This study explores ED symptoms and weight change perceptions at months 6–8 of the COVID-19 pandemic in the U.S., and has three major findings; first, that LGBTQ + individuals are likely experiencing uniquely high levels of pandemic-related stress compared to cisgender/heterosexual men (hypothesis 1 supported), and secondly, that pandemic-related stress is strongly associated with ED symptoms and perceived weight gain (hypothesis 2 supported). Third, LGBTQ + people’s interview narratives underscore complex pandemic-related health challenges, ranging from exercise constraints and disrupted eating patterns, to weight fluctuation concerns (hypothesis 3) that converged with the quantitative findings regarding LGBTQ + people’s elevated ED symptoms and perceived weight gain. While quantitative results focused on the influence of pandemic stress, qualitative narratives added additional understanding of how individuals associate being homebound (or spending a greater proportion of time at home) with disruptions to eating behavior and perceived weight gain.
Many U.S. residents, similar to peers globally, have endured unique pandemic-related stress and constraints, and our study supports prior research suggesting pandemic-specific stress and disruption to routine is likely to exacerbate pre-existing ED symptoms and/or result in engagement in new DEBs. We found that nearly 30% of our sample may be experiencing ED symptoms of clinical significance, with 38% of LGBTQ + individuals potentially experiencing clinically significant impairment associated with ED symptoms. While purposive sampling of LGBTQ + community members may be skewing results toward higher ED symptoms in this sample, approximately 18% of cisgender and heterosexual identifying men also scored 15 or higher. These findings reaffirm prior research suggesting ED is an important and understudied public health concern.47
While it is possible that, given the short time frame of the EDE-QS, that ED symptoms and weight-related concerns will subside post-pandemic, our study confirms that LGBTQ + individuals are experiencing elevated pandemic-related stress that may be detrimental to their physical and mental wellbeing. LGBTQ + individuals are likely navigating identity-related minority stressors that are exacerbated or interlocking with pandemic-specific stressors that lead to greater pandemic related stress levels.35 For example, LGBTQ + young people are at risk of experiencing elevated interpersonal trauma in their home environments, as many LGBTQ + individuals at risk of exposure to identity-related stigma and discrimination, including domestic violence, from family members.37 These LGBTQ + identity related minority stressors can have a detrimental effect on behavioral and mental health outcomes,48 over and above effect of universal stressors (e.g., the COVID-19 pandemic).49
Our findings suggest a strong association between pandemic stress and ED symptoms. While it is likely that the association is bidirectional or mutually reinforcing (e.g., individuals with ED symptoms may be more likely to report pandemic-related stress), interview narratives suggest that LGBTQ + individuals perceive the pandemic to be adversely impacting their eating and exercise routines, leading to potential or perceived weight gain. While respondents may not have experienced actual weight gain, over-evaluation of body weight and weight concerns are known risk factors for ED.50 Higher BMI was found to be predictive of elevated ED symptoms and perceived weight gain, suggesting that body weight is also an important contribution to people’s pandemic experiences. Many interview participants suggested that they were eating more frequently, and poorly, due to a combination of perceived stress and boredom due to being homebound. Prior studies suggest that cognitive factors such as boredom and rumination are associated with mental health challenges such as symptoms of anxiety and depression.51 Future studies should examine the role of these cognitive factors when investigating the long-term effects of the pandemic.
LGBTQ + interview narratives convergent with the quantitative findings and with respondents perceiving their weight fluctuations to have real adverse effects on their physical health. Notably, social support was associated with alleviating symptoms of ED, suggesting that perceived social support may be a protective factor against ED resulting from pandemic-related stress. However, resilience did not emerge as a significant protective factor; resilience is a dynamic process wherein one bounces back with positive adaptations after facing an adverse event(s).52 It may be that on-going COVID-19 related stressors continue to influence the dynamic process of resilience building, with social support playing an influential role in protecting against pandemic stress.53
However, a major limitation of this study is that data are cross-sectional and cannot speak to processes over time, such as actual weight gain or change in ED symptoms across the pandemic. In addition, cisgender women and LGBTQ + identifying persons were more likely to complete the survey, and therefore results under consider the experiences of cisgender men. Furthermore, we did not have large enough subsamples of LGBTQ + respondents to engage in more detailed examination of LGBTQ + heterogeneity. In addition, there is likely racial and ethnic disparities in pandemic-related stress, and its association with ED symptoms and perceptions of weight gain, which we were unable to fully assess due to sample size constraints.