If you are a teen, live with a teen or work with teens, you’ve probably suspected that eating disorders have significantly increased since the beginning of the COVID-19 pandemic. The good news is that your guess is correct. The bad news is that your guess is correct.
Towards the end of last year, a study published in JAMA Pediatrics found that “14 geographically diverse academic adolescent medicine sites” saw a notable increase in inpatient and outpatient eating disorder care due to the COVID-19 pandemic. Another study, published in 2021 in Pediatrics, reported that eating disorder-related admissions doubled among patients ages 10-23 years old during the first year of the pandemic.
Why did this happen and what can we do about it?
We sat down with Katie Mittelstaedt, Psy.D. & outreach consultant for the National Alliance for Eating Disorders and Mount Kisco-based certified nutritionist and fitness instructor Alena Shifrin to learn more.
What is an eating disorder?
Both Mittelstaedt and Shifrin agree that there’s a spectrum, ranging from disordered eating to eating disorders.
“When talking about disordered eating, we’re talking about people who don’t have a super healthy relationship with food and are concerned about their eating, calories or macros, but it’s not necessarily interfering with their daily life,” Mittelstaedt explains. “And when we think about a clinical eating disorder, that’s when the relationship between their food and body is really interfering with their ability to do life.”
Eating disorders can impede one’s lifestyle in various ways, from skipping classes to not hanging out with friends and family.
“There are also times when people experience an eating disorder and are still doing life, but their health is really impacted,” she continues. “But regardless of how severe their eating disorder is, everybody deserves help, and early interventions are really important.”
Why did the pandemic increase eating disorders?
Mittelstaedt and Shifrin emphasize that eating disorders are maladaptive coping mechanisms, similar to alcohol, drugs, gambling, etc.
“With the stress and uncertainty that came with the pandemic, people turned to disordered eating and eating disorders as a tool to cope,” says Mittelstaedt.
Additionally, since “the pandemic was a major stressor, most people who struggled slightly beforehand experienced that dysfunctional cycle of coping intensify,” adds Shifrin.
How to help a friend
Shifrin feels it’s better to ask how they’re doing rather than state your concern.
“A gentle way to get information is to ask ‘Hey, what’s going on? Are you struggling?’”
Mittelstaedt says to start by using ‘I’ statements, approaching the situation from a place of love and concern rather than in an accusatory manner.
For example: “I’m worried about you.” “I see you’re in pain.” “I feel you’re being really critical of your body.”
And if you’re a teen concerned about a friend, don’t keep it to yourself – share your concern with trusted adults, like parents, teachers and guidance counselors.
Shifrin says that it’s okay to be worried or scared that your friend will be angry with you, “but as their friend, it’s important to realize their health could be in jeopardy.”
“In the long term, when people are able to separate from their ‘eating disorder mentality,’ they’re typically so grateful because one of the most loving things one can do is to tell our friend we aren’t going to allow their eating disorder to hurt them anymore,” Mittelstaedt adds.
Losing weight in a ‘healthy way’
If your friend or family member pushes back, insisting they’re only trying to lose weight in a ‘healthy way,’ Mittelstaedt recommends you try to figure out why they are interested in losing weight.
“From a clinical perspective, I want people to know that manipulating their bodies and losing weight is really difficult for people to actually achieve in a healthy and sustainable way,” Mittelstaedt explains. “I think it’s a cultural myth that we have control over our body size. Research demonstrates that 97 to 99 percent of people who diet and attempt to lose weight ultimately gain the weight back or don’t lose the weight in the first place. There’s a reason it’s a $70 billion industry, partially because there are so many repeat customers.”
Instead, focus on getting in tune with your body rather than concentrating on the scale, external numbers, calories, etc.
Shifrin finds that “restrictive, extreme measures are absolutely unhealthy and not effective in the long term.” And when she meets a client who she believes has an eating disorder, she gently refers them to a medical or psychological professional who specializes in this treatment.
“Working with a specialist helps people get in touch with their bodies and ultimately, their bodies can be trusted to find their most natural, healthy weight,” Mittelstaedt explains.
Shifrin says she also struggled with her own weight at one point, but what separated her from a person with disordered eating is how she chose to handle it.
“For a good portion of my adult life, I weighed over 300 pounds,” she explains. “So from experience, I know that the best way to lose weight in a healthy way is to work with a nutritionist and personal trainer to gain an education. In a nutshell, get reliable, good information so that you can work smart, eat healthy and get the most out of your exercise.”
Creating positive thoughts and environments
Maintaining a positive environment about food and bodies is paramount and, in many ways, a preventive step.
Both experts agree that there’s no such thing as ‘good’ or ‘bad’ food.
“Food is neutral – it’s fuel, just like gasoline is fuel for a car,” Shifrin explains. ”We shouldn’t call it good or bad because if you eat something that you call bad, you’re going to feel bad about yourself.”
“All food is good and serves a purpose, whether for nutrition, enjoyment, connection, etc.,” Mittelstaedt adds. “And all of those are incredibly valid reasons to eat, nourish and enjoy.”
Instead of looking at external numbers to tell you how much to eat, what to eat or when to eat, trust your body to tell you this information.
Ask yourself the following questions: What sounds good to me right now? Do I want more protein? Do I want something lighter or denser?
“If more nutrient-dense foods like broccoli sound better than or equally as good as a less nutrient-dense food like cookies, then maybe choose the broccoli because you feel you’re in a place to do so,” Mittelstaedt advises. “The most important thing is to do all of this without judgment.”
Also, turn away from body talk, whether positive or negative.
“Instead of encouraging thinness, encourage good, healthy habits,” says Shifrin.
“Start complimenting your friends and family on the things that actually matter—‘you’re so funny’ or ‘you’re so smart,’” adds Mittelstaedt.
And, most importantly, seek help when you need it.