COVID-19 negatively impacts people with eating disorders

A study analyzing the early impact that coronavirus disease 2019 (COVID-19) is having on people with eating disorders has identified areas where their treatment needs could be better addressed.

The study, which included participants from the United States and the Netherlands, found that the pandemic had substantial and wide-ranging impacts on people with eating disorders and on behaviors that were consistent with diagnoses of the disorders.

Participants reported needing more structure, more face-to-face interaction with healthcare professionals, somebody to talk to, more support with meals, and more advice about nutrition.

Cynthia Bulik (Department of Nutrition, the University of North Carolina at Chapel Hill) and colleagues say they hope their data will help inform best practice guidelines to help healthcare professionals improve the management of eating disorders as the pandemic continues.

A pre-print version of the paper is available in the server medRxiv*, while the article undergoes peer review.

Study: Early Impact of COVID-19 on Individuals with Eating Disorders: A survey of ~1000 Individuals in the United States and the Netherlands. Image Credit: / Shutterstock
Study: Early Impact of COVID-19 on Individuals with Eating Disorders: A survey of ~1000 Individuals in the United States and the Netherlands. Image Credit: / Shutterstock

Impacts on mental health

Many aspects of the COVID-19 pandemic, ranging from the disease itself to restricted social interaction measures and economic consequences, are already having adverse effects on mental health.

Research has shown that by late May, one-third of people in the United States were exhibiting signs of anxiety or depression.

Although aspects of COVID-19 may have a negative impact on mental health among the general population, Bulik and the team suspected that people with eating disorders might face specific risks such as changes in food availability influencing binge eating and other behaviors.

Furthermore, changes in treatment availability and social support could affect progress, trigger relapse, or worsen any co-existing mental health conditions such as depression and anxiety.

What did the current study involve?

Now, Bulik and the team have conducted a study aiming to characterize the effects of the COVID-19 pandemic on people with eating disorders and to identify their treatment needs.

The team recruited 510 participants from the Netherlands and 511 from the United States using social media and the Dutch Eating disorder Register and by contacting participants in ongoing studies.

Participants completed an online survey including questions about the impact of COVID-19 on their situation, their eating disorder symptoms, their treatment, and their overall well-being.

What did the researchers find?

Most participants said their anxiety levels had increased, as well as their level of concern about the effect that COVID-related factors would have on their eating disorder and overall mental health.

Concerns commonly reported included a lack of structure, spending more time in a triggering environment, and the absence of social support.

Any worsening of eating disorder behaviors was generally consistent with the eating disorder diagnosis. Participants with anorexia reported feeling more restricted and fearful over being able to obtain foods that are line with their meal plans, while people with bulimia nervosa and binge-eating disorder reported experiencing more episodes of binge eating and more compulsion to binge eat.

Notably, even people who did not report any current change in symptoms said they had been feeling at least some degree of concern about being more susceptible to relapse.

Dissatisfaction with telehealthcare services

The researchers were particularly interested in finding out how participants felt their treatment had been affected since the COVID-19 pandemic.

Nearly half said they were not currently receiving treatment, and among those who were being treated, most had switched to telehealthcare services, which many reported being dissatisfied with. Almost half of the US participants and three-quarters of those in the Netherlands said they felt the quality of their treatment was “somewhat” or “much” worse than before they changed to telecare.

“It is not clear what influenced this perception, and we note that the survey was deployed at a time when many clinicians were just making the transition to remote care,” writes the team. “Follow-up surveys will allow us to address whether the quality of remote care continues to be a concern.”

Continuing to help patients progress towards recovery

The researchers say that to their knowledge, theirs is the “first large-scale study to capture concerns of individuals with eating disorders during COVID-19” and that although the study is preliminary, they hope it will help to guide healthcare professionals about how they can help during this time.

The most significant treatment needs were more structured (particularly around meals), face-to-face treatment, and someone to talk to (the Netherlands only), support with meals, and advice about nutrition (United States only).

“The challenges in delivering eating disorders care during COVID-19 are numerous,” writes Bulik and colleagues. “However, consistent, collaborative efforts between patient and provider may help stem the tide of worsening symptomatology and allow patients to continue to make progress toward recovery.”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
  • Bulik C, et al. Early Impact of COVID-19 on Individuals with Eating Disorders: A survey of ~1000 Individuals in the United States and the Netherlands. medRxiv 2020. doi:
Sally Robertson

Written by

Sally Robertson

Sally first developed an interest in medical communications when she took on the role of Journal Development Editor for BioMed Central (BMC), after having graduated with a degree in biomedical science from Greenwich University.


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