Continuing ED Treatment During UK Pandemic


The COVID-19 has presented many challenges for eating disorder treatment, however, adaptation to these challenges has led to inspiring innovations.

The COVID-19 pandemic has had widespread impact on eating disorder relapses, diagnoses, and treatment methodologies and availability.

As almost all frontline workers and resources were, understandably, directed toward the COVID-19 outbreak and treating those infected.

The concern, however, is that “voices of vulnerable populations, such as people scheduled for elective operations or those with mental health problems, could go unheard, potentially serving to ‘augment existing health inequalities [1].’”

Many are concerned that this has led to reduced treatment access or effectiveness for many dangerous mental illnesses including eating disorders.

Eating Disorders & COVID-19

In regard to eating disorders, COVID-19 brought about many daily stressors that can be a trigger for development, or perpetuation, of disordered eating beliefs or behaviors.

There were few areas of the world that did not implement a quarantine period wherein people were relegated to their homes and not allowed in public save for necessary trips required for daily living.

This removed a great deal of structure for many and structure is an important part of eating disorder recovery.

As one research article noted, “the absence of clear routines and markers of time and space, such as mealtimes or separations between home and work areas, may increase risk of ED behaviors by removing structures that were supporting eating plans and, in turn, leading to increased snacking and grazing [2].”

Bridge in UK

Increased time at home also meant increased time being around and handling food, particularly larger caches of food than one would typically have at home to avoid going to the store often. All of this can also be triggering.

Individuals also experienced increased weight and shape concerns due to attempting to limit time outside where they may possibly encounter others as well as social media messages glorifying using quarantine as an opportunity to “get in shape” and shaming those that may gain weight during this time.

Finally, the last year of coping with COVID-19 has been isolating for many and the inability to spend physical time with friends, coworkers, and even direct family has impacted mental wellness in many areas.

These are just a few of the many stressors that have contributed to increased eating disorder relapses and diagnoses.

Eating Disorder Treatment & COVID-19

Very few, if any, eating disorder treatment centers ceased providing treatment for those in need throughout the pandemic, however, many had to change how their programming worked to keep patients and staff safe.

The most common method of doing so was to change to virtual services.

For many treatment centers, medical stabilization (also known as inpatient) treatment and residential treatment continued to be in person with strict adjustments for both staff and patients such as no longer eating together, wearing masks and face shields, required COVID-19 testing prior to admission, and Patients staying in their rooms without congregating except for groups.

Once a patient was stepped down to a partial hospitalization program (PHP), many of the services were virtual.

Some patients reported feeling that this was helpful, as it was more accessible for them to attend the stringent hourly requirements of PHP virtually than to drive each day.

View in UK

Of course, the oversight and accountability piece of PHP is altered when services are virtual and, unfortunately, many patients report this created space for lapses into eating disorder behaviors.

Using video therapy, “The opportunity to omit or exchange items of the meal plan is made easier in virtual meal support than face-to-face and therefore this intervention relies on astute clinical observation from the staff member as well as honesty on behalf of the patient [1].”

Virtual programming also creates the challenge of patients fixing all of their own meals and snacks as well as weighing themselves, or having a loved one help to weigh them, once per week.

Group therapy also functions differently when it occurs virtually, with one study noting that “videoconferencing can hinder free-flowing dialogue and the nuances of group dynamics (such as body language, group member interactions, and therapeutic silence) can be more difficult to assess over video, which has necessitated particular attention and flexibility [1].”

The belief with many of these adaptations was, and continues to be, that they are not ideal but that they are a better option than ceasing treatment altogether.

The study mentioned above surveyed staff and participants in a PHP in south-east England and learned that, ultimately, “ staff and patients agree that the virtual programme is no substitute for face-to-face treatment, there are aspects to this way of working which may outlast this pandemic [1].”

Humans’ survival over centuries has hinged on our ability to adapt.

Adaptation in the time of the COVID-19 pandemic has allowed for continued support of others as well as inspiring innovation that will help further eating disorder treatment for years to come.


[1] Plumley, S., Kristensen, A, Jenkins, P.E. (2021). Continuation of an eating disorders day programme during the COVID-19 pandemic. Journal of Eating Disorders, 9:34.

[2] Rodgers, R. et al (2020). The impact of the COVID-19 pandemic on eating disorder risk and symptoms. International Journal of Eating Disorders.

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published May 5, 2021, on
Reviewed & Approved on May 5, 2021, by Jacquelyn Ekern MS, LPC