COVID-19 Latest information

COVID-19, also referred to as coronavirus, is an infectious disease which has caused a global pandemic. The pandemic has had a significant impact on people’s mental health and, for people experiencing an eating disorder, the increased stress and shifts in daily life have been especially challenging.

While the full extent of the impact of COVID-19 on eating disorders and other mental health conditions is unknown, during the pandemic, many people with an eating disorder experienced a worsening of symptoms and higher risk of relapse. Such negative impacts are likely due to the disruptions in access to treatment resulting from lockdowns and restrictions, self-isolation, food access limitations, changes in physical activity routines, increased anxiety and stress and environmental changes at home or work.(1, 2)

Similarly, there has been an increase in disordered eating among people who have not previously experienced an eating disorder. In particular there has been a significant increase in binge eating behaviours among the general population.(1) The COVID-19 pandemic has also seen increased rates of suicidal ideation and behaviour among people experiencing eating disorders when compared with pre-pandemic rates. (3) These increases in both disordered eating and eating disorders have placed significant demands on families and supports.(1, 4)

The worsening of existing eating disorders and significant increase in new eating disorders has accompanied a significant increase in the number of people presenting for treatment, in particular for anorexia nervosa and atypical anorexia nervosa. For example, there was a 63% increase in presentations to the Royal Children’s Hospital Eating Disorder Service in Melbourne during 2020 with timings corresponding to COVID-19 related events such as increased stress and stringent COVID-19 restrictions.(5)

Moreover, research into the prevention and treatment of eating disorders has suffered significant disruptions including difficulties with recruitment of participants, staffing, budget, funding, with some studies being shut down altogether.(6)

Early intervention is crucial to improving treatment outcomes for someone living with an eating disorder. The impact of the COVID-19 pandemic has meant that people are waiting many months to access care and treatment, with a resultant deterioration in physical and mental health.  A 2020 report compiled by NEDC from information gathered from twenty-five eating disorder-specific services in WA, SA, NSW, VIC and QLD found:

• The COVID 19 pandemic has generated a marked increase in presentations of both new and relapsing eating disorders, with associated increases in the required medical and psychological support provided by health professionals
• Increased demand for community and inpatient services, along with an increase in complexity of presentations involving high psychiatric and medical risk, has impacted on supports available at each level of the system of care.
• An increased demand for community and inpatient services across states and territories, along with an increase in complexity of presentations including high psychiatric and medical risk.
• The Butterfly Foundation has reported a 47% increase in contacts made via its Helpline (phone, webchat, or email) over the course of the pandemic and demand for Butterfly’s school services up by 150% during the first school term of 2021, compared to Term 1 2019 (pre-COVID)

Across Australia, initiatives to respond to the increased need for support and treatment have been introduced, including the swift adaptation to telehealth, greater flexibility in appointment times and accessibility to people living all over Australia. Public and private health and mental health services are shifting their response and treatment options to better manage the increasing waitlists. Strategies such as increased peer workforce involvement, online resources and support services, and tertiary consultation to other mental health services and programs are being implemented to provide support for those individuals living with an eating disorder, their families and supports as they wait to access treatment.

Information for people with lived experience and their supports

COVID Help Hub from the Butterfly Foundation

Advice for athletes, NEDC-AIS partnership

Advice for people with an eating disorder and their loved ones, InsideOut

COVID-19 and eating disorders information from Eating Disorders Victoria (EDV)

COVID-19 support from the Department of Health

Information for health and other helping professionals

Advice for coaches and performance support staff, NEDC-AIS partnership

Useful advice for eating disorder clinicians from ANZAED

Key resources for primary care practitioners and mental health services and clinicians from The Victorian Centre of Excellence in Eating Disorders (CEED)

A practical guide to setting up your practice to deliver telehealth services from Mental Health Online

References

1.      McLean, C., Utpala, R., & Sharp, G. (2021). The impacts of COVID-19 on eating disorders and disordered eating: A mixed studies systematic review and implications for healthcare professionals, carers, and self.

2.      Miniati, M., Marzetti, F., Palagini, L., Marazziti, D., Orrù, G., Conversano, C., & Gemignani, A. (2021). Eating Disorders Spectrum during COVID Pandemic: a systematic review. medRxiv.

3.      Taquet, M., Geddes, J. R., Luciano, S., & Harrison, P. J. (2021). Incidence and outcomes of eating disorders during the COVID-19 pandemic. The British Journal of Psychiatry, 1-3.

4.      Dobson, H., Malpas, C. B., Burrell, A. J., Gurvich, C., Chen, L., Kulkarni, J., & Winton-Brown, T. (2021). Burnout and psychological distress amongst Australian healthcare workers during the COVID-19 pandemic. Australasian Psychiatry, 29(1), 26-30.

5.      Springall, G., Cheung, M., Sawyer, S. M., & Yeo, M. (2021). Impact of the coronavirus pandemic on anorexia nervosa and atypical anorexia nervosa presentations to an Australian tertiary paediatric hospital. Journal of paediatrics and child health.

6.      Weissman, R. S., Klump, K. L., & Rose, J. (2020). Conducting eating disorders research in the time of COVID‐19: A survey of researchers in the field. In (Vol. 53, pp. 1171-1181): Wiley Online Library

Further reading

Baenas, I., Caravaca‐Sanz, E., Granero, R., Sánchez, I., Riesco, N., Testa, G., ... & Fernández‐Aranda, F. (2020). COVID‐19 and eating disorders during confinement: Analysis of factors associated with resilience and aggravation of symptoms. European Eating Disorders Review, 28(6), 855-863. https://doi.org/10.1002/erv.2771

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395(10227), 912-920. https://doi.org/10.1016/S0140-6736(20)30460-8

Brown, S., Opitz, M. C., Peebles, A. I., Sharpe, H., Duffy, F., & Newman, E. (2021). A qualitative exploration of the impact of COVID-19 on individuals with eating disorders in the UK. Appetite, 156, 104977. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521890/

Buckley, G. L., Hall, L. E., Lassemillante, A. C. M., & Belski, R. (2021). Disordered eating & body image of current and former athletes in a pandemic; a convergent mixed methods study-What can we learn from COVID-19 to support athletes through transitions?. Journal of eating disorders, 9(1), 1-16. https://link.springer.com/article/10.1186/s40337-021-00427-3

Castellini, G., Cassioli, E., Rossi, E., Innocenti, M., Gironi, V., Sanfilippo, G., Felciai, F., Monteleone, A. M., & Ricca, V. (2020). The impact of COVID‐19 epidemic on eating disorders: A longitudinal observation of pre versus post psychopathological features in a sample of patients with eating disorders and a group of healthy controls. International Journal of Eating Disorders, 53(11), 1855-1862. https://doi.org/10.1002/eat.23368

Clark Bryan, D., Macdonald, P., Ambwani, S., Cardi, V., Rowlands, K., Willmott, D., & Treasure, J. (2020). Exploring the ways in which COVID‐19 and lockdown has affected the lives of adult patients with anorexia nervosa and their carers. European Eating Disorders Review, 28(6), 826-835. https://doi.org/10.1002/erv.2762

Cooper, M., Reilly, E. E., Siegel, J. A., Coniglio, K., Sadeh-Sharvit, S., Pisetsky, E., & Anderson, L. (2020). Eating disorders during the COVID-19 pandemic: An overview of risks and recommendations for treatment and early intervention. Eating Disorders. Advance online publication. https://doi.org/10.1080/10640266.2020.1790271

Feinmann, J. (2021). Eating disorders during the covid-19  pandemic. bmj, 374. http://dx.doi.org/10.1136/bmj.n1787

Graell, M., Morón‐Nozaleda, M. G., Camarneiro, R., Villaseñor, Á., Yáñez, S., Muñoz, R., ... & Faya, M. (2020). Children and adolescents with eating disorders during COVID‐19 confinement: Difficulties and future challenges. European Eating Disorders Review, 28(6), 864-870. https://doi.org/10.1002/erv.2763

Haripersad, Y. V., Kannegiesser-Bailey, M., Morton, K., Skeldon, S., Shipton, N., Edwards, K., ... & Martin, A. C. (2020). Outbreak of anorexia nervosa admissions during the COVID-19 pandemic. Archives of Disease in Childhood, 0(1). http://doi.org/10.1136/archdischild-2020-319868

Hart, E. A., Rubin, A., Kline, K. M., & Fox, K. R. (2021). Disordered eating across COVID-19 in LGBTQ+ young adults. Eating Behaviors,  101581. https://doi.org/10.1016/j.eatbeh.2021.101581

Jones, P. D., Gentin, A., Clarke, J., & Arakkakunnel, J. (2020). Eating disorders double and acute respiratory infections tumble in hospitalised children during the 2020 COVID shutdown on the Gold Coast. Journal of Paediatrics and Child Health. https://doi.org/10.1111/jpc.15248

Keel, P. K., Gomez, M. M., Harris, L., Kennedy, G. A., Ribeiro, J., & Joiner, T. E. (2020). Gaining "The Quarantine 15:" Perceived versus observed weight changes in college students in the wake of COVID-19. International Journal of Eating Disorders, 53(11), 1801–1808. https://doi.org/10.1002/eat.23375

McCombie, C., Austin, A., Dalton, B., Lawrence, V., & Schmidt, U. (2020). “Now It's Just Old Habits and Misery”–Understanding the impact of the Covid-19 pandemic on people with current or life-time eating disorders: a qualitative study. Frontiers in Psychiatry, 11, 589225. https://doi.org/10.3389/fpsyt.2020.589225

Matheson, B. E., Bohon, C., & Lock, J. (2020). Family‐based treatment via videoconference: Clinical recommendations for treatment providers during COVID‐19 and beyond. International Journal of Eating Disorders, 53(7), 1142-1154. https://doi.org/10.1002/eat.23326

Maunder, K., & McNicholas, F. (2021). Exploring carer burden amongst those caring for a child or adolescent with an eating disorder during COVID-19. Journal of Eating Disorders, 9(1), 1-8. https://jeatdisord.biomedcentral.com/track/pdf/10.1186/s40337-021-00485-7.

Miskovic-Wheatley, J., Koreshe, E., Kim, M., Simeone, R., & Maguire, S. (2021). The Impact of the COVID-19 Pandemic and Associated Public Health Response on People with Eating Disorder Symptomatology: A National Australian Study. https://www.researchsquare.com/article/rs-686090/v1

Monteleone, A. M., Cascino, G., Marciello, F., Abbate-Daga, G., Baiano, M., Balestrieri, M., ... & Monteleone, P. (2021). Risk and resilience factors for specific and general psychopathology worsening in people with Eating Disorders during COVID-19 pandemic: a retrospective Italian multicentre study. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 1-10. https://link.springer.com/article/10.1007/s40519-020-01097-x

Monteleone, A. M., Marciello, F., Cascino, G., Abbate-Daga, G., Anselmetti, S., Baiano, M., ... & Monteleone, P. (2021). The impact of COVID-19 lockdown and of the following “re-opening” period on specific and general psychopathology in people with Eating Disorders: the emergent role of internalizing symptoms. Journal of Affective Disorders, 285, 77-83. https://doi.org/10.1016/j.jad.2021.02.037 

Otto, A. K., Jary, J. M., Sturza, J., Miller, C. A., Prohaska, N., Bravender, T., & Van Huysse, J. (2021). Medical admissions among adolescents with eating disorders during the COVID-19 pandemic. Pediatrics, 148(4). https://pediatrics.aappublications.org/content/148/4/e2021052201

Papandreou, C., Arija, V., Aretouli, E., Tsilidis, K. K., & Bulló, M. (2020). Comparing eating behaviours, and symptoms of depression and anxiety between Spain and Greece during the COVID‐19 outbreak: Cross‐sectional analysis of two different confinement strategies. European Eating Disorders Review, 28(6), 836-846. https://doi.org/10.1002/erv.2772

Phillipou, A., Meyer, D., Neill, E., Tan, E. J., Toh, W. L., Van Rheenen, T. E., & Rossell, S. L. (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

Phillipou, A., Tan, E. J., Toh, W. L., Van Rheenen, T. E., Meyer, D., Neill, E., . . . Rossell, S. L. (2021). Mental health of individuals with and without eating disorders across six months and two waves of COVID-19. Eating behaviors, 43, 101564. https://doi.org/10.1016/j.eatbeh.2021.101564

Pikoos, T. D., Buzwell, S., Sharp, G., & Rossell, S. L. (2021). The Zoom Effect: Exploring the Impact of Video Calling on Appearance Dissatisfaction and Interest in Aesthetic Treatment During the COVID-19 Pandemic. Aesthetic Surgery Journal. https://academic.oup.com/asj/advance-article/doi/10.1093/asj/sjab257/6305984

Raykos, B. C., Erceg‐Hurn, D. M., Hill, J., Campbell, B. N., & McEvoy, P. M. (2021). Positive outcomes from integrating telehealth into routine clinical practice for eating disorders during COVID‐19. International Journal of Eating Disorders, 54(9), 1689-1695. https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.23574

Rodgers, R. F., Lombardo, C., Cerolini, S., Franko, D. L., Omori, M., Fuller‐Tyszkiewicz, M., ... & Guillaume, S. (2020). The impact of the COVID‐19 pandemic on eating disorder risk and symptoms. International Journal of Eating Disorders, 53(7), 1166-1170. https://doi.org/10.1002/eat.23318

Salmon, J. (2022). Caring for patients with anorexia nervosa in the time of Covid-19. Nursing Times, 118(3). cdn.ps.emap.com/wp-content/uploads/sites/3/2022/02/220209-Caring-for-patients-with-anorexia-nervosa-in-the-time-of-Covid-19.pdf

Sansom-Daly, U. M., Wakefield, C. E., McGill, B. C., Wilson, H. L., & Patterson, P. (2016). Consensus among international ethical guidelines for the provision of videoconferencing-based mental health treatments. JMIR Mental Health, 3(2), e17. https://doi.org/10.2196/mental.5481

Scharmer, C., Martinez, K., Gorrell, S., Reilly, E. E., Donahue, J. M., & Anderson, D. A. (2020). Eating disorder pathology and compulsive exercise during the COVID‐19 public health emergency: Examining risk associated with COVID‐19 anxiety and intolerance of uncertainty. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.23395

Schlegl, S., Maier, J., Meule, A., & Voderholzer, U. (2020). Eating disorders in times of the COVID‐19 pandemic—Results from an online survey of patients with anorexia nervosa. International Journal of Eating Disorders, 53(11), 1791-1800. https://onlinelibrary.wiley.com/doi/full/10.1002/eat.23374

Shah, M., et al. (2020). Eating disorders in the age of COVID-19. Psychiatry research, 290, 113122. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259905/

Sideli, L., Lo Coco, G., Bonfanti, R. C., Borsarini, B., Fortunato, L., Sechi, C., & Micali, N. (2021). Effects of COVID‐19 lockdown on eating disorders and obesity: A systematic review and meta‐analysis. European Eating Disorders Review. https://onlinelibrary.wiley.com/doi/full/10.1002/erv.2861

Simpson, S. G., & Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. Australian Journal of Rural Health, 22(6), 280-299. https://doi.org/10.1111/ajr.12149

Smith, K., Ostinelli, E., Macdonald, O., & Cipriani, A. (2020). COVID-19 and Telepsychiatry: development of evidence-based guidance for clinicians. JMIR Mental Health, 7(8), e21108. https://doi.org/10.2196/21108

Smith, A. C., Thomas, E., Snoswell, C. L., Haydon, H., Mehrotra, A., Clemensen, J., & Caffery, L. J. (2020). Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). Journal of Telemedicine and Telecare, 26(5), 309–313. https://doi.org/10.1177/1357633X20916567

Solmi, F., Downs, J. L., & Nicholls, D. E. (2021). COVID-19 and eating disorders in young people. The Lancet Child & Adolescent Health, 5(5), 316-318. https://doi.org/10.1016/S2352-4642(21)00094-8

Taylor, C. B., Fitzsimmons‐Craft, E. E., & Graham, A. K. (2020). Digital technology can revolutionize mental health services delivery: The COVID‐19 crisis as a catalyst for change. International Journal of Eating Disorders, 53(7), 1155-1157. https://doi.org/10.1002/eat.23300

Touyz, S., Lacey, H., & Hay, P. (2020). Eating disorders in the time of COVID-19. Journal of eating disorders, 8(1), 1-3: Springer. https://doi.org/10.1186/s40337-020-00295-3

Vitagliano, J. A., Jhe, G., Milliren, C. E., Lin, J. A., Spigel, R., Freizinger, M., ... & Richmond, T. K. (2021). COVID-19 and eating disorder and mental health concerns in patients with eating disorders. Journal of eating disorders, 9(1), 1-8. https://doi.org/10.1186/s40337-021-00437-1 

Vuillier, L., May, L., Greville-Harris, M., Surman, R., & Moseley, R. L. (2021). The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences. Journal of eating disorders, 9(1), 1-18. https://link.springer.com/article/10.1186/s40337-020-00362-9

Waller, G., Pugh, M., Mulkens, S., Moore, E., Mountford, V. A., Carter, J., ... & Farrell, N. R. (2020). Cognitive‐behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth when face‐to‐face meetings are not possible. International Journal of Eating Disorders, 53(7), 1132-1141. https://doi.org/10.1002/eat.23289

Weissman, R. S., Bauer, S., & Thomas, J. J. (2020). Access to evidence‐based care for eating disorders during the COVID‐19 crisis. International Journal of Eating Disorders, 53(5), 639-646 https://pubmed.ncbi.nlm.nih.gov/32338400/

Zhou, X., Snoswell, C. L., Harding, L. E., Bambling, M., Edirippulige, S., Bai, X., & Smith, A. C. (2020). The role of telehealth in reducing the mental health burden from COVID-19. Telemedicine and e-Health, 26(4), 377-379. https://doi.org/10.1089/tmj.2020.0068

Zhou, Y., & Wade, T. D. (2021). The impact of COVID‐19 on body‐dissatisfied female university students. International Journal of Eating Disorders. https://onlinelibrary.wiley.com/doi/full/10.1002/eat.23521

Anyone needing support or information can contact the Butterfly National Helpline 1800 33 4673