A pandemic year of lockdowns, isolation, fear and grief has been a year like no other for everyone, and for many people it has changed their relationship with food — how, why and what they eat. The “Quarantine 15” has gotten a lot of attention, but overlooked and perhaps just as concerning is the re-emergence or slight increase in eating disorders, a new study finds.

About nine percent of Americans will develop an eating disorder in their lifetime. Eating disorders, which are often magnified by anxiety and isolation, are among the deadliest of mental illnesses, with over 10,000 people dying each year as a direct result of one.

Many young people reported that they had participated in extreme unhealthy behaviors for weight control — such as self-induced vomiting or the use of laxatives.

Looking for associations between eating behaviors during the pandemic and stress, psychological suffering and financial problems was the focus of the study carried out by the University of Minnesota Medical School and School of Public Health.

Young people who were already participants in the EAT 2010-2018 (Eating and Activity over Time) study were offered an opportunity to complete the C-EAT (COVID-19 EAT) online survey in April and May of 2020 so researchers could evaluate the impact of the pandemic on eating behaviors. Just over 700 people took the survey which asked questions related to psychological distress, stress and stress management, financial problems and food insecurity.

Six negative changes in eating behaviors were found among survey respondents: mindless eating and snacking; consuming more food than usual; lack of appetite or decrease in dietary intake; the use of food as a coping mechanism; decreased food intake due to pandemic-related situations; and an increase in eating disorder symptoms.

The most concerning finding was the increase in symptoms of eating disorders. About eight percent of the young people in the study reported that they had participated in extreme unhealthy behaviors for weight control such as self-induced vomiting or the use of laxatives. Over half of the participants had used less extreme weight control behaviors like skipping meals or smoking more. Binge eating was reported by 14 percent.

All of these behaviors were linked to a lack of stress management skills, an increase in depressive symptoms and moderate to extreme financial difficulties.

“There has been a lot of focus on obesity and its connection with COVID-19. It is also important to focus on the large number of people who have been engaging in disordered eating and are at risk for eating disorders during and following the pandemic,” said Dianne Neumark-Sztainer, principal researcher with the EAT project, in a statement. “The majority of the young adults in our study are from diverse ethnic/racial and lower income backgrounds, who often do not receive the services they need. To ensure health inequities do not increase, we need to meet the needs of these populations.”

Because the financial difficulties caused by the COVID-19 pandemic will likely linger for quite some time and may be associated with disordered eating behaviors, affordable eating disorder prevention interventions and treatments need to be accessible to people at high risk.

Mobile or online interventions that offer help with stress management, depressive symptoms and financial difficulties may be effective tools for young people at risk of developing eating disorders during the course of the pandemic.

The study is published in the International Journal of Eating Disorders.