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Advice On Combatting Disordered Eating While In Quarantine

During a pandemic, when resources are limited and the healthcare system is taxed, cognitive biases about weight will cost lives.

April 3, 2020

Lauren Rowello
On Hunger
collective nouns

verything tasted like soap. Plump, red tomatoes could only be distinguished from grainy pasta or the capers they were mixed with because each had a distinct shape, size, and texture. From family favorites like jambalaya — overflowing with colorful vegetables and spices — to my spouse’s crunchy, fresh-baked chocolate chip cookies, none of the options presented to me were satisfying. Each of them offered the same sour, chemical flavor.

I could no longer enjoy the food I tried to eat — but that seemed like the least of my worries. I was being treated for COVID-19.

A sputtering cough became gasping hacks that produced thick, yellow mucus. I often ran out of breath while trying to chew small forkfuls, periodically spitting out little bits of food or scooting boluses into my cheek so that I could pause to take in enough air to continue. I started skipping dinner with my kids to avoid mealtime anxiety.

I didn’t expect COVID-19 to impact my ability to eat. It triggered obsessive thoughts about my body and compulsive behaviors — like meal avoidance which shifted to purging and restricting certain types of food as I recovered.

Dr. Colleen Reichmann is a clinical psychologist who specializes in eating disorders and body image at her private practice—Wildflower Therapy—in Philadelphia.

She explains that illnesses are common triggers for eating disorders. Shifts in appetite, weight fluctuations, and other symptoms (like my difficulties eating, loss of taste, and extreme fatigue) can trigger those who are already concerned about food, movement, or weight. These experiences can even be the cause of disordered thoughts and behavior someone didn’t have before.

A potent, low-dose corticosteroid was prescribed to decrease the inflammation in my lungs — but when I ran out of meds, my respiratory symptoms got worse. The quiet rumble in my chest progressed again to a noisy crackle, and my breaths became shallow and weak. Telemedicine connected me to a new doctor who denied my request to continue using the steroids I needed for just one reason: they could make me gain weight.

I was shocked that this doctor seemed more interested in maintaining my waistline than helping me breathe again, but weight stigma in health care is nothing new. These kinds of encounters can delay treatment for serious medical concerns — like pneumonia, my diagnosis — and stifle recovery for those struggling with disordered eating.

Dr. Reichmann subscribes to the Health at Every Size perspective, which encourages practitioners to avoid using weight, size, or BMI as a health standard. This movement advocates for body and fat positivity, underlining that health can have many definitions. This includes the recognition that disordered eating and exercise can occur in people with a variety of diverse bodies.

Unfortunately, it is not something all providers understand — and they’ll continue to harbor cultural ideals about thinness while they analyze the severity and urgency of symptoms and discern treatment options.

This is dangerous even in typical times — but during a pandemic, when resources are limited and the healthcare system is especially taxed, these cognitive biases about weight will cost lives.

Experiences of trauma and adversity are also linked with disordered eating or exercising. So are pre-existing mental health concerns. Those already living with anxiety, depression, OCD, or other struggles are especially challenged right now as the world reels in an increasingly chaotic state. The lack of normalcy in and of itself could lead some to spiral — and many are additionally grieving jobs, hobbies, and loved ones or living in fear during this crisis.

Dr. Reichmann explains that even slight changes in schedules cause difficult adjustment periods which shift meal times — making it easier to skip eating or cause us to feel unmotivated to consume food altogether. It also leaves more time for compulsive exercise. Food scarcity and economic insecurity create additional barriers for accessing foods that people feel safe and comfortable eating. For some, it means difficulty finding any food at all. She reminds us,

“This is an extremely trying time. This moment in human history is dark. You are surviving.”

As a writer, social media helps me find and share stories, but it’s also a place where other writers talk about the projects they’re working on and friends oblivious to diet culture promote problematic views. I consistently see requests for interviews from those who wanted to share tips to avoid gaining weight during their time at home, and I’ve even been invited to a weight loss group boasting free portion-control containers for new members.

Reichmann warns against using weight as a goal.

“I never actually recommend intentional weight loss — pandemic or no pandemic. You are allowed to gain weight.”

Memes that promote diet culture and increased access to online workouts have caused some people to set fitness goals by participating in social media challenges.

“Engaging in exercise challenges can be an awesome way to cope with this stressful time with one caveat: the exercise must bring you joy! If you are engaging in these challenges with compensation or guilt in mind, then my opinion is that the positive benefits are negated.”

In contrast, some people feel worried that they’re sitting, eating, or sleeping too much. Reichmann is especially concerned for those who feel isolated right now.

“Remind yourself that you’re surviving a global pandemic! If exercise is the last thing on your mind, or you are eating more (or differently) than you normally would, that is okay!

Research shows that loneliness is one of the most difficult emotions that we feel as humans. It is natural to want to numb that emotion. Those with eating disorders discover, somewhere along the line, that disordered behaviors like restricting, binging, purging, [and other habits] are effective tools.”
They’re just not healthy ones.

Better coping mechanisms include art, music, breathing exercises, reading, seeking out a positive community, and even watching a few shows on Netflix.

Chatter on social media can be problematic — but it’s also a source of connection and strength. I’ve been careful lately about what groups or organizations I’m interacting with and intentionally checking in with specific individuals rather than mindlessly scrolling through my feeds.

Dr. Reichmann is currently working on a book about steps to take when recovering from an eating disorder using a more radical approach. Her perspective includes embracing fat positivity while in recovery — but she suggests that all people need to be reminded of its toxicity.

“Remember the anti-diet principles of Health at Every Size and Fat Positivity, and hold fast to these ideas when those around you or online spew diet culture BS.”

These principles include eating in ways that promote pleasure, finding joy in our bodies, and celebrating diversity. Eating disorder recovery groups can include many thousands of participants on Facebook, Reddit, and other platforms — and they have been crucial to me in times of crisis. These peer-led spaces aren’t for “thin-spiration” or content that promotes unhealthy habits.

They serve to create gathering points for people who want to share about their experiences and come together in mutual understanding and support. When I was first starting to recognize that my disordered tendencies were back, members reminded me that I am a person of value, that the food allotted to me isn’t a waste even if I can’t finish it all.

I’m now more consistently present with my family during meals, and I never regret showing up to the table.

Reichmann, who is active on Instagram, also recommends social media as a resource for those who don’t have access to counseling or those who need additional support.

“Many eating disorder specialists and dietitians are using Instagram and Facebook Live events in order to provide virtual, in-the-moment support for those in need. There is also an Instagram account called @COVID19eatingsupport which provides around the clock Instagram Lives with clinicians, including meal support every two hours.”

This could be helpful for those who need a community with structure.

Eating and exercise disorders are rarely only concerned with food or weight and one common theory is that people who struggle with these behaviors seek a sense of control. I suspect that the cause of my relapse is at least in part a loss of control throughout my illness and my inability to do much about the condition of the world during this crisis.

We’re living in a time of waiting, pause, and confusion. Those realities often lead me to focus on what I can manage as a coping skill. Redirecting my anxious energy to a more minute aspect of my life helps me combat the stress of chaos and uncertainty. I’ve realized that I need to guide my energy away from more compulsive thoughts and behavior to healthier outlets — like organizing my home or focusing on a creative project.

It often takes a lot of awareness to recognize when we’re struggling with these issues. Reichmann explains:

“Disordered eating and exercise basically refers to a relationship with food and/or movement that is problematic. This can manifest as being overly consumed by what or how one eats, becoming dependent on exercise to cope with life stressors, or using [food and exercise related] behaviors to numb out unwanted emotions. Both disordered eating and disordered exercise occur on a continuum, and it can be tough to tell when one crosses over from normal to disordered.”

To evaluate whether or not this is cause for concern, Reichmann recommends asking yourself some questions:

  • Does my relationship with food or movement cause me stress or distress?
  • Is my relationship with food or movement inflexible?
  • Do I find myself missing out on areas of my life I would rather not miss out on (socializing, favorite meals, etc.) due to the way I relate to food and movement?
  • Do thoughts about food or movement take up a great deal of cognitive space?
The following tips for surviving triggers might feel like no-brainers, but these are reminders we often lose track of when we need them most:

1. “Rally your troops. Make sure you are reaching out to those you trust. Isolation is different from social distancing; it can be poisonous to the mind. Be wary of going days without talking to people.” This doesn’t need to go further than texting or calling those you want to connect with. If you don’t have anyone, utilize social media to find your people.

2. Get support when you need it. Ask a partner, friend, or roommate to sit with you during or after meals, prepare foods for you, or help you establish a schedule to ensure you’re eating and exercising more appropriately. If you aren’t sure what kind of support you need, just letting someone you trust know that you’re struggling might be enough to relieve some of the pressure you feel and reassure you that you aren’t in this alone.

3. Write it down! Schedules and other ideas you have to maintain a routine can be written down so that you have reminders, but Reichmann recommends journaling too. You could write about what motivates you to stay in recovery if you fear relapse, opt for prompts that are specific to your issues with disordered eating or exercise, choose affirmations to pick you up out of a dark place, or just vent.

More formal resources — like the structured care of online support groups or books, podcasts, and other materials on the subject are just a few clicks away. If you want to speak to a professional, you could seek online counseling as a new client with a variety of clinicians who have moved their practices to virtual care for now.

Reichmann reminds us, “Keep your appointments with therapists (even if you feel that virtual therapy is not optimal).” For those in crisis, inpatient treatment is still an option.

She urges, “Be kind to yourself. Now is not the time for guilt about what or how much you are eating or engaging in movement. Remember that you are allowed to rest right now. You are allowed to have all the feelings. And keep reminding yourself of the fact that this is temporary.”

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