Eating Disorders During the Holidays

by Dr. Jean Doak, Clinical Director, UNC Center of Excellence for Eating Disorders

The holiday season is a time accompanied by celebrations, observances, religious, family, and cultural traditions, and increased time with family and friends. While it can be a time of excitement, anticipation, and joy, it can also be a time of increased stress and anxiety. In fact, an American Psychological Association survey conducted in 2010 reported that 38% of Americans say their stress increases during the holidays, often bringing increased fatigue, anger, and irritability. This can be especially true for people who have eating disorders as navigating the holiday season may mean navigating the challenges of food-centered celebrations.

A recent report found that more than 28.8 million Americans alive today will have an eating disorder at some point in their lives (Deloitte Access Economics, 2020). Eating disorders have one of the highest mortality rates of any mental illness and affect people of all genders, ages, races, and socioeconomic backgrounds. Recent research has also indicated the COVID-19 pandemic has had a significant impact on individuals with eating disorders and has contributed to substantial increase in the number of individuals identified with an eating disorder and referred to treatment.

More than one third of participants surveyed during a 2020 study published in the International Journal of Eating Disorders reported that the impact of COVID-19 has made managing eating disorders more challenging. Participants identified concerns about worsening of the eating disorder due to lack of structure, being in a triggering environment, lack of social support, and being unable to access food consistent with their meal plan.

These concerns are often included in discussions with patients and families and can be used to develop a plan to reduce stress and maintain recovery during the holidays. Below are a few strategies you and friends/family members can use to support your treatment and recovery.

For you:

  • Be proactive. Create a plan to help you prepare for upcoming get-togethers and meals. Practice maintaining your schedule and routine, including regular meals and snacks, leading up to and including the day of the event. This is also an opportunity to review and write down your motivation for treatment and recovery.
  • Have a support system at the ready. Reach out to friends/family on whom you can rely for support. This may include a phone call, FaceTime, or texts that can offer motivation or even distraction and can assist with fostering connectedness.
  • Practice self-care. Self-care is not being “selfish.” It is something you owe yourself and can assist with upholding overall physical, emotional, and cognitive health. Strategies to consider are activities that reduce stress and anxiety and provide fulfillment and joy.
  • Set limits. Identify what and how many events you anticipate attending. Draw upon previous experience and review pros/cons. It is ok to decline an invitation or limit the amount of time you spend at an event.
  • Limit use of social media. Content promoting disordered eating and/or a thin body image can have negative effects, leading to feelings of inadequacy, body dissatisfaction, and low self-esteem. Take breaks from social media use to center yourself and focus on what is important in your treatment and recovery journey.

For friends/family members:

  • Create an environment that focuses on the reason for gathering, rather than focusing on food.
  • Engage in activities that do not involve food, like community service, playing board games, watching movies together, or outdoor activities.
  • Avoid making comments about calories, portion sizes, “good” food/”bad” food, body size, weight, or shape.
  • Create a plan with the person who needs extra support of identifying when and how to provide that support.

These strategies do not imply you have to avoid food-centered celebrations or activities. Food is how we fuel our bodies and is intertwined with our expression of culture, tradition, connectedness, and community. Instead, these strategies offer an opportunity to find balance and enjoyment while promoting overall well-being.

Wishing you a peaceful holiday season…