The impact of the <scp>COVID</scp>‐19 pandemic on eating disorder risk and symptoms

This is not an experimental study. It is a narrative review and theoretical model paper. The authors proposed three mechanisms (pathways) through which the COVID-19 pandemic and associated lockdowns could increase eating disorder (ED) risk and worsen existing symptoms:

1. **Disruption pathway:** Lockdowns disrupted daily routines (eating schedules, exercise patterns, sleep), reduced access to outdoor activities, and increased time at home, which could increase weight and shape concerns. Social isolation removed protective factors like social support and adaptive coping strategies.

2. **Media exposure pathway:** Increased time on social media and video conferencing (Zoom, FaceTime) exposed people to more body-focused content and constant self-viewing on camera, which could heighten body dissatisfaction. Anxiety-provoking news about the pandemic could also trigger restrictive eating as a coping mechanism.

3. **Health anxiety pathway:** Fear of COVID-19 infection could drive restrictive diets aimed at "boosting immunity," or increase health-related eating disorder symptoms (e.g., orthorexia, contamination fears around food).

The authors did not test any intervention. They did not compare groups. They did not measure outcomes. They reviewed existing literature on eating disorder risk factors and applied it logically to the pandemic context. The paper is essentially a set of hypotheses with proposed mechanisms, intended to guide future research and clinical practice.

No participants were studied. This is a theoretical review paper. The authors cite existing research on eating disorders from pre-pandemic populations, but they collected no original data. The paper is based on the authors' expert opinion and synthesis of prior literature.

No measurements were taken. The paper does not use any instruments, scales, or quantitative data collection methods. The authors propose that future research should measure:

Eating disorder symptoms (e.g., using the Eating Disorder Examination Questionnaire, EDE-Q, which yields a global score from 0–6, higher = more severe symptoms)

Body dissatisfaction (e.g., using the Body Shape Questionnaire)

Exercise frequency and type

Sleep quality (e.g., Pittsburgh Sleep Quality Index)

Media exposure (time spent on social media, video conferencing hours per day)

Perceived stress (e.g., Perceived Stress Scale)

Social support (e.g., Multidimensional Scale of Perceived Social Support)

But none of these were actually used in this paper.

**Study design:** This is a narrative review and theoretical model paper. It is not a systematic review, meta-analysis, or empirical study. The authors present a conceptual framework based on their reading of existing literature and clinical expertise.

**No randomisation, no blinding, no control group, no washout period, no duration.** There is no experimental design whatsoever. The paper is essentially an opinion piece with citations.

**What this design can prove:** Nothing, empirically. Theoretical models can generate hypotheses, identify gaps in knowledge, and guide future research. They can help clinicians and researchers think about what factors might matter. But they cannot demonstrate causation, correlation, or effect sizes.

**What this design cannot prove:** It cannot prove that the pandemic actually increased eating disorder risk. It cannot quantify how much risk increased. It cannot identify which pathway is most important. It cannot distinguish between correlation and causation. It cannot rule out alternative explanations (e.g., maybe people with existing eating disorders were simply more aware of their symptoms during lockdown, rather than symptoms actually worsening).

**Major methodological weaknesses:**

No data collection whatsoever

No systematic search strategy (not a systematic review)

No inclusion/exclusion criteria for cited studies

No assessment of study quality or risk of bias

No quantitative synthesis

Authors may have confirmation bias—they set out to argue that the pandemic increases ED risk, and they found evidence to support that view

The paper was published in June 2020, only 3–4 months into the pandemic, so it could not have included any empirical data on actual pandemic effects

**Why this design matters for self-experimenters:** This paper is useful as a source of hypotheses to test in your own life. The three pathways are plausible mechanisms that you could investigate in an n=1 experiment. For example, you could test whether reducing video conferencing or social media exposure decreases body dissatisfaction. But you should not treat the paper's conclusions as proven facts.

Since this is a theoretical review with no original data, there are no numerical findings. The authors' main conclusions are:

The pandemic created three distinct pathways that could increase eating disorder risk: routine disruption, media exposure, and health anxiety.

Social isolation during lockdown removed protective factors (social support, adaptive coping) that normally buffer against eating disorder symptoms.

Increased reliance on video conferencing (Zoom, FaceTime) forces individuals to view themselves constantly, which may increase body dissatisfaction and shape concerns.

Anxiety-provoking media coverage of the pandemic may trigger restrictive eating as a way to regain control or "boost immunity."

Fear of contamination may increase eating disorder symptoms related to health concerns, particularly in individuals with orthorexia or contamination-related OCD.

The authors call for increased screening, telehealth services, and targeted interventions for at-risk populations during the pandemic.

**No effect sizes, no confidence intervals, no p-values, no group differences.** The paper contains zero quantitative results.

There is no effect magnitude to report because no effects were measured. The authors do not estimate how much eating disorder risk might increase, what proportion of people might be affected, or how large the impact of any single pathway might be. The paper is entirely qualitative and speculative.

For context, subsequent empirical studies (published after this review) found that eating disorder symptoms did increase during the pandemic, with some studies reporting that approximately 30–50% of individuals with existing eating disorders experienced worsening symptoms, and that new cases increased by roughly 15–25% in some populations. But those findings come from later research, not from this paper.

**What the authors acknowledge:**

The paper is based on preliminary observations and existing literature, not original data.

The three pathways are theoretical and require empirical testing.

The pandemic context is rapidly evolving, so recommendations may need updating.

The authors note that individual differences (age, gender, pre-existing mental health status, socioeconomic status) likely moderate the effects, but they do not explore these in depth.

**What a critical reader would note:**

**No data:** This paper provides no evidence for its claims. It is a hypothesis paper, not a research study.

**Publication bias:** The authors are eating disorder researchers who likely have a professional interest in demonstrating that the pandemic is harmful. They may overemphasise risks and underemphasise resilience or positive outcomes (e.g., some people may have improved eating habits during lockdown due to more home cooking).

**No systematic review methodology:** The authors did not conduct a systematic search of the literature, so they may have missed relevant studies or selectively cited papers that support their view.

**No consideration of protective factors:** The paper focuses entirely on risk factors and does not discuss factors that might protect against eating disorders during the pandemic (e.g., increased family time, reduced social comparison with peers, less exposure to diet culture in the workplace).

**Generalisability:** The paper does not discuss how these pathways might differ across cultures, socioeconomic groups, or individuals with different types of eating disorders (anorexia vs. binge eating disorder vs. bulimia).

**No practical recommendations for individuals:** The paper calls for systemic changes (telehealth, screening) but offers no actionable advice for individuals trying to protect their own mental health.

**Conflict of interest:** The authors do not report any conflicts of interest, but the paper was published in a special issue on COVID-19, which may have prioritised rapid publication over rigorous peer review.

For someone running their own n=1 experiment to understand how pandemic-related factors affect their eating behaviours and body image:

### What to test (specific intervention and dose)

Based on the three pathways identified in this paper, you could test:

1. **Video conferencing reduction:** Reduce daily video call time (Zoom, FaceTime, Teams) by 50% for 2 weeks. If you currently spend 2 hours/day on video calls, reduce to 1 hour/day. Use audio-only calls when possible, or turn off self-view (hide your own video feed).

2. **Social media diet:** Limit exposure to body-focused social media (Instagram, TikTok, fitness accounts) to 15 minutes/day total for 2 weeks. Use app timers or block specific accounts.

3. **Routine stabilisation:** Create a fixed daily schedule for meals (3 meals + 2 snacks at set times), exercise (same time each day), and sleep (same bedtime and wake time) for 2 weeks. Compare to a baseline week where you follow your natural pandemic routine.

4. **Health anxiety reduction:** Limit COVID-19 news consumption to 10 minutes/day from a single reliable source (e.g., CDC website) for 2 weeks. Avoid doomscrolling.

### Minimum meaningful duration

**2 weeks per condition** is the minimum to see changes in eating behaviours and body image, based on typical habituation and mood regulation timeframes.

**1 week baseline** before any intervention to establish your normal patterns.

**1 week washout** between conditions if you test multiple interventions sequentially.

Total experiment: 4–6 weeks if testing one intervention, 8–10 weeks if testing multiple.

### What to measure (specific metrics)

Measure daily (same time each day, preferably evening):

1. **Body dissatisfaction** (1–10 scale, 1 = completely satisfied, 10 = extremely dissatisfied)

2. **Eating disorder symptoms** (use a validated short screener like the SCOFF questionnaire weekly, or track specific behaviours: binge episodes, purging episodes, restrictive eating days, skipped meals)

3. **Weight and shape concerns** (1–10 scale, "How much did you think about your weight or shape today?")

4. **Exercise minutes** (total minutes of intentional exercise per day)

5. **Meal regularity** (number of planned meals/snacks consumed vs. skipped)

6. **Video conferencing time** (minutes per day)

7. **Social media time** (minutes per day, broken down by platform)

8. **COVID-19 news exposure** (minutes per day)

9. **Perceived stress** (1–10 scale)

10. **Sleep quality** (1–10 scale, or use Pittsburgh Sleep Quality Index weekly)

### Key confounds to control for

**Pandemic phase:** Local COVID-19 case rates, lockdown stringency, and personal exposure to illness will change over time. Track your local restrictions and case numbers.

**Seasonal effects:** Mood and eating patterns vary with seasons (winter = more comfort eating, summer = more body consciousness). Run your experiment in a single season if possible.

**Life events:** Job loss, illness, family stress, relationship changes. Log major events daily.

**Menstrual cycle:** For women, body dissatisfaction and eating behaviours vary across the cycle. Track cycle phase or run experiments over a full cycle (4 weeks).

**Pre-existing eating disorder:** If you have a diagnosed eating disorder, consult a therapist before running self-experiments. This paper's pathways may affect you differently.

**Social support:** Changes in contact with friends/family can confound results. Track social interaction hours.

**Exercise changes:** If you start a new exercise routine during the experiment, it will affect body image and eating. Keep exercise consistent or track it as a covariate.

### What a positive result would look like

**Body dissatisfaction decreases by ≥1 point** on the 1–10 scale (this is a clinically meaningful change for self-report).

**Eating disorder symptoms decrease by ≥20%** (e.g., from 5 binge episodes/week to 4 or fewer, or from 3 restrictive days/week to 2 or fewer).

**Weight and shape concerns decrease by ≥1 point** on the 1–10 scale.

**Meal regularity improves** (e.g., from skipping 3 meals/week to skipping 1 or fewer).

**Perceived stress decreases by ≥1 point** on the 1–10 scale.

**Sleep quality improves by ≥1 point** on the 1–10 scale.

A positive result means that when you reduce the hypothesised risk factor (e.g., video conferencing), your eating disorder symptoms and body dissatisfaction improve. A negative result means no change or worsening. A null result means the factor may not matter for you personally, or your experiment was too short/confounded to detect an effect.

**Important caveat:** This paper provides hypotheses, not proven effects. Your n=1 experiment may find that reducing video conferencing helps, hurts, or does nothing for your eating behaviours. That is valuable data—it tells you what works for *you*, regardless of what a theoretical model predicts for the average person.