Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review

Mario Miniati; Francesca Marzetti; Laura Palagini; Donatella Marazziti; Graziella Orrù; Ciro Conversano; Angelo Gemignani

doi:10.3389/fpsyg.2021.663376

Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review

Front Psychol. 2021 Sep 29:12:663376. doi: 10.3389/fpsyg.2021.663376. eCollection 2021.

Authors

Mario Miniati¹, Francesca Marzetti², Laura Palagini¹, Donatella Marazziti¹, Graziella Orrù², Ciro Conversano², Angelo Gemignani²

Affiliations

¹ Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
² Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy.

Abstract

Background: Several data suggest that coronavirus disease 2019 (COVID-19) pandemic may exacerbate or trigger eating disorders (EDs). The aim of this paper was to summarize current literature studies on COVID pandemic and EDs. Methods: Literature search, study selection, methods, and quality evaluation were performed according to the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. Results: A systematic search allowed the initial selection of 172 papers; 21 (12.2%) papers were eligible and included in the review. In selected studies, a total number of 29,108 subjects were enrolled (range: 10-11,391; mean/SD: 1,386 ± 2,800), 6,216 were men (21.4%), 22,703 were women (77.9%), and 189 (0.7%) were gender fluid or not declared. The mean age/SD of subjects was 30.2 ± 7.7. About 12 studies (57.1%) were online surveys, 4 (19.0%) were retrospective studies, 2 (9.5%) were qualitative studies, 2 (9.5%) were longitudinal cohort studies, and 1 was a social media survey (4.8%). Their analysis revealed five main findings: (1) changes in the routines of physical activities were related to the worsening of preoccupation on weight/body shape; (2) food access limitation during pandemic represented the risk factors for both triggering and exacerbating EDs; (3) restriction in healthcare facilities contributed to increase anxiety levels and to modify treatment compliance; (4) social isolation was related to the exacerbation of symptoms in patients with EDs who are home-confined with family members; and (5) conflicts and difficulties in relationships with "no way out" were the maintenance factors for ED symptoms, especially in adolescents and young adults. Conclusion: The COVID-19 pandemic had a negative impact on EDs that might be triggered by the exceptional conditions derived from COVID-19-related stress in predisposed subjects. Patients who were already affected by EDs experienced the worsening of their clinical conditions and related quality of life (QoL).

Keywords: COVID-19; SARS-COV2 disease; anorexia nervosa; binge eating disorder; bulimia nervosa; eating disorders spectrum; pandemic.

Publication types

Systematic Review