An Eating Disorder Pandemic
When the Covid-19 lockdowns began in March 2020, Rachel and her husband decided that they and their two daughters would isolate completely. The 37-year-old resident of Northern California marks this point as the moment her binge eating disorder resurfaced. “I became food obsessed again,” said Rachel, who had struggled with the disorder for decades though she was only officially diagnosed a few years ago.
She obsessively baked cinnamon buns and cookies, part of “a desperate need to make our little world feel like every day was special,” recalled Rachel, who asked that her real name not be used. She also began consuming large amounts of food that she didn’t entirely enjoy in order to cope with her anxiety—a hallmark of binge eating. The pandemic had brought back the intense focus on food that had begun for her at age 16, a cycle of losing and gaining weight, restricting calories and binging. After being diagnosed as an adult, group therapy had helped her manage the behavior. But the stress of the pandemic was undoing her progress.
According to clinicians and treatment centers, the incidence of eating disorders—anorexia nervosa, bulimia nervosa, binge eating and other forms of mental illness around food—has risen dramatically in the United States during the pandemic. Between March 2020 and December 2021, the National Eating Disorders Association reported a 107 percent increase in the volume of calls to its helpline. And while figures for 2022 aren’t yet available, anecdotal evidence indicates that the numbers remain at their pandemic high.
Among the deadliest of the mental health illnesses, eating disorders have been recognized by medical professionals for decades. Nevertheless, myths and misconceptions continue to surround them. The most prevalent is that they are only a problem among teens and 20-somethings. Yet eating disorders, found in all races and genders, afflict all age groups.
The disorders can be triggered by stress around family or social dynamics and by underlying mental health issues. There are also genetic markers that increase the risk of developing an eating disorder. Rachel’s experience, too, is far from unique. According to medical professionals, these issues can reoccur or develop for the first time in adulthood.
With most studies focused on teens and younger women, there is comparatively little current research on how eating disorders impact those middle-aged and older. According to a 2012 study in the International Journal of Eating Disorders, 13 percent of American women 50 or older experience symptoms of an eating disorder and 60 percent report that their concerns about weight negatively affect their lives. A 2017 review of eating disorder studies in Current Opinion in Psychiatry concluded that eating disorders in adults frequently go undetected by primary care doctors.
The Renfrew Center, a national network of facilities for the treatment of eating disorders, has seen an increasing number of individuals in their 30s through 60s seeking treatment, according to Ashley Moser, a clinical education specialist at the center, which has developed a program to help those suffering from these disorders in midlife. “Oftentimes eating disorders in middle-aged patients go undertreated due to continued stereotypes about who the typical eating disorder patient is,” she noted. “Middle-aged patients can be hesitant to disclose eating disorder behaviors due to the belief that it is a ‘young’ person disorder and the connected feelings of shame. However, eating disorders do not discriminate and can affect anyone from any background and at any age.”
Indeed, images of those suffering from these disorders tend to focus on underweight white teens, yet anorexia is the least prevalent of the eating disorders listed by the American Psychiatric Association, though it has the highest mortality rate. Research indicates that rates of women who are anorexic, which can include restricting calories as well as excessive exercising, plateau around age 26; that bulimia rates don’t peak until around age 47; and that rates of binge eating disorder hit their highest level in people in their 70s.
Meanwhile, the most common eating disorder is “other specified feeding and eating disorder” (OSFED), a classification for those with symptoms of one or more disorders and who do not strictly meet diagnostic criteria. This diagnosis covers, for example, a person who purges without the binging of bulimia, or restricts calories and has other symptoms of anorexia without being significantly underweight.
Dr. Debra Safer, a psychiatrist and co-director of the Stanford Adult Eating Disorders Program at the Stanford School of Medicine, said her clinic is one of the many that have noted a huge increase in demand over the past two years, and some cases are certainly triggered by the circumstances of Covid. “Family dynamics coupled with the scarcity around food, these are very important with eating disorders,” Dr. Safer said, “as well as having large amounts of non-perishable food stocked up, especially if you’re working or studying at home. You’re surrounded by food all the time. You also can’t get out to socialize with friends or do other things that would distract you.”
Temimah Zucker, a New York City therapist who specializes in eating disorders, pointed out that people with these illnesses are often not physically compromised or underweight.
She noted that a combination of factors can trigger an eating disorder, a “recipe” that might come together at any point in life. These include underlying conditions such as post-traumatic stress disorder, anxiety or depression, or big changes such as children leaving home or parents beginning to age.
As an Orthodox Jew, Zucker is frequently in demand by observant clients with eating disorders. Several reports have indicated that rates of these disorders are both on the rise and underreported among Orthodox Jews, according to the National Eating Disorders Association. Holidays, Zucker explained, can be challenging for those in treatment due to the emphasis on large family meals. Even Shabbat can seem like a “weekly Thanksgiving,” Zucker noted, with many decisions around food to navigate that can be overwhelming and lead to obsessive thinking. A woman might think, “I had a piece of cake with Kiddush in the morning at my synagogue or shul,” Zucker said, explaining one possible scenario, and she has to decide if “that was my snack or my breakfast.”
Fast days such as Tisha B’Av, observed during the summer, or Yom Kippur can be “very stressful” for those with disordered eating, noted Dina Cohen, a New Jersey nutrition therapist and certified eating disorders registered dietitian and supervisor. She recommends that her clients take concerns seriously and consult with their rabbis about whether to fast. “I’ve seen people relapse from fasting,” she said. “It’s getting back into that mindset of ‘Oh right, that’s what restriction feels like. Why did I ever stop doing it?’ You might see people who are at a normal weight and have no medical problems, and they’ll still be told not to fast, because it can be a real psychological trigger.”
Cohen described the pandemic as a “perfect storm” of stress and uncertainty, heightening underlying vulnerabilities. But even under normal circumstances, she said, for those in recovery, the struggle to resist diet culture—a term for the pervasive belief that thinness and body shape are more important than physical, emotional and psychological health—is like driving against the flow of traffic on a highway. Success, she added, takes a lot of support.
Reaching out for that support is the first step, and Relief, a nonprofit that provides mental health referrals for the Jewish community, has connected patients with treatment providers for over 20 years. Devorah Levinson, director of the eating disorder division at Relief, says one of the biggest challenges over the past two years has been not only the rise in eating disorder cases, but also the lack of clinicians to treat them. She saw an increase of over 50 percent in the number of calls related to eating disorders between 2019 and 2021, and while other mental health issues have risen as well, the eating disorder spike has been highest.
Providing support and finding ways to prevent stressful situations from causing disordered eating is something Debbie Saroufim has learned through experience. Saroufim, 42, from Los Angeles, had struggled with the illness since early childhood and was diagnosed with OSFED at age 14, working with a therapist and dietitian to overcome it. “There were good foods and bad foods,” Saroufim recalled, “and there were good bodies and there were bad bodies. And if you had a less desirable body, it was made very apparent very early on that you should do anything within your power to fix that.”
Today, Saroufim is a personal coach, helping women explore body image and how it relates to food and exercise. She encourages clients of all ages to confront fat-phobic beliefs in order to strive for a forgiving relationship with their body. The tools that she teaches, Saroufim said, provide “a means of checking in. Oftentimes we don’t even know we’re stressed until the eating disorder voice in our head gets louder.”
Saroufim also noted that re-emerging from Covid isolation brings a certain amount of pressure to her clients. “Everybody’s terrified that they’re fatter,” she said. “Or, if they’re thinner, they worry about how to keep it. It really is a situation where nobody’s allowed to win. But what happens if we just decide we don’t want to play?”
As Covid-related protocols in the United States have eased, Zucker has noticed her existing patients benefiting from the return to normal activities. Still, she said, the number of patients reaching out for help has remained high. It is possible that the numbers will continue to rise, Zucker speculated, as some people may have been waiting for restrictions to lift before seeking help.
For Rachel, being able to send her daughters back to school and regain some time for herself has helped ease her anxiety, and consequently, her binge eating has largely stopped.
“Everyone just got through 2020 and 2021 the best ways they could,” she said, noting that she is still considering reaching out to a therapist. “But being a woman, inhabiting a woman’s body, adds a layer of complication.
Where to go for help
National Eating Disorders Association is among the largest organizations in the United States dedicated to providing education and referrals around eating disorders.
The Renfrew Center is a pioneer in the treatment of eating disorders, with centers throughout the country and a program for treating adults in their 30s through 60s.
Relief provides mental health referrals for the Jewish community and has a division focused on eating disorders.
Sarah Yahr Tucker is a freelance writer and journalist based in Los Angeles.