JoAnn Daehler-Miller, Student Health Service
On this page:
- Uncertainty = increased stress = anxiety = maladaptive eating behaviors. The current situation may trigger an eating disorder or lead to relapse for those recovering. In addition, eating disorders often co-exist with other disorders that are increasing related to Covid-19 such as anxiety, depression, and substance abuse but the eating issues are often overlooked.
- Struggles with ambiguity tolerance = Feeling out of control = either a. eating out of control OR b. trying to control eating (restrict or purge) because it is one area that provides a sense of control; being in control of eating distracts from other problems and allows one to feel better.
- Social isolation and unstructured time increase anxiety, create an environment where eating disorders are more likely to thrive and decrease access to the social supports for positive eating behaviors interfering with recovery or supporting continued or increased disordered eating behaviors.
- Many are experiencing financial impacts related to Covid-19 (loss of jobs or reduced hours) and food prices are increasing = less money available for food or can’t purchase as much with available funds (this may be real or perceived) = food restriction (limiting food purchases, eating less to make food last longer) or buying less healthy food items with the belief that those are less expensive (which may then trigger binge eating or guilt about eating and purging).
- Decreased food access (i.e. harder to grocery shop due to limited numbers allowed in stores, need to wear a mask, limits on bus travel), decreased food availability (food supply issues), and increased distress when shopping (changes in the store layout, rules related to shopping, preferred types of foods or brands not available) = Increased stress and anxiety = decreased food shopping and trying to stretch food to make it last longer by skipping meals or eating less.
- Inadequate food intake (primarily lack of energy intake) contributes to increased mental health issues, such as anxiety and depression, due in part to the effect of food/adequate energy intake on lowering stress hormone levels. Low energy intake also decreases physical energy and then motivation for any type of activity (eating, studying, going to class or social events, etc.). Adequate food intake is also key to supporting the effectiveness of medications used for managing mental health.
- Increased rates of eating disorders due to increased dieting behaviors or unintentional weight loss. Those with dysfunctional eating will use some of the issues of limited food access as good excuses to diet; others will not eat due to stress and unintentionally lose weight. Dieting is the number one contributor to the development of an eating disorder; those who lose weight unintentionally to a low weight are also at greater risk of developing an eating disorder.
- Increased social media messages about weight gain, emotional eating (suggesting it’s bad/wrong), and the need to exercise/workout including messages or jokes about quarantine or covid-19 weight gain, eating all one's stocked up food in one day (making fun of binge eating), and messages that one is lazy if they aren't using the new found time to "improve" their body (focused on weight loss and getting fit) = increased focus on diet behaviors with the potential for developing disordered eating, denying oneself food as a comfort (which may be an appropriate way to soothe at this time), increasing the shame of those with eating disorders and contributing to increased challenges with recovery.
- Eating disorders are often not recognized as mental health issues, especially in populations of diverse identities (Note: Eating disorders are not mentioned in the EMHF documents even though they are the mental health disorder with the highest mortality rate). We need to provide increased education/awareness that mental health problems may manifest as eating behaviors and indicators to watch for. This information needs to be distributed to students, parents, faculty and staff especially those that interact closely with students, community members, and health professionals.
- Eating disorders do not discriminate but many people believe they are a disease of privileged white women. We need to increase awareness of when and how to identify maladaptive eating behaviors by educating those in contact with higher risk populations such as specific sports with a focus on body size/shape (including sports clubs – such as the triathlon club, running club), departments with higher risk populations (such as the dance department), student groups and organizations (dance club, MISSE). As the reports noted below indicate, eating disorders are prevalent in populations of diverse identities. In addition, this data was gathered using frameworks and diagnostic tools developed for white women. Accurate estimation of prevalence is difficult, and it is believed that a large percentage of eating disorders in diverse populations are unreported and untreated.
- Recurrent binge eating is more common among Black women than among white women (Striegel-Moore, Wilfley, Pike, Dohm, & Fairburn, 2000).
- Black girls are 50 percent more likely than white girls to engage in bulimic behavior (Goeree, Ham, & Iorio, 2011).
- Though anorexia is less common in Black Americans than in white Americans, Black Americans with anorexia develop the disorder at a younger age and struggle with it for longer periods (Taylor, Caldwell, Baser, Faison, & Jackson, 2007).
- Gay males are thought to only represent 5% of the total male population but among males who have eating disorders, 42% identify as gay.*
- Gay males were seven times more likely to report binging and 12 times more likely to report purging than heterosexual males.*
- Compared with heterosexual men, gay and bisexual men had a significantly higher prevalence of lifetime full syndrome bulimia, subclinical bulimia, and any subclinical eating disorder.*
- Females identified as lesbian, bisexual, or mostly heterosexual were about twice as likely to report binge-eating at least once per month in the last year.*
- Elevated rates of binge-eating and purging by vomiting or laxative abuse was found for people who identified as gay, lesbian, bisexual, or “mostly heterosexual” in comparison to their heterosexual peers.*
- Black and Latinx LGBs have at least as high a prevalence of eating disorders as white LGBs.*
*from https://www.nationaleatingdisorders.org/learn/general-information/lgbtq 7/30/2020
- We need to increase awareness and access to financial resources for food and provide opportunities for learning how to manage food budget most effectively. According to the Student Basic Needs: Institutional Services and Awareness - Results of the AACRAO March 2020 60-Second Survey lack of student awareness is ranked the number one challenge in getting students access to basic needs resources such as food resources. Additional information needs may include easy to make meals that are low cost, strategies for food prep to save money, and information related to making meals with limited time and resources.
- Information needs to be simplified, specific and direct. There are many resources available! Students, and specifically those with eating disorders or those overwhelmed by anxiety or other mental health issues, may have more difficulty identifying the resources to best support them. It is essential that support staff help them narrow the options to a few that will best meet their needs, then provide follow up to explore barriers to accessing support or modify resource information provided to better meet the individual’s needs and ability to take action.
Eating Disorder Network - a collaborative group of health professionals from across the University of Iowa campus that have come together to offer services for the treatment and prevention of eating disorders. For information: https://studentwellness.uiowa.edu/eating-disorder-network/ or schedule an appointment with University Counseling Service, Student Health or Student Wellness dietitian
Myself and My Body – University Counseling Service therapy group designed to provide a safe and supportive space for individuals who are recovering from eating disorders, disordered eating, and/or body dissatisfaction.
"Making Peace with Food and Your Body" - University Counseling Service (UCS) – outreach program that specifically addresses the impacts of the pandemic on one's body image and relationship with food. Contact UCS to schedule.
BIEDA - Body Image and Eating Disorder Awareness student organization – student organization that provides activities and social media communications to support awareness of eating disorders, improve body image and guide students to resources for treatment, if needed. https://uiowa.campuslabs.com/engage/organization/bieda ; https://www.facebook.com/UIBIEDA ; https://www.instagram.com/uibieda
Student Wellness Eating on a Budget resources(includes menus/meal planning information, lower cost food ideas, recipes, cookbooks, cooking videos and other resources to help reduce food costs)
Contact EAP (Employee Assistance Program) for support or referral to appropriate resources:
Anyone on Campus:
University of Iowa Hospitals Behavioral Health Eating Disorder Services. These include outpatient, partial hospital and in-patient services for all ages.
Dietitian Services: eating disorder certified dietitian for individual counseling or educational programs in Iowa City area
- National Eating Disorder Association (NEDA) website:
- Screening tool – available to anyone; a private place to assess risks, get feedback and access to resources:
- Eating disorders and Covid-19 - Resources for supporting those with eating concerns at this time:
- Eating disorders and people of color –
- General information and resources – available to anyone: National Eating Disorder Association (NEDA) website:
- General information and resources – available to anyone but has a focus on research, scholarly articles and evidence-based information and includes issues such as eating disorders in underrepresented populations: Eating Disorders Information Gateway (EDIG) . Disclosure: this resource is offered by Eating Recovery Center but offers a single portal for easy access to unique information.
- Meal support for anyone in recovery: @covid19eatingsupport Instagram account - provides free and accessible meal and snack support to those recovering from eating disorders who were faced with new physical, emotional, and mental triggers while isolated from their forms of in-person support (friends, family, treatment center, etc). Eating support from 8am-midnight EDT daily in the form of Instagram live videos led by eating disorders clinicians and advocates. The mission of the @covid19eatingsupport account was clarified: to center the needs and experiences of folks with non-dominant systemic identities within the eating disorder community to create an equitable and brave space for community meal support.
- Online support for those in recovery from an eating disorder (during the times of limited, consistent in-person support):
Other websites for support and information: