It began with skipping breakfast. When the first work-from-home order was announced last year, Elle Pemberton saw little need for the bowl of porridge that had fuelled her 50-minute commute.
To compensate for her new sedentary lifestyle, the 27-year-old also committed to a two-hour online workout every day. In April, she embarked on a ‘healthier’ diet too – a perfect distraction from worries about the health of her mother, a frontline NHS worker. ‘I’ve always been keen on staying in shape through diet and exercise, and, I guess, a bit body-conscious,’ says Elle, a copywriter from Salford.
‘But I suddenly had more time to stare at the bits of my body I don’t like, such as my waist. I couldn’t stand Zoom either, seeing myself on the screen all the time and hating my own image.’
Within four months, Elle had dropped from a healthy dress size 8 to a size 4. ‘I couldn’t concentrate on anything apart from controlling my weight,’ she says.
Fixations: Elle Pemberton, above, who became obsessed with online workouts and her stringent diet. ‘I suddenly had more time to stare at the bits of my body I don’t like’, she says
One night in May, Elle’s housemate heard her making herself sick, and suggested she visit A&E for help.
After a series of tests, she was sent for an appointment with a local mental health team, but ‘underplayed’ her eating problems, instead focusing on her low mood. ‘I didn’t think I was unwell enough to deserve treatment,’ she says.
It took three months of therapy for anxiety and depression before clinicians uncovered her eating disorder, and referred her to specialists. But almost three months from this point, thanks to a backlog in cases, Elle is yet to have an initial assessment. Sadly, she is part of what experts are calling a ‘tsunami’ of eating disorder patients, sparked by the pandemic.
The UK’s leading eating disorder charity, Beat, has seen an 81 per cent increase in calls to its helpline since March. In the same period, hospital admissions for bulimia, which involves periods of compulsive eating and purging, rose by 75 per cent. Across the UK, referrals for treatment are up roughly 40 per cent – an increase typically seen over the space of two years.
So what is it about lockdown that helps these conditions, the deadliest of mental illnesses, to thrive?
The cause of eating disorders is thought to be three-pronged: first, specific personality traits, such as rigidity and perfectionism. Second, a traumatic or difficult life event. Lastly, a trigger. And the stress of lockdowns, experts warn, has lit this match for many.
‘Those who are vulnerable also tend to be the kinds of people who need structure and routine in their daily life to feel calm,’ says Professor Ulrike Schmidt, consultant psychiatrist and head of eating disorders at King’s College London. ‘Lockdowns took this away, so people look to something else to control. Diet and exercise is an easy choice.’
Elle’s eating disorder was set off by the dramatic change to her routine last spring.
The UK’s leading eating disorder charity, Beat, has seen an 81 per cent increase in calls to its helpline since March (file photo)
‘I’d never let my body-conscious thoughts stop me functioning before,’ she says. ‘I was distracted by work colleagues or friends, which stopped me thinking about it. Suddenly, I had all this anxiety building up but no distractions and bags more time and headspace. I needed something to focus on.’
Prof Schmidt says this is classic of many of the patients she has seen during lockdown. ‘Many are suddenly using food as a way to exercise control in a situation that feels so unstable, with no way out,’ she says. ‘It’s almost something to do, a focus, and soon it becomes a habit that spirals out of control.’
Did you know?
Teenage girls who regularly post selfies are likely to be dissatisfied with their body and diet obsessively, say Australian researchers.
Australian studies show that since March, a third of people of all ages are restricting food intake, compared with less than ten per cent previously. According to researchers from Yale University, the release of the stress hormone cortisol impacts the balance of compounds involved in appetite regulation. Anxiety is associated with a reduction of hormones that signal hunger – the ‘fight-or-flight’ reaction temporarily pauses the digestive system, reserving energy for survival.
And, as in Elle’s case, the increase in virtual interactions also caused problems. ‘People find Zoom very distracting. They’re staring at their own face, constantly analysing the things they don’t like,’ says Prof Schmidt.
And then there’s social media, such as Instagram and video-sharing app TikTok, use of which has surged over the past year.
Experts have long warned that looking at fitness-related content is linked to restrictive-eating behaviours. This was certainly one of the triggers for Sofia Jones, 17, from South London, who noticed her social-media feeds were full of online workouts as soon as school shut last March. In the same month she lost her grandmother, who died of cancer, and the ban on funerals denied her a proper goodbye.
She says: ‘All of social media was saying, “Now is the time to get a summer body,” and it took my mind off feeling upset,’ says Sofia, who was then a size 8.
She adds: ‘My friends were sharing their workouts on Instagram every day and following online PE classes – it made me feel like I should be doing more.’
Sofia Jones, 17, from South London, noticed her social-media feeds were full of online workouts as soon as school shut last March (file photo)
Soon, Sofia began cycling – sometimes 20 miles in a day – as well as doing daily online workouts. ‘I’d also contracted Covid and lost my sense of taste, so I didn’t have much appetite,’ she says. ‘I started eating smaller portions at every meal and it became like a habit.’
Her parents, David, 53, and Paula, 49, became concerned when they noticed Sofia’s slight frame shrink further. ‘It was obvious she was losing weight rapidly,’ says David, an accountant.
‘We could see kilogram after kilogram dropping off her. Meal times became tense, she was very anxious about eating big portions, especially carbohydrates such as potatoes and rice. Her mannerisms changed too – she went from being relaxed to prickly.’
What’s the difference…
…between virulence and transmissibility?
The terms are often used interchangeably at the moment to talk about the emerging Covid variants, but they mean very different things.
We know that at least one of the new mutations of the virus makes it more transmissible – this means it’s easier to catch it and it spreads faster.
What has been seen is more outbreaks involving more people who turn out to have the new variant.
Virulence, however, refers to the ability of the virus to overcome the immune system and cause disease.
A more virulent virus would mean we’d be seeing more severely unwell patients, and as yet there is no evidence of this.
By May, Sofia had lost nearly a stone. David and Paula, a Pilates teacher, called the family GP. Covid delays meant a specialist referral took weeks, so they found a private therapist instead, who diagnosed Sofia with anorexia nervosa.
Since August, Sofia has seen a psychologist specialising in eating disorders, for weekly appointments, and has started to improve. One eating disorder specialist told this newspaper that several of her patients whose illness has been triggered by the pandemic. In most cases, she said, fitness advice on social media has contributed.
‘It starts healthily, sticking to workouts and following a fitness guru’s eating plan,’ she says. ‘Then they get hooked on the weighing and measuring food, the obsessionality increases and they become addicted to starvation. Boom… hello anorexia.’ Meanwhile, experts have warned that increased time at home puts youngsters at risk of copying relatives’ unhealthy eating.
‘Being suddenly thrown in with someone who has strange eating habits, that’s difficult for some,’ says Prof Schmidt. ‘In therapy, we often have to teach people how to deal with comments about weight and food from loved ones that aren’t intended to be harmful.’
Researchers at Northumbria University found that 87 per cent of those with a history of eating disorders have seen symptoms re-emerge, or worsen, over the past year.
Supermarket food shortages at the beginning of the first lockdown was one reason.
‘Lots of people in recovery have limited diets, so will only eat one type of bread or yogurt,’ says Prof Schmidt. ‘In the first lockdown, if patients couldn’t access these, they’d just go without, and become stuck in a restrictive cycle again.’
Stockpiling during lockdown also presented a challenge for the fifth of patients who struggle with binge-eating.
Supermarket food shortages at the start of the first lockdown was one reason for those with a history of eating disorders seeing symptoms re-emerge, or worsen, in past year (file photo)
Prof Schmidt says: ‘Knowing there’s several packets of something in the cupboards increases the temptation to binge.’
One reason for the spike in hospital admissions has been the lack of available NHS staff to prevent patients from becoming sicker.
‘Services can’t run at full capacity, so there’s long waiting lists, with most therapy sessions going online,’ says Prof Schmidt. ‘So much of eating-disorder treatment is practical, for instance supporting someone while they eat lunch. Now staff would have to wear a mask, which would be distressing.’
Dr Jart Ceramidin Trial Kit
Three moisturising creams packed with uber-hydrating ceramidin, said to smooth skin damaged by the drying effects of central heating.
But there is some hope. Experts have welcomed the nationwide rollout of a fast-track treatment programme proven to quadruple rates of recovery from anorexia and bulimia.
The protocol, called FREED, slashes waiting times for psychological treatment from several weeks to a few days, thanks to an extra bank of specialists funded by the charity The Health Foundation and the Department for Health and Social Care.
Studies show those who receive medical intervention within the first few months of illness are more than twice as likely to make a long-term recovery.
Within days of a referral, patients will receive a phone call from a mental health professional to discuss their problems ‘in a manner that young people can relate to’.
Talking therapy begins in two to three weeks, including advice for coping with troubling images on Instagram and weekly sessions with a dietician. Prof Schmidt says face-to-face appointments continue to take place weekly, if medics feel they are needed.
‘While we can’t deliver the exact care we’d like to at the moment, we can make a start,’ says Prof Schmidt. Yet those who qualify – young adults who have recently become ill – represent just a small chunk of the total 1.25 million sufferers in the UK.
‘There’s thousands who aren’t in that age bracket or don’t live near one of the 18 specialist centres,’ says Caroline Price, director of services at Beat. ‘Or those who were previously ill years ago, but the pandemic has caused them to relapse – what happens to those people?’
Sofia’s father David feels lucky to have picked up on her weight loss quickly. Rapid intervention means that now, five months after she began therapy, she’s regained most of her lost weight – and has cut her online workouts down to just one a week.
His advice? ‘As soon as you notice anything different – act. Be observant. Watch out for odd mannerisms or peaks in anxiety. Don’t wait for the illness to take hold. Call your GP.’