Eating Disorders during Covid-19 pandemic

March 15 is the Lilac Ribbon Day, established in Italy to raise awareness around eating and nutrition disorders. An eating disorder completely changes the life of those who suffer from it, limits their relational, work and social skills: in fact, everything seems to revolve around food and body perception.

These thoughts are constantly present throughout the day, not only during meals: their intensity and intrusiveness, taking the form of a real obsession, makes it almost impossible to finish a school task or complete a work commitment.

In times of a pandemic, the situation has gotten worse: eating disorders have seen a significant increase, in which many new cases have been observed throughout the country, reaching up to +50% in children.

What has happened in the last year? What to do when the disorder begins? How to notice it? What is the most suitable diet for students and workers in home-schooling and remote work?

Let us listen to the advice of Prof. Anna Ogliari, UniSR Clinical Psychology Associate and Expert in Eating Disorders in Developmental Age, and Dr. Stefano Erzegovesi, nutritionist and psychiatrist, Director of the Center for Eating Disorders of the San Raffaele Hospital.

Eating Disorders and Pandemic: what happened?

During the Covid-19 pandemic, eating disorders have seen a significant increase, with children of developmental age at greater risk of onset of an eating disorder. We have observed a significant increase in new cases throughout the country, which reaches up to 50% in the youngest [personal communication, Editor's note].

The increase in the incidence of disease is not the only concerning data: in fact we have been able to observe a worsening of symptoms in subjects who had a diagnosis prior to the onset of the pandemic and a marked lowering of the age of onset that has always become earlier and saw an alarming 'pandemic epidemic' in the pre-adolescent stage (10-13 years). Last but not least, the data of the increase in cases in males is alarming, in a pathology that has always shown greater vulnerability in the female sex [personal communication, Editor's note].

If in the early stages of closure we observed an increase in more restrictive behaviors with weight drops of up to 20 kg (such as happens in anorexia), during the second pandemic wave we saw an increase in bulimia nervosa and binge eating disorder.

What are the reasons for this "epidemic within a pandemic"?

The reasons for this worsening can be found in the loss of daily habits, social relationships especially in developmental age that have increased the risk of onset or relapse. This great moment of stress leads to greater concentration on body image and unattainable models.

To the well-known multifactorial causes (biological, psychological and social) we must necessarily add the stressful situations that we all experienced in the lockdown, situations that leverage the predisposing factors for eating disorders, such as emotional dysregulation, some temperamental aspects, extreme precision and a dysregulated approach to food intake. In fact, the time spent in lockdown has inevitably led to an approach to 'pantries' and to a different eating style that could have revealed erroneous eating habits.

The period of closure brought with it the possibility of an extreme concentration on one's body with the risk of concentrating on non-existent imperfections, increasing physical exercise, the use of diuretics and laxatives and exacerbating or reviving the symptoms.

What to do when the disorder begins, what are the alarm bells?

Obviously it is necessary to contact specialized centers and multidisciplinary teams who will be able to direct the treatment from a medical, psychological and nutritional point of view. But it is also important to maintain an atmosphere at the table (and in the family and relational context) as reassuring as possible without postponing any judgment on both the body and the amount of food eaten.

Attention to some alarm bells is one of the fundamental elements for an early diagnosis and in the implementation of therapeutic programs that lead to the improvement of the clinical picture and the remission of symptoms. It is important to pay attention to any changes in eating habits (both in terms of reduction or marked intake, and in terms of attention to the healthy diet profile), and/or the increase in physical activity. It is also important to pay attention to the pursuit of physical perfection and in daily activities.

What foods are the most suitable for this period?

The Mediterranean diet, world heritage of humanity according to UNESCO, is rightly cited as the most suitable dietary style to stay healthy and prevent chronic diseases that afflict our age: cardiovascular diseases, tumors, diabetes 2, brain aging, diseases neurodegenerative, etc.

However, compared to the "poor" Mediterranean diet of our ancestors, rich in whole grains, legumes, fresh vegetables and fruit, the modern Mediterranean diet risks exposing us to an excessive wealth of animal proteins and refined carbohydrates.

Compose a Mediterranean plate

We had already talked about it a few months ago, but it is useful to have a quick review on how to compose our Mediterranean plate, "poor" but very rich in nutrients that are friends of physical and psychological well-being.

1. Take a flat plate and fill half of it with seasonal vegetables

"Filling" really means "filling up to the brim, creating a beautiful mound", considering vegetables as a real main course.

My advice is to eat, at every meal, a double dose of seasonal vegetable: a first course as an appetizer, to appreciate it when you are most hungry, and a second course to add to the first or second course.

The key words, when it comes to vegetables, are varieties and colors: let yourself be guided by the colors of the vegetables and try to range from the green of the spinach to the white of the cauliflower, from the yellow/orange of the pumpkin to the red of the tomato up to the blue/violet of purple cabbage.

2. Fill a quarter of the plate with a whole grain cereal

Brown rice, spelled, barley, rye, buckwheat (both as grains and as polenta) and wholemeal pasta must once again be the protagonists of your daily meal. If you cook the pasta al dente and accompany it with rich portions of vegetables, white durum wheat pasta can also be fine.

3. Fill the last quarter of the plate with a healthy protein

The most recent food guidelines are clear about protein: we are used to eating excessive amounts of animal protein and we need to cut it down drastically.

My advice, considering the two main meals of each day, is to eat vegetable proteins, in the form of legumes, for at least once a day. Let's learn to appreciate the infinite shades of colors and textures of legumes: peas, lentils, chickpeas, borlotti beans, cannellini beans, azuki beans, black or black-eyed beans are just waiting to be rediscovered and appreciated for their taste and health qualities.

At the other meal of the day, you can regularly alternate animal proteins: eggs 1-2 times a week, cheese 1-2 times a week, fish 2-3 times a week, meat 1-2 times a week.

4. Fill a bowl with seasonal fruit

Whether as an end of a meal or as a snack between meals, follow the principle of variety and colors for fruit as well. There is no right way for everyone to eat fruit: there are those who prefer to "wipe their mouths" at the end of a meal with fruit, digesting it very well, and there are those who digest it better by eating it between meals.

Listen to your body and adjust how it feels right for you.

References

• Shah, M., Sachdeva, M., Johnston, H. (2020). Eating disorders in the age of COVID-19. Psychiatry Research, 290 https://doi.org/10.1016/j.psychres.2020.113122
• Rodgers, R.F. et al. (2020). The impact of the COVID‐19 pandemic on eating disorder risk and symptoms. International Journal of Eating Disorders, 53(7):1158-1165 https://doi.org/10.1002/eat.23318
• Phillipou, A. et al. (2020). Eating and exercise behaviors in eating disorders and the general population during the COVID‐19 pandemic in Australia: Initial results from the COLLATE project. International Journal of Eating Disorders, 53(7): 1158-1165 https://doi.org/10.1002/eat.23317