The coronavirus SARS-CoV-2, identified in China at the end of 2019, and the disease it causes (COVID-19), has triggered a large outbreak that became a pandemic and a great public health emergency . Due to the absence of a vaccine and an approved treatment protocol, the World Health Organization  announced that to control the spread and infection rate of this global pandemic, confinement and other social distancing measures were required.
On March 19, 2020, the Portuguese government installed the state of emergency in Portugal. The state of emergency is an exceptional regime, in which certain rights are suspended, with the sole purpose of adopting the necessary measures for the protection of public health, in this case, in the context of the COVID-19 pandemic. Thus, a set of measures were implemented to contain the disease, namely: compulsive confinement at home or in a health establishment; prohibition of unjustified travel; closure or limitation of commercial activities; mandatory work from work, except for essential workers; cross-border controls; Limitation or prohibition of holding meetings or demonstrations that, due to the number involved, enhance the transmission of the new Coronavirus, including religious events and celebrations. This state of emergency ended, in Portugal, on May 3, 2020, and all imposed measures were lifted or adapted .
Besides being a public physical health emergency, COVID-19 outbreak and subsequent prevention and control strategies, also seem to have a great psychological and social impact [3; 37]. Recent studies have reported that the coronavirus pandemic, its exponential spike in disease and death, and the subsequent compulsory global lockdown (from school and university closures, travel restrictions or full lockdowns) has brought a parallel emotional pandemic of fear, stress, anxiety, and depression . Several authors have pointed out that beyond the potential benefits to control the outbreak, the mandatory confinement and other social distancing measures will have psychological costs .
Regarding the field of eating psychopathology, this stressful situation is associated with substantial changes in daily routines, which for many people may lead to or intensify body and eating-related difficulties. The daily routine changes due to COVID-19 quarantine (e.g., eating and food-related practices, the closing of gyms, movement restriction and confinement) may contribute to weight and body shape-related preoccupation (e.g., fear of weight gain) and promote disordered eating behaviours (ranging from severe caloric restriction to overeating; ). Previous studies have shown that food insecurity, defined by the perception of limited access to food by contextual or financial hardship, is associated to increased binge eating behaviours . On the other hand, being at home for extended periods and the continuous exposure to food during the confinement can, also, be a trigger to binge-eating behaviours . Moreover, emotional eating and binge eating may occur as a maladaptive emotional strategy to suppress or soothe negative emotional experiences (e.g., anxiety, anger or boredom), frequently experienced in distressing and challenging contexts [9; 10].
Disordered eating behaviours (DEBs) are described as serious maladaptive eating behaviours that comprise a high clinical burden, whether or not they warrant a diagnosis of a specific eating disorder . Among the spectrum of DEBs (such as dietary restrictions, fasting, binging, or other unhealthy behaviours to control weight and/or body shape), binge eating episodes have consistently shown to be the most prevalent [12-18].
Binge eating is characterized by the consumption of an unusually large amount of food in a discrete time period, with a sense of lack of control over one’s eating , accompanied by severe discomfort or distress . There is increased recognition that binge eating is a serious public health concern, even when in its sub-clinical forms . In addition to its high prevalence, there is empirical evidence that suggests that binge eating episodes tend to become recurrent and progressively more severe , which may contribute to the development of a clinical form of eating disorder and carry harmful physical and mental health consequences, such as obesity , as well as poor psychological adjustment [14; 15]. Additionally, weight and shape concern have been found to be related to certain eating-related difficulties [23; 24], often appearing as a risk factor or/and a symptom for the development of eating disorders [25; 26].
Body Mass Index (BMI) has been described as having a crucial role in the development of disordered eating attitudes and behaviours (e.g.: restrictive practices; binge eating behaviours; use of compensatory behaviours [27; 29]). More specifically, the relationship between the development of eating-related difficulties and a higher BMI (pre-obesity and obesity group samples) have been thoroughly explored, with study’s emphasizing the importance and significance of this, especially in young female samples [23; 30-32].With this information it is important to explore the role that BMI takes on during a strenuous time, such as quarantine.
Considering the need to further understand BMI’s role in eating-related difficulties, this study aimed to explore how women from different BMI groups (underweight, normal weight, pre-obesity and obesity; ) experienced quarantine (i.e., isolation, confinement, closing of gyms, continuous exposure to food, etc). Particularly: i) exploring the changes introduced in eating and exercise routines and ii) understand how shape concern, weight concern and binge eating behaviours manifested during this time.
We hypothesised that (i) eating and exercise routine- related changes introduced by women during quarantine varied according to the belonging BMI group and that (ii) women from the obesity group would experience in this period more shape concern, weight concern and binge eating, in comparison to the other BMI groups.