Watch What You Eat: How Talk of Weight and Healthy Eating Can Be Harmful during COVID-19

Fresh produce at a grocery store

Megan Reynolds

Master’s Student in Nutritional Sciences

September 17, 2020

Throughout the COVID-19 pandemic, the impact on food intake and body weight has been widely talked about and heavily researched. Much of the public discourse has focused on food insecurity and weight gain, while important public health issues like eating disorders and weight stigma have taken second stage.

According to Jeffrey Hunger, a weight-bias researcher at Miami University in Ohio, “the increased media coverage of obesity and COVID-19 increases the prevalence of weight stigma and bias, and it might lead to blaming individuals for actually contracting the virus.”

While promoting healthy eating during uncertain times may be well-intentioned, messaging that incites one’s fear of weight gain contributes to weight stigma, which encourages negative psychological outcomes.

While promoting healthy eating during uncertain times may be well-intentioned, messaging that incites one’s fear of weight gain contributes to weight stigma, which encourages negative psychological outcomes including self-blame, feelings of shame, depression, and anxiety, as well as lower self-esteem and body image.1

It is these exact feelings that trigger many to engage in disordered eating behaviors, and for individuals already diagnosed with an eating disorder, these emotions can lead to relapses or more severe restricting, binge eating, and purging behaviors.2 COVID-19 has exacerbated these triggers in a myriad of ways: elevated concerns about health and fitness during confinement, increased time spent using social media platforms that promote unrealistic body ideals, as well as isolation, loneliness, and difficulty with emotional regulation.3

This is especially worrisome for those living in larger bodies, who are drastically less likely to seek treatment from medical professionals, and who are also much less likely to be diagnosed with an eating disorder by their clinician.4,5 During a pandemic, this situation becomes even more dire, as there is much at stake by not getting treated when sick.

This disparity in treatment is amplified among minority populations—specifically black individuals and American Indians—because of historical racism and discrimination, which is associated with underutilization of healthcare services.6 Additionally, social determinants of health, which have negatively impacted these populations due to the historical and still-pervasive consequences of systemic racism, play a role in the disproportionately negative health outcomes seen in these populations.

Things such as redlining, food deserts, limited access to transportation, lack of access to health care, and lack of education and employment opportunities are all examples of how social determinants of health can act as barriers to health equity. Many of these issues have been brought to light during the COVID-19 pandemic, where it is already well-evidenced that black Americans are dying at a disproportionately higher rate than their white counterparts due to these structures.7,8 Discrimination based on body weight and size compounds these effects and increases stress and barriers to health.

When health is at the forefront of the conversation, it is also imperative to acknowledge and reconcile the fact that these conversations need to occur through a lens that includes the repercussions of systemic racism and injustice.

It is also imperative to address the negative mental health implications of this stigmatization as well. The current pandemic as well as previous outbreaks have increased fear, panic, and post-traumatic stress disorder (PTSD) symptoms, as well as elevated anxiety.9 Current evidence suggests that amongst those already at risk for adverse mental health outcomes, the adverse cognitive and psychiatric outcomes caused by coronavirus may have long-lasting effects.9 For example, increased news coverage of food insecurity may trigger those who hoard food, and binge eating, which is associated with food insecurity, may negatively impact one’s financial standing and cause family strain.9,10

Keeping this evidence in mind, it is important for researchers, policy makers, reporters, and advocates to be mindful of the implications of discussing food and bodies—especially during COVID-19. When health is at the forefront of the conversation, it is also imperative to acknowledge and reconcile the fact that these conversations need to occur through a lens that includes the repercussions of systemic racism and injustice. Nutrition experts, specifically, should also be mindful of the weight stigmatization that occurs when talking about healthy eating and weight gain prevention during a time when both mental and physical health are already suffering from this experience of trauma and collective grief.

References

  1. Pearl, R. L. and Puhl, R. M. “Weight Bias Internalization and Health: A Systematic Review.” Obesity Reviews 19/8 (August 2018):1141-1163.
  2. Termorshuizen, Jet D. et al. “Early Impact of COVID-19 on Individuals with Eating Disorders: A Survey of ~1000 Individuals in the United States and the Netherlands.” medRXiv (June 2020).
  3. Fernández‐Aranda, F. et al. “COVID‐19 and Implications for Eating Disorders.” European Eating Disorders Review 28/3 (May 2020):239-245.
  4. Drury, C. A., and Louis, M. “Exploring the Association between Body Weight, Stigma of Obesity, and Health Care Avoidance.” Journal of the American Academy of Nurse Practitioners 14/12 (December 2002):554-561.
  5. Sonneville K.R., and Lipson S.K. “Disparities in Eating Disorder Diagnosis and Treatment according to Weight Status, Race/Ethnicity, Socioeconomic Background, and Sex among College Students.” International Journal of Eating Disorders 51/6 (June 2018):518-526.
  6. Burgess, D. J., et al. “The Association between Perceived Discrimination and Underutilization of Needed Medical and Mental Health Care in a Multi-Ethnic Community Sample.” Journal of Health Care for the Poor and Underserved 19/3 (August 2008):894-911.
  7. Egede, L. E., and Walker, R. J. “Structural Racism, Social Risk Factors, and Covid-19—A Dangerous Convergence for Black Americans.” New England Journal of Medicine 383 (September 2020):e77.
  8. Yancy, C. W. (2020). “COVID-19 and African Americans.” Journal of the American Medical Association 323/19 (April 2020):1891-1892.
  9. Touyz, S., Lacey, H., and Hay, P. “Eating Disorders in the Time of COVID-19.” Journal of Eating Disorders 8/19 (April 2020).
  10. Rasmusson, G. et al. “Household Food Insecurity Is Associated with Binge-Eating Disorder and Obesity.” International Journal of Eating Disorders 52/1 (December 2018):28-35.

About the Author

Megan ReynoldsMegan Reynolds is a master’s student studying Nutritional Sciences at the University of Michigan School of Public Health. She is interested in weight bias and discrimination, eating disorder prevention, the relationship between mental health and nutrition, and promoting social justice and equity in the field of dietetics. She is president of Student Advocates for Nutrition (SAN) and works as a graduate program assistant at Wolverine Wellness.

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