Hard to stomach

The pandemic has derailed the support systems available for those suffering from eating disorders. The disruptions to eating patterns, daily routines, food habits and social interactions have exacerbated disturbed eating behaviours among the young.

Fear, paranoia and stress are never pleasant, but they make for especially terrible companions during anxiety-ridden times such as these. Food, which is usually a source of comfort, then becomes an epicentre of hypervigilance, restriction or bingeing.

Disordered eating habits affect close to 2 per cent of the global population. A study by Indian researchers estimated that 26.6 per cent of adolescent girls struggle with anorexia nervosa, bulimia and binge-eating disorders. Despite this, eating disorders are not thought of as a significant problem in the Indian mental health landscape. This is evident from the alarming lack of data, despite the ubiquity of eating disorders. Anecdotal evidence strongly suggests people of all ages and identities suffer from them.

The limited resources presently available paint a dire picture. Many suffer in silence and may never seek help or support. In fact, these illnesses are firmly rooted in guilt and shame about one’s own body and a lack of self-worth. Disclosing these difficulties to others is not easy, as was the case with most people mentioned in this article.

“I hadn’t talked about this to anyone. Throughout college, I was restricting my food intake, bingeing and purging, but could not bring myself to tell even my closest friend, whom I confided in about everything,” said Vidya Reddy* (24), a media professional. It was years later that she finally found the courage to share her story. “To my surprise, I found that my friend was going through the same thing, but felt too ashamed to tell me,” she recounted.

Some of the key factors that contribute to disordered eating include body image issues, stress, beauty ideals and a lack of control. Eating disorders commonly occur in tow with other mental health illnesses such as suicidal tendencies, depressive and anxiety disorders. Studies have found that up to 97 per cent of people who experience disordered eating receive another psychiatric diagnosis. Prolonged restrictive eating can also lead to severe malnutrition, heart conditions and osteoporosis, among several other health complications.

Self-isolation has only caused disturbed eating behaviours to be swept further under the rug, while also exacerbating them. In addition to providing a fertile ground for stress and anxiety, the pandemic has brought disruptions to daily schedules, eating patterns, activity levels and social support systems.

Side-effects of the pandemic

Before Covid-19, day-to-day social interactions centered around food, and kept those struggling with eating disorders accountable to their friends and family. As with many other things, coronavirus has derailed these systems of accountability as well.

Combined with the extra time to think, reflect and compare, this period made Sahana M* (23), an NGO worker, very critical of herself. “Since the period was one of inactivity and irregular eating, I soon became fixated on how my body was changing. I began to feel a constant fear of losing control of my weight and decided to start cutting back and restricting certain foods and even meals, until I earned them through exercise,” she said.

An awareness of the inactivity or lower activity during this new normal is also symptomatic of these times. “I’m happy being at home, but that means being more inactive than before, what with most of my life being online. I felt guilty and paranoid about putting on weight, because this is going to be my life for a while now,” said Caroline P* (27), a student.

Upside-down routines

The loss of structures including set routines, time markers and boundaries between home and work spaces can also increase the risk of disordered eating patterns, according to a research conducted during the pandemic. Consistent eating patterns often depend on these familiar structures and habits and in their absence, one may begin to snack excessively, binge or miss meals.

For example, Tania M* (26) a writer-researcher based in Kolkata, used to order food online regularly through delivery apps. At the time of lockdown, she found herself at a loss. “When I could not order online, I felt out of my depth. I had come to rely on food as a coping mechanism for stress. After this, I ended up stocking my home with snacks and packaged foods.”

The current situation has impacted how people shop for groceries. Due to the fear of scarcity, many may hoard certain foods in large quantities, particularly snacks, which in turn increases the possibility of binge eating.

Food and feelings

More often than not, the foods we crave or eat have very strong associations with our emotions. Psychologists tell us that this is due to schemas, which are mental categories that we use to sort and organise similar information. “We have associations with everything. Take chocolates, for example, all your memories and feelings related to it are stored in a schema. So, if you like chocolate, then the schema will be associated with positive feelings. Whenever you think of chocolate, that thought will be accompanied by a sense of happiness or love,” said Baldeep Kaur, a 36-year-old psychologist and founder of a Positive Psychology coaching solutions’ company.

Our schemas of food cause us to associate favourite meals with positive emotions. Good food begins to be viewed as a reward for certain desirable behaviours. On the inverse, for some, food may inherently be associated with negative emotions of guilt, shame and disgust. “My insecurity has made me binge a lot even though I don’t want to. I restricted as much as I could, but every time I ate even a biscuit, I’d feel really guilty and over exercise...So my relationship with food is definitely a hate relationship right now, but I still tend to overeat,” explained Hope Mathew* (16), a student.

There is also a constant pressure to prioritise fitness and health in the pandemic — to avoid gaining weight or even to transform one’s body. Caroline feels this pressure, “It’s good to eat healthy, of course, but I think, many times, it’s not just about healthy eating, but also fitting into society’s ideal of ‘thin’. It’s confusing, because we ought to take care of our bodies. There’s nothing wrong with that. However, we should not feel pressured to do so in order to match up to an ideal.” She pointed out that even food delivery apps promote healthy eating, which can lead to feelings of guilt while ordering.

A trigger for these feelings of guilt and shame that come to be associated with eating, is a general environment of fear and uncertainty, explained Kaur. “Coronavirus also has its own schema. There is a repository of all the news we read, the feelings that we associate with this news — fear, grief, awareness, feeling restricted. These bubble up from time to time whenever we read more about the virus or think about it. Unfortunately, instead of dealing with these emotions, we suppress them, which only intensifies them in the long run,” she concluded.

In the midst of unpredictable times, food, eating and weight loss become the only areas of one’s life over which many like Harleen Singh*, a PR professional, are able to exercise some amount of control.

“I was going through a tough time, a man who I was interested in made a comment about my weight and that stuck with me. My family was facing financial problems and I had to take care of them. I changed my job three times. Everything seemed out of my control. The pandemic really gave me the space to exert control over my food.”

Cultural context

This struggle to regain control is common in the Indian context, particularly in joint families and more traditional family structures. For those facing judgement of their eating habits by their families, lockdown and self-quarantine offer little escape, as was the case with Tania M. “Isolation was really hard for me, I got stuck in my home, marooned from my support system — which largely consisted of friends and family outside of my home. My family is a massive trigger for me. Since everybody is at home, whatever I eat at the lunch or dinner table is noticed and comes under increased scrutiny,” she said.

This scrutiny can present itself as comments and remarks about weight gain or appearance. Shivli Shrivastava (24), a counselling psychologist, explains that since appearance is external, it tends to be deemed public — many feel comfortable criticising others’ bodies. “Whenever I go home from Bengaluru to Raipur, my neighbourhood aunties or relatives would talk about my weight gain or loss, my pimples and my general appearance,” she said. Weight-related teasing and criticism is not only common, but studies show they also contribute to body dissatisfaction, binge eating, purging and restrictive eating.

Opinions on weight and appearance generally reflect beauty ideals, which often value ‘thinness’ or a certain body type above others. These standards are further being reinforced by cinema, social media and advertisements. In the current scenario, as people spend more time online and on social media, the effect of content that reinforces a narrow idea of beauty has intensified. Hope and her friends found themselves spending a lot of time on Instagram, “browsing through various accounts and seeing how pretty and fit some people are and how productive they’ve been during this time has made me really insecure about my body,” she said.

The cumulative effect of beauty standards, specific cultural pressures, a general sense of uncertainty and distancing from vital support systems creates a bleak atmosphere for those battling disordered eating. This also acts as a risk factor for people who may not have faced these issues in the past.

“From a very young age, I have memories of feeling ashamed about my weight and worrying about how I looked. In many ways, this anxiety stole a lot of freedom from my childhood and adolescence. Young children these days see and worry about not looking like the fitness models on their feed. I wonder what it would be like if we all grew up and lived, not having to fight all these pressures from within and without and just be able to feel comfortable in our own bodies,” mused Sahana.

(*Some names have been changed to protect privacy.)
Content warning: This article contains personal accounts of eating disorders that may be triggering for some. If the article upsets you in any manner, please seek family or professional support.