Early impact of COVID ‐19 on individuals with self‐reported eating disorders: A survey of ~1,000 individuals in the United States and the Netherlands

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Abstract

Objective

We evaluated the early impact of COVID‐19 on people with self‐reported eating disorders.

Method

Participants in the United States (US, N = 511) and the Netherlands (NL, N = 510), recruited through ongoing studies and social media, completed an online survey that included both quantitative measures and free‐text responses assessing the impact of COVID‐19 on situational circumstances, eating disorder symptoms, eating disorder treatment, and general well‐being.

Results

Results revealed strong and wide‐ranging effects on eating disorder concerns and illness behaviors that were consistent with eating disorder type. Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased restriction and fears about being able to find foods consistent with their meal plan. Individuals with bulimia nervosa and binge‐eating disorder (US 30% of sample; NL 15%) reported increases in their binge‐eating episodes and urges to binge. Respondents noted marked increases in anxiety since 2019 and reported greater concerns about the impact of COVID‐19 on their mental health than physical health. Although many participants acknowledged and appreciated the transition to telehealth, limitations of this treatment modality for this population were raised. Individuals with past histories of eating disorders noted concerns about relapse related to COVID‐19 circumstances. Encouragingly, respondents also noted positive effects including greater connection with family, more time for self‐care, and motivation to recover.

Discussions

COVID‐19 is associated with increased anxiety and poses specific disorder‐related challenges for individuals with eating disorders that require attention by healthcare professionals and carers.

Article activity feed

  1. SciScore for 10.1101/2020.05.28.20116301: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: The minimum age to participate without parental consent was 18 years in the US and 16 years in NL.
    IRB: Ethical approval was granted by the University of North Carolina Biomedical Institutional Review Board.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableWe then conducted one-way analyses of covariance (ANCOVA) to explore differences between groups (defined later) on continuous items from the various questionnaire sections, controlling for biological sex (male or female, intersex excluded), age, and day of study enrollment.

    Table 2: Resources

    No key resources detected.


    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our rapid deployment did yield limitations. First, eating disorder diagnoses were self-reported as interviews were not feasible in the timeframe. Second, despite many striking similarities, differences between the US and NL emerged in terms of sample composition as well as the countries’ approach to pandemic control—with the NL strategy being more comprehensive and uniform and the US being more fragmented. Moreover, differences in these strategies and stage of the pandemic at deployment could affect the pattern of responses. Our use of convenience sampling could introduce bias in the responses, as individuals who were most worried/concerned might be more inclined to participate. Finally, our use of predetermined questions, did not allow for an unbiased survey of respondents’ concerns. Although outside of the scope of the present study, given that many individuals with eating disorders returned to their families of origin during lockdown, it would be of value to document the impact of COVID-19 on carer’s and family member’s experiences particularly with relation to stress, burnout, mealtimes, and healthcare provider support. In summary, individuals with eating disorders may be experiencing a worsening of symptoms and that those with past eating disorders may be vulnerable for relapse during COVID-19. Although these data are primarily descriptive, we aim to provide preliminary guidance to healthcare providers about ways in which they might be of assistance during this time. Bot...

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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