“Watch out for the Quarantine-15!”

“If you’re not reaching your goals, it’s not an issue of time, it’s an issue of self-discipline.”

“Me, after finishing all the quarantine snacks after 2 days.”

Have you seen these sorts of social media posts? Society has framed the quarantine during the COVID-19 pandemic as a recipe for disaster; being stuck at home, close to snacks with nothing to do but sit around. Weight loss, working out and dieting are being pushed as necessities to help you come out of this pandemic feeling refreshed and renewed. Ideas like these ignore the fact that this is not a vacation, and that while we may have extra time on our hands, it does not mean that we have the bandwidth or the finances to cook, eat healthy or work out regularly. For many of us, our routines—and the feelings of security that go with them—have disappeared, and this can cause a disruption in eating patterns and self-image.

EATING DISORDERS AND COVID-19

The threat of COVID-19 is particularly disruptive to those with eating disorders. Two particular challenges are food scarcity and food accessibility. Empty store shelves and panic-buying can lead to a scarcity mindset and increased preoccupation with food. It can increase a desire to hoard food or lead to rationalizing the urge to avoid the hassle of getting food or leaving the house. Those with eating disorders may rely on eating safe foods, but with this pandemic comes the possibility that those foods may not be as available. This may increase anxiety and the desire to restrict. On the other side, there is also more access to food due to increased time at home and stockpiling behaviors. This may create the desire to restrict food intake, or binge and/or purge.

Eating disorders thrive in isolation even when times are normal. The social distancing and stay-at-home orders associated with the pandemic only increase the loneliness, shame and avoidance those with eating disorders experience. An eating disorder can often be used as a distraction from experiencing distress, as well as a way to feel in control and manage uncertainty. For vulnerable patients, the COVID-19 pandemic has disrupted routines, undermined the structures that formerly provided support, and increased feelings of uncertainty, leaving many feeling overwhelmed and dysregulated.

SOCIAL MEDIA, FAT SHAMING AND DIET CULTURE

Humor is a great way to foster resilience and connection. Humor about gaining weight, dieting and negative body talk, although often used as means of connection in our culture, is dangerous. These jokes do not bring us together, they only increase fear. They promote fat bias and self-objectification. They make light of a fear and anxiety that millions of Americans struggle with on a daily basis. These jokes are rooted in our society’s beliefs that certain bodies are desirable, that we are nothing more than the way we look, and that fat is bad and needs to be avoided at all costs.

The truth of the matter is that during a pandemic, we may eat more, we may gain weight, and our exercise routines will be disrupted. Food is reliable, and it is often a source of comfort and relaxation during times of uncertainty and stress. Yes, there are health risks with regularly over-eating and not exercising. However, eating healthy and having time to exercise are privileges not experienced by everyone. Instead of promoting inclusivity, connection and empowerment, these jokes and messages drive shame, stigma and isolation. All of these messages can increase worries about weight, body image, feeling out of control, and not being good enough, which can lead to more behaviors of disordered eating or eating disorders.

PRACTICAL WAYS TO HELP

If you or someone you know is dealing with struggles around body image, below are tips that can help.

For ourselves and loved ones:

•             Create structure and routine in the day, especially around meals and snacks.

•             Stay connected to friends and loved ones.

•             Schedule video sessions or meetings around snack and/or meal times, so that you can support and model normalized eating. If this does not seem doable, check out online virtual meal support groups like the ones from The Eating Disorder Foundation.

•             Practice self-compassion and mindfulness. It is common to experience increased symptoms during this stressful time. Encourage loved ones to give themselves grace and to practice accepting “good enough,” while modeling this behavior yourself.

•             Support self-care and maintain simple hygiene/grooming routines (i.e. showering, combing your hair, washing your face, etc.).

•             Focus on foods that fuel your body and taste good. Moderation is key. Eat balanced meals and snacks throughout the day. If emotional eating or binging occurs, focus on doing the next right thing at the next meal (i.e. eat a normal meal rather than skipping it).

•             Food does not have moral value; it cannot be good or bad. Empower yourself to let go of these labels. By neutralizing food and letting it be just food, we can decrease shame associated with the basic need to eat.

•             Validate the distress underneath. When we feel uncertain, we may turn to food and our bodies as things we can easily control. Address the underlying feelings and emotions beneath that surface-level desire for control.

•             Encourage mindful movement. A workout does not need to be a 60-minute cardio session. A good workout can be a 30-minute walk around the neighborhood.

•             Support mindful social media use, whether it’s setting time limits or unfollowing unhelpful accounts.

•             The National Eating Disorders Association (NEDA) is a great resource for anyone struggling. The helpline phone number is 1-800-931-2237.

For clinicians:

•             Help your patients see that they are more than their body, a number on the scale, or what diet they are on. Discuss what is being lost when we treat ourselves as objects. Instead, direct them toward their values and goals.

•             Encourage gratitude for one’s body. Help your patient recognize the body image and food messages they have internalized. Help them reframe and defuse. Support them in reaching a place of body appreciation or body neutrality.

•             Support patients in finding alternative coping skills and hobbies. With social distancing and many places closed, you and your patient may need to get creative.

•             If required, encourage seeking a higher level of care. Many treatment centers are still operating and accepting new patients.

•             As a clinician, take inventory of your own food and body talk. While there are no doubt many other things on your mind right now, this may be the exact time to truly look at your relationship with food and your body. Who knows? You might gain some insight and come out of this with a stronger appreciation for your body, and for your being as a whole.

Emily Hemendinger, LCSW, MPH, CPH
OCD Therapist, Instructor
DBS Coordinator, Department of Psychiatry
University of Colorado Anschutz Medical Campus

MIND THE BRAIN PODCAST

Listen to Dr. Neill Epperson and Emily Hemendinger discuss our relationship with food and how it is impacted by the COVID-19 pandemic.

Mind the Brain CME Information
CME Survey for the June 9, 2020 Edition

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