Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Nov;29(6):826-841.
doi: 10.1002/erv.2861. Epub 2021 Aug 30.

Effects of COVID-19 lockdown on eating disorders and obesity: A systematic review and meta-analysis

Lucia Sideli  1 , Gianluca Lo Coco  2 , Rubinia Celeste Bonfanti  2 , Bianca Borsarini  3 , Lucia Fortunato  2 , Cristina Sechi  4 , Nadia Micali  3
Affiliations
Meta-Analysis

Effects of COVID-19 lockdown on eating disorders and obesity: A systematic review and meta-analysis

Lucia Sideli et al. Eur Eat Disord Rev. 2021 Nov.

Abstract

Objective: This systematic review and meta-analysis aimed to examine: the pooled prevalence of symptomatic behaviours and mental health deterioration amongst individuals with eating disorders (EDs) and obesity during the COVID-19 confinement. Moreover, we examined changes in EDs and distress before and during the confinement, and the association between psychosocial factors and EDs symptoms.

Method: A systematic search was carried out in biomedical databases from January 2020 to January 2021. Both cross-sectional and longitudinal studies that used quantitative measures of ED symptoms and psychological distress during and after the COVID-19 confinement were included.

Results: A total of 26 studies met inclusion criteria (n = 3399, 85.7% female). The pooled prevalence of symptomatic deterioration in EDs was 65% (95% CI[48,81], k = 10). The pooled prevalence of increased weight in obesity was 52% (95% CI[25,78], k = 4). More than half of the participants experienced depression and anxiety. Moreover, at least 75% of the individuals with EDs reported shape and eating concerns, and increased thinking about exercising. However, the pooled analyses of longitudinal studies showed no significant differences from pre-pandemic levels to the first lockdown phase in Body Mass Index and ED symptoms, whereas only few studies suggested increased distress, particularly among individuals with anorexia nervosa.

Conclusions: The majority of individuals with EDs and obesity reported symptomatic worsening during the lockdown. However, further longitudinal studies are needed to identify vulnerable groups, as well as the long-term consequences of COVID-19.

Keywords: COVID-19; distress; eating disorders; meta-analysis; obesity; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flowchart of study selection
FIGURE 2
FIGURE 2
Forest and Doi plot of symptom deterioration in eating disorders. 95% CI = 95% confidence interval; EDs = eating disorders; ES = effect size
FIGURE 3
FIGURE 3
Forest and Doi plot of symptom improvement in eating disorders. 95% CI = 95% confidence interval; EDs = eating disorders; ES = effect size
See this image and copyright information in PMC

References

    1. Abawi, O. , Welling, M. S. , van den Eynde, E. , van Rossum, E. F. C. , Halberstadt, J. , van den Akker, E. L. T. , & van der Voorn, B. (2020). COVID‐19 related anxiety in children and adolescents with severe obesity: A mixed‐methods study. Clinical Obesity, 10(6), e12412. 10.1111/cob.12412 - DOI - PMC - PubMed
    1. Albano, G. , Cardi, V. , Kivlighan, D. M. , Ambwani, S. , TreasureLo Coco, J. G. , & Lo Coco, G. (2021). The relationship between working alliance with peer mentors and eating psychopathology in a digital 6‐week guided self‐help intervention for anorexia nervosa. International Journal of Eating Disorders, 54, 1–1526. 10.1002/eat.23559 - DOI - PMC - PubMed
    1. Almandoz, J. P. , Xie, L. Y. , Schellinger, J. N. , Mathew, M. S. , Gazda, C. , Ofori, A. , Kukreja, S. , & Messiah, S. E. (2020). Impact of COVID‐19 stay‐at‐home orders on weight‐related behaviours among patients with obesity. Clinical Obesity, 10(5), e12386. 10.1111/cob.12386 - DOI - PMC - PubMed
    1. Athanasiadis, D. I. , Hernandez, E. , Hilgendorf, W. , Roper, A. , Embry, M. , Don Selzer, M. D. , & Stefanidis, D. (2020). How are bariatric patients coping during the coronavirus disease 2019 (COVID‐19) pandemic? Analysis of factors known to cause weight regain among postoperative bariatric patients. Surgery for Obesity and Related Diseases, 17, 756–764. 10.1016/j.soard.2020.11.021 - DOI - PMC - PubMed
    1. Baenas, I. , Caravaca‐Sanz, E. , Granero, R. , Sánchéz, I. , Riesco, N. , Testa, G. , Fernández‐Aranda, F. , Treasure, J. , Jiménez‐Murcia, S. , & Fernández‐Aranda, F. (2020). COVID‐19 and eating disorders during confinement: Analysis of factors associated with resilience and aggravation of symptoms. European Eating Disorders Review, 28, 855–863. 10.1002/erv.2771 - DOI - PMC - PubMed

FURTHER READING

    1. Arroll, B. , Goodyear‐Smith, F. , Crengle, S. , Gunn, J. , Kerse, N. , Fishman, T. , Falloon, K. , & Hatcher, S. (2010). Validation of PHQ‐2 and PHQ‐9 to screen for major depression in the primary care population. Annals of Family Medicine, 8, 348–53. 10.1370/afm.1139 - DOI - PMC - PubMed
    1. Bernstein, D. P. , Stein, J. A. , Newcomb, M. D. , Walker, E. , Pogge, D. , Ahluvalia, T. , Stokes, J. , Handelsman, L. , Medrano, M. , Desmond, D. , & Zule, W. (2003). Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect, 27, 169–190. 10.1016/S0145-2134(02)00541-0 - DOI - PubMed
    1. Blomquist, K. K. , Roberto, C. A. , Barnes, R. D. , White, M. A. , Masheb, R. M. , & Grilo, C. M. (2014). Development and validation of the eating loss of controlscale. Psychological Assessment, 26, 77–89. 10.1037/a0034729 - DOI - PMC - PubMed
    1. Bohn, K. , & Fairburn, C. G. (2008). The Clinical Impairment Assessment Questionnaire (CIA 3.0). In C. G. Fairburn (Ed.), Cognitive behavioral therapy for eating disorders. New York, NY: Guilford Press. p. 315–8.
    1. Calugi, S. , Sartirana, M. , Milanese, C. , El Ghoch, M. , Riolfi, F. , & Dalle Grave, R. (2018). The clinical impairment assessment questionnaire: Validation in Italian patients with eating disorders. Eating and Weight Disorders, 23(5), 685–694. 10.1007/s40519-018-0477-2 - DOI - PubMed