COVID-19 and eating disorders

As we face the COVID-19 epidemic coupled with social distancing, we’re seeing increases in eating disorders and other disordered behaviors. This makes perfect sense, since eating disorders are a coping mechanism, and if we have ever need to cope with something, this is it!

Our teens are missing out on critical milestones, our college kids are back home and miserable, and our young adults are worried about their careers. This is stressful. And eating disorder behaviors typically increase during times of stress.

Why COVID-19 is bad for eating disorders:

• We are quarantining with our families, which can be highly stressful
• We are living in a time of high anxiety and uncertainty, both of which contribute to eating disorders
• Without regular schedules, food and exercise patterns can become chaotic
• When so much is out of our control, it can seem soothing to try to control our bodies with food and exercise behaviors

Eating disorders may seem like they are about food and body issues. But in fact they are complex mental disorders that serve as a powerful emotional coping mechanism. In fact, they are a form of self-care. But of course they have unfortunate side effects, which is why we seek to recover from eating disorders. Often the goal is to learn to reach for less damaging coping mechanisms.

The Royal College of Paediatrics and Child Health in Great Britain announced in December 2020 that doctors have seen a three or four-fold increase in eating disorder cases compared to last year. Eating disorder specialists are also reporting significant increases in Australia and the United States.

The mental health impact of COVID-19

By June 2020, the Centers for Disease Control (CDC) already had data demonstrating a marked increase in mental health issues. Here is a grim recap of their data:

• Anxiety disorder symptoms ~3x higher in June 2020 compared to Q2 2019
• Depression symptoms ~4x higher in June 2020 compared to Q2 2019
• Suicidal ideation ~2x higher in June 2020 compared to 2018

The COVID-19 pandemic is creating huge amounts of stress, anxiety, depression, and panic. Even people who are typically emotionally stable are finding themselves struggling to uphold their mental health. Anyone who has a history of an eating disorder is at high risk of relapse right now. It makes perfect sense. But ideally we would like to see if we can maintain as much recovery as possible as we go through this.

How parents can help kids who have eating disorders during COVID-19

Parents are just as stressed as their kids. This is a tough situation for all of us. Please engage in active self-compassion right now. You deserve so much care and love right now, too. Please reach out for support in any way you can. When you can, please give your child who has an eating disorder a little extra love and support during this time. Here are some ideas:

1. Be on the lookout for eating disorder symptoms

Remember that eating disorders are mental disorders, so you’re looking for mental distress and symptoms of anxiety and depression. If you only focus on weight, you may miss important symptoms. Here are some major symptoms to look out for:

• Cutting out certain foods from their diet entirely, either for taste reasons (e.g. no longer tolerate mushy foods), “health” reasons (e.g. Whole 30, Keto, etc.), or even ethical reasons (e.g. vegetarian, vegan)
• Increased signs of stress during meal times, or avoiding meals with the family altogether
• New exercise regimen that is programmed and rigid
• Skipping meals all day and then eating significant portions (possibly in secret) at night

These are just a few of the signs. You can take our quiz: Does My Child Have an Eating Disorder?

2. Get professional support

If you are concerned that your child has an eating disorder, it’s best to get them to see a therapist and/or dietitian as soon as possible. You can begin with your primary care doctor, but you should be aware that most doctors have very little training in eating disorders, especially if it’s anything other than clinically underweight anorexia. Seek support form a trained eating disorder professional if at all possible. We have a directory of professionals that can help get you started.

Your child may resist or even refuse help. In this case you may be able to force them, but it may actually be better for you to get some counseling or coaching for yourself so that you can more effectively communicate your concerns and work with them. You are not stuck doing nothing if your child refuses treatment – you can actually make a significant impact if you are the one who sees a professional.

I recognize that eating disorder treatment is expensive. And I assure you that professional care is necessary and important in cases of eating disorders. If you are under financial strain, consider the following options before you avoid or cancel treatment due to cost:

• Ask your child’s providers if they can offer a sliding scale for right now. Each therapist will handle this individually, and there are no guarantees, but it’s worth at least asking if you have any options
• Ask your child’s providers if they are offering special support groups during COVID-19. Many therapists are opening up Zoom groups to support those in need. Even if your therapist is not doing this, they may know someone else who is.
• Call the National Eating Disorders Association (NEDA) Helpline at (800) 931-2237. They can help you problem-solve and figure out options
• Review the free and low-cost treatment options on the NEDA website

3. Learn about how stress impacts eating disorder symptoms

Learn as much as you can about eating disorders. Most of what people assume about eating disorders is incorrect or vastly over-simplified. But the important thing to know is that they are both serious and not a choice. They are a mental disorder and should not be ignored or swept under the rug.

Let your child know that times of high stress can trigger eating disorder behaviors. The reason we do this is to let our kids know that it’s OK if they are struggling. We don’t want them to hide their eating disorder behaviors or feel ashamed that they are tempted to use them. And we also want them to know that we are available to help.

Don’t do this just once, because you will most likely get a brush-off. “I’m fine, mom,” is the most likely response, followed by a dramatic eye-roll. But don’t leave it there. Return to this subject in small ways to keep the conversation alive.

It’s OK to check in with your child every day about this. It doesn’t have to be a big long discussion, but you can say “How are you doing today? Is anything going on with your eating disorder that you would like to talk about?”

Your child does not have to engage in the conversation to recognize that you are looking out for their safety and wellbeing right now. While you certainly don’t want to pressure your child, you do want to let them know that you are paying attention and remain vigilant and ready to support them.

You also don’t need to be your child’s therapist. You are asking the question and opening the conversations so that you can direct them to talk to their treatment providers if anything comes up. Eating disorders can be sneaky and tricky, so the more we can bring them into the light, the greater our chance of treating them.

4. Keep an eating schedule

It can be challenging to keep an eating schedule if you aren’t used to it. But if you have a child who has an eating disorder it’s important that you schedule regular eating times.

A major red flag that your child’s eating disorder is acting up is if they skip meals. You want to proactively state your belief that your child needs to eat on a schedule every day in order to try and prevent eating disorder relapse.

Sit down with your family and discuss meal times that work mostly for everyone. These should include at least three meals plus two snacks. Some families add an after-dinner snack or dessert time. Make sure that you schedule at least one meal or snack time that everyone in the family will share.

Next, discuss food preferences for all the meals and snacks and create a family shopping list. It’s important that you involve your whole family in this discussion so that everyone feels as if they are engaged in the process of planning and eating meals. You should not have to carry this burden all by yourself, and you’ll have more buy-in if they participate.

Depending on your child’s eating disorder behaviors, you may need to accommodate certain food fears. Be aware that these fears are part of the eating disorder, and work with your child to recognize that these are unusual times, and additional structure will be necessary to make it through COVID-19.

5. Connect every day

One of the biggest risks of COVID-19 in the digital age is the ability for family members to isolate in their rooms with electronics. Many parents already feel disconnected from their kids due to electronic use, and although we’re stuck in the same house together, that doesn’t mean we’re interacting.

Human connection is one of the most important pieces of mental health. And deep, loving, accepting connection with parents is a healing factor for all of us. Don’t be surprised or feel like you’re failing if you have to insist upon connection opportunities. Most parents who have strong relationships with their kids insist on “together time,” especially when things are hard.

There are a lot of messages out there about just letting your kids do whatever they want right now. This is in contrast to other messages that say we need to rigidly schedule our kids’ days to ensure they don’t fall behind. But these are just two ends of an extreme. This is the same old permissive vs. authoritarian parenting argument.

A better goal is the “authoritative” parenting role. Authoritative parents take a leadership role without being dictators or allowing a free-for-all. An authoritative parent will insist upon some family connection. This will take practice if you’ve never done it before, but please persist. It’s worth it.

Connecting during COVID-19

Here are some ideas for connecting with kids every day during COVID-19:

• Take a walk together – just 10 minutes a day is a good place to begin. Don’t have an agenda or expect deep conversations. Just move together side by side and you may be surprised over time at the conversations that come up.
• Play a game together – pick non-competitive games that feel low-stakes, and keep the focus on playing, not winning or keeping score. Your goal is to spend time together, not dominate each other. So if you can’t keep your cool during Monopoly, pick something else. A good alternative to games is doing a craft project, drawing together, or MadLibs-style games.
• Eat together – there are no more excuses for not eating together at least once per day. Avoid the temptation to allow everyone to retreat into separate corners of the house to eat. Insist that everyone meet in one room and put devices away for at least one meal each day.

It’s important with all of these activities to have minimum expectations – just ask that everyone shows up and is polite. But keep expectations of deep, meaningful communication to a minimum. Your child may or may not open up in any one of these settings, but keep showing up anyway. You need to have a lot of resilience here, since your child will likely resist even if they recognize that it’s good to connect.

Parenting a child with an eating disorder during COVID-19 is tough. Please be kind to yourself as you figure out your own best path forward.

See Our Guide To Parenting A Child With An Eating Disorder