by Cynthia Bulik, PhD and Sarah Faigle, RD, MPH

This is Part 2 of a three part blog series on safe eating after returning to college. Part 1 focused on safe dining for a general UNC student audience and Part 3 will discuss food insecurity on campus in the fall.

Researchers at UNC CEED led a study recently published in the International Journal of Eating Disorders (Termorshuizen, in press) that surveyed over 1000 individuals (511 in the United States and 510 in the Netherlands) about the impact of COVID-19 on their eating disorder. Results of the study showed us that in many ways, the pandemic (and the essential public health measures designed to contain the virus) poses very specific challenges to individuals with eating disorders. The concerns varied somewhat depending on what type of an eating disorder people had.

For example, people with anorexia nervosa and avoidant and restrictive food intake disorder (ARFID) often have very limited numbers of safe foods that they are comfortable eating. With the food supply chain being somewhat uncertain, and shopping options being limited, many people with these illnesses reported being very worried about the ability to find foods that were consistent with their meal plans and their safe foods.

On the other hand, people with bulimia nervosa and binge-eating disorder were struggling with being surrounded by foods that people were stockpiling in case the food supply became interrupted (which can also happen when people are stocking up on food during hurricane season), as many of those high density foods can be very difficult to have around when you have a strong urge to binge.

Universal concerns expressed by all respondents were challenges they were having with a lack of structure to their days and the effects of social isolation. These are two things that might improve as school starts back up again—even if some of the social interaction is virtual. Getting back to classes may at least lend some additional structure to your days that can help you build in regular meal and snack schedules. If you are taking virtual classes and you have difficulty with grazing or mindless eating, you might want to separate out your class screen time from eating time, so that you can pay full attention to both your classes and to your meals. If you find your online classes are not providing enough structure try to implement your own schedule. Create a weekly plan for yourself, aim to include blocks of time and location for coursework, self-care, and meals.

If you are concerned about finding safe foods when you get back to college, especially if you are living off campus, you might want to do some checking online of local grocery stores to see who stocks items that are important to you. Many stores have online shopping that can give you the opportunity to see what is available.

If you are coming back to campus, things are going to be different this year (see Part 1 of this series) and some of those changes may be difficult for people with eating disorders. Some of the changes to shopping and dining might challenge your commitment to recovery. In addition, limitations to food choices and anxiety about changes in dining patterns could leave you feeling like restriction is the only option. But restriction will only make coming back to school during a pandemic even more anxiety-provoking. In our study of over 1000 individuals, a full 68% of respondents with an eating disorder also met criteria for an anxiety disorder. Anxiety is rampant right now with all of the uncertainty around the course of COVID-19. So keeping your recovery on track can help you manage some of that anxiety as well. Planning ahead for difficult days or meals may be the best way to avoid setbacks. Consider some of your safest nonperishable items and keep them on had to supplement inadequate meals or to replace a meal when groceries or takeout don’t feel like an option. These pantry items may include: oatmeal, nut butters, trail mix, canned soups, protein/meal bars, shakes (boost, ensure, breakfast essentials), easy mac, tuna packets, applesauce, canned veggies, shelf stable milk or milk alternatives, and crackers. When in doubt, ask for help! Your dietitian can help with navigating food apps, grocery planning, pantry staples, and easy meal ideas.

If you have a treatment team, stay in touch. So often students will say they are too busy for therapy or for an appointment with their dietitian. But a relapse takes up much more time than a weekly check-in. If you are able to arrange continued treatment with your treatment team, great! Do so!  If you have crossed state lines to get to college and need to find professional support, reach out to your Student Wellness services or, if there is one, the eating disorders program associated with your university. At UNC, you have access to CEED. You can also get extra digital help from apps like Recovery Record, or chat with a therapeutic bot via programs such as Woebot. If finances are a concern, affordable counseling is available via the Open Path Collective.

The bottom line is that help is available in many forms We know that eating disorders thrive in isolation and we know that the unusual circumstances caused by the pandemic can be especially challenging for people with eating disorders, so we encourage you to stay connected to stay well!

Termorshuizen JD, Watson HJ, Thornton LM, et al. Early impact of COVID-19 on individuals with self-reported eating disorders: A survey of ~1,000 individuals in the United States and the Netherlands [published online ahead of print, 2020 Jul 28]. Int J Eat Disord. 2020;10.1002/eat.23353. doi:10.1002/eat.23353