Weeks before the COVID-19 pandemic began, Anastasia Vlasova, then a junior in high school, started seeing a therapist. In middle school, she began playing tennis competitively and, simultaneously, joined a gym and social media, following fitness influencers and athletes. She launched a fitness and tennis account, where she posted workouts and recipes, and became obsessed with “fitness culture.”
“I went through periods where I’d eat really ‘clean,’ and then I would deprive my body of things that had more sugar, and then I would binge eat,” Vlasova said. “That turned into a cycle of restricting and binging, and then feeling shame, guilt, and self-hatred on the days I would binge, that I lived with for about five years.”
The shame associated with binge eating–along with the pressure she put on herself over academics and sports–led Vlasova to hit what she called a “breaking point.” One day at school, she had a panic attack, prompting her mother to pick her up. They went to the botanical garden they always go to, where Vlasova sobbed for two hours. That week, they researched therapists; the first one Vlasova met with has been her therapist for the past two years.
As Vlasova’s experience shows, eating disorders were prevalent before the pandemic. The National Eating Disorders Association (NEDA) estimates that 30 million Americans will experience an eating disorder at some point in their lives. There is no single cause, but disordered eating behaviors–including over-exercising and restrictive eating–can manifest in individuals who are perfectionistic, experience anxiety, or whose hobbies center on physical activity. It is difficult to know exactly when disordered eating turns into a diagnosable eating disorder, but when thoughts of food and body image interfere with daily life, including school, work, and relationships, attention is warranted.
Reported cases of eating disorders increased significantly during the pandemic. Research shows that inpatient hospitalizations for eating disorders doubled in 2020, and the average length of stay increased from eight days to 12. NEDA also reported a 107% increase in calls to their helpline since the start of the pandemic.
Researchers cannot definitively explain this increase. However, the pandemic disrupted the way people live, work, and learn–exacerbating and amplifying circumstances that reinforced isolation, anxiety, depression, loss, and other challenges that, in turn, made the emergence of an eating disorder more likely. With concerns about the “Quarantine 15,” and obesity a risk factor for COVID-19 severity, the pandemic itself may have prompted disordered eating.
The uptick does not surprise Doris Iarovici, MD, a psychiatrist at Harvard University’s Counseling and Mental Health Services and subject matter expert with The Jed Foundation (JED). In August 2020, she wrote that although it was too soon to know if the pandemic would increase eating disorder rates, COVID-19 conditions created a “perfect storm of increased risk.”
Grocery shopping took on perceived heightened risk due to contagion concerns, and fears about food shortages encouraged hoarding behaviors, “making us all think about how and what we eat much more than usual,” Dr. Iarovici said.
People “saw” themselves more due to online classes and remote work, creating opportunities for self-criticism, and teens used social media more during the pandemic, too. Social media has long been tied to body dissatisfaction, and Vlasova maintains it contributed to her eating disorder. She scrutinized every image she posted, feeling pressure to uphold a lean, athletic ideal. After occasional “digital detoxes,” Vlasova left social media in May 2021.
This pressure persisted during the pandemic. Among teenagers who sought health information online between September and November 2020, searches for fitness and exercise information came second only to searches for COVID-19 content–surpassing searches on anxiety, stress, and depression.
The emerging data shows Dr. Iarovici was right to be concerned. She has since seen in her work what mental health professionals are seeing nationwide: increased demand for services and a decline in overall well-being. She’s also seen new eating disorder diagnoses in people who hadn’t struggled before, relapses, and more disordered eating in general.
According to Dr. Iarovici, isolation and logistics may have also contributed to increased eating disorder rates. When dining halls suspended in-person services, “grab and go” meals made it easier to skip eating altogether or necessary to eat in private. Campus closures may have forced students to return to difficult living situations; in some cases where a student had a sibling with an eating disorder or other mental health issue, the close proximity made well-controlled symptoms flare again.
For Vlasova, the pandemic consisted of ups and downs. “I was nervous about being home all day where I’d have access to food,” she said. Although she was worried about binge eating, she continued therapy and began making progress.
Vlasova is now a freshman at New York University, and much of her anxiety has dissipated. “I was so focused on getting into college that I didn’t think about what would happen after,” she said. “Now, I’m focused on learning, growing, and enjoying the process.”
But there have been challenges. Vlasova is working through anxiety about not always knowing exactly how her food is made, and during her first semester, she usually ate in isolation. However, that is changing, too.
“Eating with friends changes your internal narrative about food,” Vlasova said. “Instead of thinking it’s something scary I have no control over, I see it as something that makes people feel warm and connected. It’s also a reminder that we need to eat for fuel.”
Food is essential, and diet culture and emphasis on body image are widespread in modern society, making eating disorders especially insidious. Dr. Iarovici says it’s hard to predict what the long-term implications of the rise in eating disorders during the pandemic will be, but she is encouraged by broader conversations about diet culture and disordered eating.
Recovery from an eating disorder can take time because it means re-learning healthy eating habits and coping skills. Moving forward is key, and that’s what Vlasova is doing with the support of her family, friends, and therapist.
“I still get thoughts of, ‘Oh, I want to turn to food,’ when I’m super stressed or anxious,” Vlasova said. “That was frustrating and scary at first. But my therapist told me that this is my first time in eating disorder recovery moving to a new city, my first time in recovery starting college. There will be unexpected triggers with new experiences. That doesn’t mean I’m relapsing or that I’ll be restricting and binging for the rest of my life. It’s my body learning to adjust as new things happen, and that’s okay.”
For more information, visit our page on Understanding Eating Disorders and resources for parents and caregivers and educators. To get help right away, contact the National Eating Disorders Association (NEDA).