The present study sought to analyze the predicting role of age and symptoms of depression, anxiety and stress on risk behavior for eating disorders in Brazilian adults during the COVID-19 pandemic. The main findings confirmed both hypothesis: a) women had greater symptoms of anxiety, stress, depression and eating disorders compared to men; b) The combined age and symptoms of depression, anxiety and stress predict risk behavior for eating disorders in both sexes and our last hypothesis is partially confirmed by demonstrating that age would positively predict the symptoms of depression, anxiety, stress and risk behavior for eating disorders in Brazilian adults during the COVID-19 pandemic in only women.
The first population study to assess the depression and anxiety of people in Hong Kong during the COVID-19 pandemic provided important and timely data on the impact of COVID-19 on individuals' mental health. It was found that 19% of respondents had depression and 14% had anxiety. In addition, 25.4% reported that mental health had deteriorated since the beginning of the pandemic . In individuals with eating disorders, the results are even more worrying, as more than 50% reported comorbid mood and anxiety disorders and had moderate to extremely severe levels of depression, anxiety and stress .
The findings that symptoms of depression, anxiety and stress were also significant predictors for Eating disorders, in both sexes, confirmed the second hypothesis in the study. The results demonstrated that psychosocial stressors (depression, anxiety and stress) stemming from the COVID-19 pandemic, may exacerbate ED-related triggers and present a challenging environment for individuals with eating disorders (e.g. anorexia nervosa and bulimia nervosa) or development of risk behavior for eating disorders [25,40]. According to Cooper et al.  individuals with eating disorders may be at risk of worsening symptomatology during COVID-19, because they are exposed to specific risks that include food insecurity, fatphobic messaging, and restricted healthcare access, which can help trigger eating disorders.
A study conducted with a significant number of Australians found that 27.6% of the general population reported a higher level of food restriction when compared to before COVID-19, and 34.6% reported an increase in binge eating behaviors. It was also found that, in the group that reported having or already had an eating disorder, 35.5% indicated an increase in binge eating behaviors, while 18.9% reported an increase in purging behaviors . Portuguese adults showed altered eating habits during the pandemic, and a significant percentage of the participants reported that they started to eat more frequently, in greater quantity, and that they did not carry out a careful selection of food . Thus, studies have reported that managing eating disorders properly is crucial to mitigating the potential long-term impacts on individuals who have this disorder or develop this disorder during the pandemic [26, 42] observed that individuals with eating disorders have a higher risk of suicide under normal conditions and situations related to the COVID-19 pandemic can further increase this risk.
With regard to sex, our findings confirmed the first hypothesis of the present study. This finding reveals that the women would show higher symptoms of development of pathologies (e.g. depression, anxiety and stress), such as risk behavior for eating disorders. These results are similar to that of Antunes et al.  who identified that females had greater symptoms of development of pathologies (anxiety) compared to males, suggesting that women may be a group of greater vulnerability. Wang et al.  demonstrated, in an online survey in China, that 53.8% of respondents rated the psychological impact of COVID-19 as moderate or severe depression (16.5%), anxiety (28.8%) and stress (8.1%). The authors also noted that women, in special students, were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression. In addition to the differences found between the sexes, it is important that the research took into account the age groups, since the pandemic has different impacts depending on the age group analyzed [16, 38, 41].
On the other hand, recent studies conducted in China, Italy and Spain which suffered a severe COVID‐19 pandemic, showed a high frequency of development of pathologies (e.g. depression, anxiety and stress) in both sexes [19, 43-46]. Moreover, Huang and Zhao  demonstrated, in a cross-sectional research with 7,236 Chinese adults, a high depressive and anxiety symptomatology. In Italy, Casagrande et al.  reported a high frequency of anxiety symptoms in 2,291 Italian adults. In Spain, recent online cross‐sectional studies observed high frequencies of depressive and anxiety symptoms in the population [43-46].
Regarding the risk behavior for Eating disorders, it can be noted that women reported having a higher risk of developing EDs than men. These findings are similar to other studies in literature which demonstrate a significant proportion of the risk for eating disorders reported in women during the pandemic [39, 47]. Phillipou et al.  observed, in Australians represented by a sample composed 80% by women, that binge eating and anorexia nervosa had an increase during the pandemic. According to the authors this may be due to a number of factors, including the availability of specific foods, as well as increased stress, anxiety and depressive symptoms as a result of social distance measures. Papandreou et al.  affirmed, in a cross-sectional study with a higher prevalence of women, that eating behaviors can be affected during the pandemic and can thus trigger risks for the development of eating disorders. The authors also noted that the Spanish population suffered less from binge eating when compared to the Greek population.
Variables such as depression, anxiety, stress and eating disorders are psychological dimensions that play a significant role in people’s quality of life and well-being and, in this scenario, considering the psychological dimensions, according to sex and age group, is essential for the definition and creation of intervention strategies during and after the period of social isolation. Our results highlight the importance of identifying factors and predictive variables of eating disorders and, by identifying vulnerable groups, intervention strategies can be better targeted, increasing its effectiveness.
Limitations and Future Research Directions
The present study fulfilled its objectives regarding the elucidation of the association of age, depression, anxiety and stress with risk behaviors for eating disorders in Brazil adults of different ages and regions of the country during the COVID-19 pandemic. However, some limitations need to be pointed out, such as the use of a convenience sample, which does not allow us to extrapolate the results, and the use of self-reported instruments applied online. Nonetheless, this does not invalidate the results found, especially because of the number of participants (n=715) and the fact the instruments used present adequate psychometric evidences.
Moreover, understanding how theses variables explain the risks for eating disorders in different stages of life should be a topic approached in future studies. Anyhow, studies of this nature can contribute to better understand the impacts of the pandemic in vulnerable groups, such as individuals with higher predisposition to common mental disorders (anxiety, depression and stress), which have more chances of developing eating disorders.
Lastly, the literature available on this topic during the pandemic is originated from countries who suffered with the disease, especially developed ones. Therefore, it may not represent the experience of the population from other countries. In this scenario, the present study brings important contributions regarding mental health disorders during the COVID-19 pandemic in Brazil.