A mixed‐studies systematic review of the experiences of body image, disordered eating, and eating disorders during the COVID‐19 pandemic

Abstract

Objectives This systematic review assessed the influence of the COVID‐19 pandemic and associated restrictions on body image, disordered eating (DE), and eating disorder outcomes. Methods After registration on PROSPERO, a search was conducted for papers published between December 1, 2019 and August 1, 2021, using the databases PsycINFO, PsycARTICLES, CINAHL Plus, AMED, MEDLINE, ERIC, EMBASE, Wiley, and ProQuest (dissertations and theses). Results Data from 75 qualitative, quantitative, and mixed‐methods studies were synthesized using a convergent integrated approach and presented narratively within four themes: (1) disruptions due to the COVID‐19 pandemic; (2) variability in the improvement or exacerbation of symptoms; (3) factors associated with body image and DE outcomes; (4) unique challenges for marginalized and underrepresented groups. Disruptions due to the pandemic included social and functional restrictions. Although most studies reported a worsening of concerns, some participants also reported symptom improvement or no change as a result of the pandemic. Factors associated with worse outcomes included psychological, individual, social, and eating disorder‐related variables. Individuals identifying as LGBTQ+ reported unique concerns during COVID‐19. Discussion There is large variability in individuals' responses to COVID‐19 and limited research exploring the effect of the pandemic on body image, DE, and eating disorder outcomes using longitudinal and experimental study designs. In addition, further research is required to investigate the effect of the COVID‐19 pandemic on body image and eating concerns among minoritized, racialized, underrepresented, or otherwise marginalized participants. Based on the findings of this review, we make recommendations for individuals, researchers, clinicians, and public health messaging. Public Significance This review of 75 studies highlights the widespread negative impacts that the COVID‐19 pandemic and associated restrictions have had on body image and disordered eating outcomes. It also identifies considerable variations in both the improvement and exacerbation of said outcomes that individuals, researchers, clinicians, and other public health professionals should be mindful of if we are to ensure that vulnerable people get the tailored support they require.

The prevalence and risk factors of screen-based disordered eating among university students: a global systematic review, meta-analysis, and meta-regression

“…Moreover, we found a slight decrease in the weighted pooled prevalence of screen-based disordered eating from the pre-COVID period of 2015–2019 (23.8%) to the post-COVID period (2020 onwards; 20.8%). Our data are consistent with several other recent reviews [ 167 , 168 ] in suggesting that a COVID-19 effect is accurate in some places and for some vulnerable people—and, in particular, people who already have an eating disorder—but not in general. Future research and meta-analytic reviews are needed to clarify the moderating and mediating variables at work here.…”

Unheard voices: The impact of the COVID‐19 pandemic on disordered eating in people with marginalized identities: Commentary on Devoe et al. (2022), Linardon et al. (2022) and Schneider et al. (2022)

“…People facing financial stressors may have also experienced fewer reported benefits of the pandemic, such as increased time for self‐care. Similarly, Schneider et al ( 2022 ) reported that people of Asian heritage with EDs reported higher psychological distress during COVID‐19, which could in part reflect increased discrimination and hate crimes against this group (see Supplemental Material for additional resources addressing this issue). These are important findings that can help guide screening and treatment to ensure we are reaching all individuals in need of care, many of whom do not fit the historical white, wealthy, cisgender/heterosexual stereotype of those affected by EDs/DE.…”

“…The three reviews in this special issue (Devoe et al, 2022 ; Linardon et al, 2022 ; Schneider et al, 2022 ) illuminate the profound impact the COVID‐19 pandemic has had on people with eating disorders (EDs) or disordered eating (DE; i.e., distressing symptoms such as binge eating or body dissatisfaction) in Western countries (unfortunately, research in non‐Western contexts remains limited). The storm of the pandemic has brought with it increased stress, isolation, anxiety, body image concerns, and both DE and EDs that have led to a dramatic increase in hospitalizations for adults and youth (Devoe et al, 2022 ).…”

“…Emerging research highlighted in these three reviews suggests that people with marginalized identities (e.g., LGBTQ + individuals, people of color) and preexisting stressors such as socioeconomic disadvantage may have been affected particularly profoundly. For example, both Schneider et al ( 2022 ) and Linardon et al ( 2022 ) found that people facing food insecurity or broader financial stressors were more likely to experience increased DE during the pandemic. Because stress is a well‐documented risk factor for EDs and DE, it is not surprising that people undergoing financial hardship during the pandemic would experience the greatest increases in DE.…”

“…Concurrently, and as highlighted by Schneider et al ( 2022 ), there is much we still do not know regarding the impact of the pandemic on people with marginalized identities. Partially, this is a measurement problem—specifically, what has not been measured and what we do not know about the identities of those participating in research on EDs/DE.…”