Q. A patient recently complained about all the comments she sees on social media that might be viewed as “weight shaming.” That is, she began noticing all the attention given to the possibility of weight gain and a shaming of those who might experience weight increases during self-quarantining during the current pandemic. Are there any ways to help patients arm themselves against these comments—that is, beyond merely advising them to turn off their phones or computers? ( F., Des Moines, IA)
A. Those with eating disorders are certainly under duress in this pandemic. As one example, the COLLATE project in Australia was designed to identify changes in eating and exercise behavior in a sample of Australian individuals with eating disorders during the COVID-19 outbreak (Int J Eat Disord. 2020;8:1). This study included 5469 participants, 180 of whom self-reported a history of an ED. Among the ED population, increased restricting, binge-eating, purging, and exercise behaviors were reported (less exercise was reported during the pandemic). Self-reported binge-eating and purging behaviors increased by 35.5% and 18.9%, respectively; 64.5% of respondents reported increased restricting. The authors suggest that even in the early stages of the pandemic, such as 3 weeks after the announcement of the viral outbreak by the World Health Organization, people with EDs were already reporting changes in their eating and exercise patterns. This may have been due to the availability of specific foods, or increased stress, anxiety, and depression because of mandated social distancing.
Several groups have recently addressed social media aspects of this very problem. Turning off a computer or smartphone may not seem viable for most young adults (and for many, due to work or other obligations, may be impossible), educating them about this unfortunate trend toward stigma and shaming might be more helpful. The Australian government is actually working on a plan to increase help-seeking among the estimated 16% of the Australian population who have a DSM eating disorder (Sydney Morning Herald. 2018; 209:5014). The Australians are recommending that a Mandatory Code of Conduct be developed that would guide media toward more neutral medical programming, which could depict real people from varied backgrounds with real experiences of having an eating disorder (J Eat Disord. 2020; 8:11). This may then help educate writers and media producers about how some types of media coverage can perpetuate shame and stigma among program viewers.
Meanwhile, what can patients do to counteract the flow of shaming and stigmatizing information? An article by Dr. Rebecca L. Pearl from the University of Pennsylvania addresses the “quarantine-15” social media posts that have popped up lately. Dr. Pearl and co-workers identified more than 15,000 Instagram and Twitter posts that may be contributing to shaming. Many of these posts showed blatant weight-shaming before and after quarantine, using memes that show people in the “after” screen with extra weight, ill-fitting, unflattering clothing, and eating excessive amounts of food. These images portray common stereotypes claiming that people with obesity are lazy slobs with a lack of self-control. They also imply that having a higher body weight is an intolerable problem, one to be avoided at all costs.
Dr. Pearl’s group suggests several steps to try to counteract the potential harm of these online posts. First, they suggest “flooding the zone” with more positive health messages that encourage good self-care and self-compassion. In addition, clinicians can talk with patients about the bad effects of such stigmatizing messages and can continue to support patients in their health goals. When patients do report weight gain, clinicians can “communicate acceptance, without judgment, and validate the stressors that we are all facing at this time, while simultaneously helping patients continue to do their best to maintain their health and well-being,” according to Dr. Pearl.