eating, and those can be sources of support. COVID19EatingSupport on Instagram is just one of the many.
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