Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review

  1. Mario Miniati
  2. Francesca Marzetti
  3. Laura Palagini
  4. Donatella Marazziti
  5. Graziella Orrù
  6. Ciro Conversano
  7. Angelo Gemignani

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Abstract

Background: Several data suggest that coronavirus disease 2019 (COVID-19) pandemic may exacerbate or trigger eating disorders (EDs). The aim of this paper was to summarize current literature studies on COVID pandemic and EDs.

Methods: Literature search, study selection, methods, and quality evaluation were performed according to the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines.

Results: A systematic search allowed the initial selection of 172 papers; 21 (12.2%) papers were eligible and included in the review. In selected studies, a total number of 29,108 subjects were enrolled (range: 10–11,391; mean/SD: 1,386 ± 2,800), 6,216 were men (21.4%), 22,703 were women (77.9%), and 189 (0.7%) were gender fluid or not declared. The mean age/SD of subjects was 30.2 ± 7.7. About 12 studies (57.1%) were online surveys, 4 (19.0%) were retrospective studies, 2 (9.5%) were qualitative studies, 2 (9.5%) were longitudinal cohort studies, and 1 was a social media survey (4.8%). Their analysis revealed five main findings: (1) changes in the routines of physical activities were related to the worsening of preoccupation on weight/body shape; (2) food access limitation during pandemic represented the risk factors for both triggering and exacerbating EDs; (3) restriction in healthcare facilities contributed to increase anxiety levels and to modify treatment compliance; (4) social isolation was related to the exacerbation of symptoms in patients with EDs who are home-confined with family members; and (5) conflicts and difficulties in relationships with “no way out” were the maintenance factors for ED symptoms, especially in adolescents and young adults.

Conclusion: The COVID-19 pandemic had a negative impact on EDs that might be triggered by the exceptional conditions derived from COVID-19-related stress in predisposed subjects. Patients who were already affected by EDs experienced the worsening of their clinical conditions and related quality of life (QoL).

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  1. Version published to 10.3389/fpsyg.2021.663376
  2. ScreenIT

    SciScore for 10.1101/2021.04.16.21255390: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    2.2 Eligibility Criteria: We included all studies published between 2019 and October 2020, by using PubMed, SCOPUS and Google Scholar, provided that they met the following criteria: 1) written in English; 2) original articles on studies with a longitudinal design; and 3) prospective or retrospective, observational (analytical or descriptive), experimental or quasi-experimental, controlled or non-controlled studies.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    The PubMed database was systematically screened using the following terms: [EATING DISORDER] AND [COVID] OR [LOCKDOWN] (n=48); [COVID] AND [BINGE-EATING] (n=16); [COVID] AND [BULIMIA NERVOSA] (n=16); [COVID] AND [ANOREXIA NERVOSA] (n=8), leading to a total of 88 papers.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)

    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:
    Study limitations: Across studies, the main weaknesses were due to limited assessment of pre-lockdown EDs symptoms, and to the absence of comparison groups. Moreover, in some studies, the EDs diagnoses were self-reported and specific information on disorders was not collected. Participants were mostly recruited online, via social media, resulting in samples being biased towards those who were familiar with the use of technology. The discrepancy in data collection points (early stage of lockdown vs. late stage) made difficult to compare the main findings.

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.04.16.21255390v1 on medRxiv