Recent news reports state that the incidences of eating disorders have exploded since the start of the pandemic in part due to increased anxiety and depression, as well as other related mental health challenges and conditions exacerbated during the pandemic.
To help, we interviewed Judith Banker, MA, LLP, FAED, Founder and President of the Center for Eating Disorders in Ann Arbor.
Banker founded the organization in 1983 and has served as the Executive Director/President since that time.
The Center for Eating Disorders is a non-profit organization dedicated to the treatment of children, teens, and adults with eating disorders, the promotion of community education and awareness, and the prevention of eating disorders.
Eating disorders and mental health
“Eating disorders (ED) are strongly linked to a range of mental health disorders including mood disorders such as anxiety and depression, and other conditions such as obsessive-compulsive disorder, trauma, and substance abuse,” Banker described. “It is well-documented that general mental health has suffered as a result of the pandemic.”
Banker described that the economic challenges due to loss of jobs, at-home schooling, illness, loss of family members, and other stressors created an enormous strain on large segments of our society.
“The isolation from the early public health lockdowns, and other measures to avoid contracting Covid-19 placed family members in close proximity to each other, without outside social outlets, for long periods of time,” Banker said. “Any existing tensions in those relationships were exacerbated by this excessive proximity leading to an increase in physical and emotional abuse as well as the natural loneliness, loss of self-esteem, and despair that accompanies social isolation.”
The pandemic intensified many of the overwhelming feelings people were experiencing.
“Those with pre-existing eating disorders experienced an increase in their ED symptoms as any underlying or co-occurring conditions became intensified,” she said. “Many people developed eating disorders from increased efforts to diet during the pandemic to avoid gaining weight, while others turned to food to manage anxiety, depression, boredom, and loneliness.”
Banker added that access to mental health AND eating disorder treatment was severely limited as in-person treatment options closed down or were overwhelmed with treatment requests.
“Our Center closed our physical office in 2019 and moved all of our services to a virtual platform for the safety and health of our staff and clients during the pandemic. Many other providers did the same. We weren’t sure if people would seek out virtual treatment, but we found we couldn’t keep up with the demand,” she described. “From the beginning of the pandemic, we received more requests for services than ever before, as did other mental health providers in our community. We were hard-pressed to be able to find providers to refer people to – as, like us, all had long waiting lists or simply were not taking new referrals.”
Eating disorders are complex mental and physical illnesses that arise from a variety of factors. EDs have among the highest mortality rates of any mental illness and among the highest incidents of death and disability.
The community and caregivers can help.
How to help
“First, take eating disorders seriously,” Banker stated. “They are not a fad or a bid for attention. They are not a choice. They are dangerous illnesses that can take over a person’s life resulting in ongoing disability and even death.”
She described how children and teens are particularly at risk.
“A growing body can be quickly affected by a reduction in food intake leading to profound physiological and mental dysregulation,” Banker described. “Supporting families and those with eating disorders in their efforts to seek treatment are important. So is avoiding comments about appearance and dieting, avoiding weight stigma and diet/fat talk, and understanding that overcoming an eating disorder is often a long, difficult process.”
Trivializing eating disorders leads families and those with eating disorders to feel shame and to feel isolated as they seek out help. But fortunately, people are more aware today than ever.
“To a large extent, the public is better educated about eating disorders like anorexia and bulimia than when we first opened the doors to our center over 40 years ago,” Banker said. “Almost everyone knows at least one person who has had or currently has an eating disorder like anorexia or bulimia. There is some knowledge that these illnesses are dangerous. But what people often think of as an eating disorder is the skeletally thin actress or young woman they see on the street. In fact, these cases are the least common eating disorders. In general, you can’t tell if someone has an eating disorder simply by looking at them.”
Breaking the circuit
Banker stated that eating disorders often are linked to a mental circuit that is typically quite similar from person to person. This circuit includes thoughts and extensive rules and regulations about what, when, where, and how to eat, to move, along with deeply critical thoughts and judgments about who and what you are, including distorted perceptions about your qualities and appearance.
She added that this circuit gets stronger the less the person eats or the more the person diets. Restriction and dieting can also trigger the expression of previously latent or inactive mental illnesses including obsessive-compulsive disorder, anxiety, depression, et cetera. Dysregulated eating also affects all organ systems. It can cause insomnia, lethargy, emotional volatility, apathy, loss of sense of humor and sex drive, digestive issues, and a litany of other extensive side effects.
“Our bodies need nutrition to function—and must receive nutrition on a fairly reliable basis to function well,” she added. “When we alter our intake to restrict certain nutrients or engage in fasting or other diet practices, our bodies respond physiologically by slowing our metabolic rate, setting off urges to binge, and other ways to help us survive. Avoid diets, and avoid excessive rules and regulations around eating and activity. Moderation keeps our brains/bodies operating as efficiently and effectively as possible.”
All bodies are beautiful
According to Banker, there is a natural bell curve of body sizes – some people are naturally quite thin, most fall somewhere in the middle, and a number of people fall in the higher weight end of that bell curve. These body sizes are all healthy and normal. And people of different body weights/sizes may have very similar eating habits. In fact, some very thin people may eat much more than someone with a larger size body, she stated.
“It is important to keep in mind that the most common eating disorder is binge eating disorder or BED, not anorexia nervosa or bulimia – and the consequences of BED are equally as severe or devastating,” she described. “In most cases, weight loss simply isn’t an option because diets don’t work. And our bodies tend to build up metabolic defenses against regular attempts to restrict or starve. Many people actually find that they gain weight as a result of dieting – which is often called yo-yo dieting.”
Bottom line, according to Banker, we need to learn as a society, as friends, parents, family members, and as individuals, to stop judging people for their appearance, to focus less on external factors and more on character, integrity, and unique intrinsic personal gifts we each offer.
There are no simple answers for someone with an eating disorder. But Banker does have some advice.
“I can only say to not give up,” she suggested. “Seek out support and solid treatment advice where you can. Seek out reputable organizations and resources for treatment and/or support in person or online. If you suspect your child or a loved one has an eating disorder, seek a consultation with your family physician or a reliable mental health provider who has experience in the assessment of eating disorders.”
Banker said there are more and more virtual services available, including some low or no-cost services.
“Avoid any social media sites or influencers that make you feel bad about yourself or motivate you to be thin or focus on your weight or appearance, find friends and family members who are not diet or weight focused and who see in you aspects of yourself that you authentically value. And keep working on your own personal growth and recovery. There is no absolute recovery line,” Banker said.
Banker said we live in a diet-obsessed culture. The pressures to alter your eating or activity habits, or how you see yourself are ever-present.
“Build a community of safe people that do not engage in the toxic diet culture,” she continued. “You are not alone. Progress can be slow and difficult, but every small step can lead to substantial change and freedom from the oppression of the eating disorder.”
As a society, she added, we can fight weight stigma and end diet culture by avoiding talking about diets and encouraging others to lose weight. Further, we can promote a focus on internal characteristics rather than appearance and on intrinsic satisfaction rather than reliance on meeting standards established by corporations and other groups simply trying to foster dissatisfaction for economic or political gain.