Tiktok, Covid bubbles and body image: Why eating disorders are on the rise

A Tiktok video titled "How to lose a lot of weight quickly" that does not go on to offer any advice received thousands of comments, many along the lines of "I just starve myself for 5 days" or "I'm skinny but I just wanna see my body thin as it can be."

Posted on April 17, it got more than 5,200 comments, many with dangerous tips on how to shed weight quick and easy. 

The post had over 416,000 likes by April 27. 

Since the start of the pandemic, people who suffer from anorexia nervosa, bulimia nervosa, binge eating and other eating disorders, have been reporting an increase in their desire to “restrict food intake” and/or to "use food as a means of emotional comfort". 

This report from Loma Linda University, several academic studies and individual accounts all suggest the pandemic is having a "profound, negative impact" on people with eating disorders, with increased social isolation, loss of control over circumstances and exposure to triggering messages playing a significant role.

The UK is experiencing a "tsunami of eating disorders”, Dr Agnes Ayton, Royal College of Psychiatrists Eating Disorder Faculty chair, told The Guardian.

Ayton said the department observed a 41 percent increase in the number of children and young people completing treatment, with an 86 percent increase in those completing urgent treatment.

The situation seems to be worse in younger age groups. UK eating disorder charity Seed reported a 68 percent rise in those seeking ED support between the ages of 10 to 19, the BBC reported.

Similar reports have been seen in the US, where ED are among the deadliest mental illnesses, resulting in 10,200 deaths a year, second only to opioid addiction, according to National Association of Anorexia Nervosa and Associated Disorders (ANAD). Anorexia contributes significantly to these deaths.

Calls to the US National Eating Disorders Association increased 70 to 80 percent in 2020, compared to 2019, NPR reported.

Psychiatrists and other experts say this was an expected consequence of the pandemic, given social isolation and increased engagement on social media can trigger new EDs or worsening pre-existing ones.

Factors brought on by the pandemic

There are "three pathways" by which the pandemic may increase symptoms and risk of ED, according to researchers Rachel F Rodgers, Jake Linardon and Sebastien Guillaume.

Their research, published in the International Journal of Eating Disorders in June 2020, said the major factors were disruptions in daily routines, increased exposure to “ED‐specific or anxiety‐provoking” media, and fears of Covid-19 contagion that can "increase ED symptoms specifically related to health concerns, or by the pursuit of restrictive diets focused on increasing immunity".

The authors of the study noted social distancing brought on by the pandemic reduced access to social support and much-needed distractions for people working through EDs. The pandemic prevented their access to care because of increased social restrictions.

Disruption in daily routines and a perceived loss of control over life has the run-on effect of stripping people of their known management tools, presenting challenges with emotional regulation in a situation where people with EDs find themselves increasingly isolated.

READ MORE: Covid-19 has triggered a silent pandemic of depression and anxiety

Social isolation

Eating disorders thrive in isolation where fears can go unchallenged.

One UK study found that 86.4 percent of a group of 129 individuals currently experiencing, or in recovery from, an ED, felt greater feelings of social isolation in the pandemic.

For many of these individuals aged between 16 and 65 years, “spending time with friends and family represents a vital factor in their ED recovery,” the study said.

Ryan Sheldon, a model in Los Angeles who has a binge-eating disorder, told NPR "eating disorders are isolating to begin with, and here we are, isolating ourselves even more.”

New Yorker Stephanie Parker shared being alone and confined in her studio apartment brought up past trauma associated with her ED and aggravated symptoms.

"The OCD and anxiety ... just made my eating disorder more intense, and for me that meant I would become obsessed with cleaning everything and then checking in with myself to see if I deserve to eat,” said Parker.

Many suffering from ED say they are unable to do activities or engage in social interactions as healthy coping mechanisms because of Covid restrictions.

In a self-reflective piece, Margaret Janse van Rensburg said social isolation “meant that there was little available” for her “in terms of ‘crowding out’ her ED with other meaningful activities.”

Isolation can also impact ED recovery through reduced feelings of accountability and increased “opportunity to engage in undetected ED behaviours,” as over 20 percent of the study’s sample reported “feeling less social pressure to recover due to the pandemic.”

Triggering media

Research shows young people are spending more time than ever on social media during quarantine, where negative messaging surrounding body image and weight gain, or “the quarantine 15" may be perpetrating ED.

App Annie reported an average increase of 20 percent in daily time spent in apps on Android devices worldwide in 2020.

The mobile data and analytics site said China was the worst affected country with a reported 30 percent increase in social media usage to 5 hours per day on average compared to 2019, followed behind by Italy at 11 percent.

“In the context of the pandemic, teens are on social media more. That means they’re potentially exposed to more content that could potentially trigger the development or maintenance of an eating disorder,” Psychologist Alix Timko, at Children’s Hospital of Philadelphia, told The Philadelphia Inquirer.

Professional counsellor and cofounder of the Center for Hope & Health, a treatment centre for ED, Melissa Harrison said her clients, as young as 12 years old, said they “learned ways to restrict their eating on TikTok” last year.

Dangers of social media algorithms

Harrison said TikTok’s algorithm is particularly dangerous because if a user spends time watching a triggering video chosen for them on the home page, the app creates “a self-fulfilling prophecy” to provide similar content over and over again.

TikTok, Instagram and editing apps available on Apple and Android devices also contain numerous filters that allow users to change their appearance and skew their perception of what their body and face should look like.

UK eating disorder charity Beat said these apps and filters "encourage the stigmatisation of weight or promote the idealisation of thinness” which “could cause distress for people suffering from an eating disorder or vulnerable to one.”

“The apps make me thinner and curvier than my body, even if I trained all the time, could ever be,” Danae Mercer, a health journalist with a history of disordered eating, told the BBC. 

“They eliminate my pores in a way that’s not even possible in nature. They create a ‘me’ that is, quite simply, unachievable — and they do it all with a click of a button,” she added.

Psychological stress

Psychiatrists point to heightened psychological stress that people have been facing during the pandemic.

“Depression and anxiety have very high comorbidity rates with eating disorders,” Dr Ellen Astrachan-Fletcher said, which have heightened exponentially during the pandemic.

“Last year at this time, everything was ‘normal,’ but hundreds of thousands of people have died from Covid and numerous homes will be suffering from a loss,” Astrachan-Fletcher pointed out.

Researchers at Biomed Central put together a series of papers called Journal of Eating Disorders that detail all impacts that the “global crisis may have, or is having, on people living with an eating disorder.”

One study found that 83.1 percent of 207 participants with ED surveyed online, reported that their symptoms had worsened in the pandemic, “most notably due to difficulties managing emotions like anxiety around the unknown situation, changes in routine and in physical activity.” 

Ways to cope

Whilst the full extent of the pandemic’s impact on ED patients is still unknown, all literature points to the group's enhanced vulnerability during this time and need for more support from the mental health community.

Loma Linda University’s Behavioural Health Medical Director, Melissa Pereau recommends a list of top 10 things to do for people struggling with disordered eating during this time.

Pereau recommends people make safe plans to spend time with others, such as online game nights or going on a brief walk with a family member. 

She also recommends people “stick to online groups that specifically promote body positivity and consider taking a hiatus from or deleting apps that encourage a culture of body shaming.”

If you or someone you know needs help, please check out global resources at F.E.A.S.T.