The study attempted to examine the mediating relationships between the psychosocial impact of the COVID-19 pandemic and disordered eating behaviors in a community sample. We found that the change brought about by the COVID-19 lockdown was significantly associated with psychological distress, indirectly mediating some forms of disordered eating behaviors. Our findings thus suggest that individuals who experience changes in various domains of their daily life will experience increased psychological distress, resulting in more disordered eating. This finding, in turn, is hypothesized and supported by studies by Philippou and Ramalho. [13, 25]
According to numerous studies on psychological distress, people in crises frequently experience chronic psychological trauma that might result in depression, anxiety disorders, or substance abuse. [31] Additionally, it was found that those forced to stringent pandemic control techniques, like isolation and quarantine, report feeling depressed, anxious, lonely, and bored, with some even attempting suicide. [32] In this context, disordered eating patterns may serve as a maladaptive means to cope with the adverse events due to the COVID-19 pandemic during the lockdown. [33, 34]
In this study, 55.4% of participants perceived an increase in body weight during the peak of the COVID-19 pandemic period. While lack or decreased physical activity may mediate some of this change, this percentage is still much more significant than the studies by Dey and Ghosh. [17,35−37] Furthermore, although this is a self-report of perceived weight variations among the general population, it calls for attention to the impact of lockdown on overweight and obesity rates, as reported in some previous studies. [38, 39] The perceived weight gain may indicate underlying disordered eating attitudes/behaviors and body image issues, making it a target for clinical attention.
The participants in our study reported a high prevalence of disordered eating behaviors on screening. These figures point towards a significant presence of unhealthy dietary patterns in the community, as seen in studies by Ghosh, Basu, and Kumar, wherein higher snacking and food consumption were seen during the pandemic-induced restriction phase.[37, 39, 40] A similar study conducted among the Australian population, where eating behaviors of adults were compared to their pre-pandemic behaviors, suggested an increase in food restriction and binge eating behaviors, thus, illustrating the significant impact of lockdown periods on eating behaviors.[13] However, in a cohort study conducted in the USA, the prevalence of disordered eating behaviors during the COVID-19 pandemic was similar to earlier measurements done before the pandemic. Also, poorer stress management and more significant stress, depressive symptoms, and financial difficulties were significantly and positively associated with concurrent disordered eating in this cohort.[41] Thus, there are two substantial implications from the above findings- there needs to be robust, large-scale screening for psychological distress in the youth and educating the youth about stress management, especially now, as the conditions are being restored to pre-pandemic levels. Secondly, as many of these patterns serve as a precedent for developing clinical eating disorders, early detection and treatment become crucial to prevent long-term disability and morbidity.
Another crucial data is that 10% of participants were already at risk for or likely suffering from an eating disorder at the time of the survey and required detailed clinical evaluation. Given that a brief, self-report screening instrument devised initially in the context of Western culture was used in this study, it is challenging to comment precisely on the nature and extent of this problem in India. However, as studies by Taquet and Lin have suggested, there has been a definite upsurge in reported eating disorders during the COVID-19 pandemic. [42, 43] In the Indian context, however, eating disorders are still under-researched and under-reported. Moreover, culture bears a strong influence on the presentation of eating disorders in India, as suggested by the presence of culturally sanctioned fasting practices, the presence of the "Non-fat phobic" variant of anorexia, and likewise.[44] Given such ambiguity, there is an imminent need to develop culturally sensitive instruments for diagnosis and generate locally relevant epidemiological data about eating disorders from the larger community and hospital settings to formulate targeted interventions.
Our study attempted to study mediation patterns between various variables in developing disordered eating behaviors, which have not been studied in the Indian context until now. However, the generalizability of this study is limited due to its cross-sectional nature and the choice to only include individuals with working internet access, which inhibits causal hypotheses from being tested. Moreover, the psychological and eating behavior assessment was self-reported which may be affected by recall bias and stigma associated with psychological issues. Finally, we did not include adolescents in this study, who are usually considered at risk for developing eating disorders. Therefore, our recommendation for future work will be to examine the above variables longitudinally to confirm causality in a diverse sample and to use face-to-face assessments for better accuracy. In addition, studies on the frequency of help requests to healthcare services related to disordered eating behaviors will reinforce these study results.
To conclude, among other things, the COVID-19 pandemic has caused significant psychological distress among the youth. Moreover, it has indirectly mediated disordered eating patterns among the younger population at higher risk for developing mental disorders. Overall, the presented findings help to understand the impact of lockdowns on individuals' eating behaviors in the face of large-scale disasters such as a pandemic and may help develop innovative intervention strategies to prevent and reduce the early adverse effects of lockdowns. Thus, mandatory screening for mental disorders, especially among the youth, becomes imperative for clinicians to formulate targeted community interventions in the long term.