HEALTH MATTERS 2/25: Tips for Recognizing Changes in Eating Behaviors


Since the COVID-19 pandemic began, increased levels of stress, anxiety and depression have been widespread across the globe. For those at risk for or those with current eating disorders, the challenges and mental health fallout appear to be compounded.

To spread awareness and educate the community, Penn Medicine Princeton Center for Eating Disorders is participating in #NationalEatingDisordersAwarenessWeek. It is an annual campaign, initiated by the National Eating Disorders Association (NEDA) to educate the public about the realities of eating disorders and to provide hope, support and visibility to individuals and families affected by eating disorders.

This year, Princeton Center for Eating Disorders will focus on behaviors to watch out for in people struggling with a potential eating disorder or a relapse.

Princeton Center for Eating Disorders experienced an overall increase in admissions during the pandemic. Nutrition Therapist Kelly Davidson, RDN, reports that patients have cited higher levels of anxiety and depression and an increased use of eating disorder behaviors to manage these symptoms and fill time in isolation, which can result in a downward spiral.

According to Princeton Center for Eating Disorders Senior Therapist Alison Locklear, LCSW, 90 percent of the adult and adolescent patients she counseled between August 2020 and February 2021 cited the pandemic as a contributing factor to eating disorder symptoms. Half of her patients—all adults—had prior treatment and mentioned the pandemic as a factor in their relapse.

Rebecca G. Boswell, PhD, psychologist supervisor at the Princeton Center for Eating Disorders, who will be presenting at the June 2022 International Conference on Eating Disorders (ICED) on Exploring the Lived Experience of Severe and Enduring Anorexia Nervosa (SE-AN), advises being compassionate to those who are struggling with changes in eating behaviors or are relapsing.

“The pandemic has magnified social and interpersonal stressors that are known to contribute to eating disorders, and increased isolation may keep symptoms below the radar,” Boswell said. “As part of compassionate care, I recommend taking immediate action that could intervene in the development of an eating disorder or prevent a relapse to eating disorder symptoms before it spirals out of control.”

Below are behaviors to look out for in case there is concern about a change related to eating, exercise, and medical and psychological concerns.

  1. Changes in Eating Behaviors

• Dieting behavior (e.g., fasting, removing food groups, skipping meals).
• Changes in food preferences (e.g., disliking foods previously enjoyed, new reported allergies or intolerances, replacing meals with fluids).
• Rituals around eating (e.g., eating slowly, cutting food into small pieces).
• Secretive behavior around food (e.g., eating in private, hiding food).
• Frequent trips to the bathroom after meals.

2. Changes in Exercise

• Exercising more than recommended.
• Exercising even when sick or injured, in bad weather, or to compensate for eating.
• Experiencing distress if exercise is not possible.

3. New Medical Concerns

• Low energy
• Poor sleep
• Dizziness or fainting
• Diarrhea or constipation
• Dental problems
• Irregular or low heart rate

4. New Psychological Concerns

• Preoccupation with food, eating, body shape/weight
• Feeling “out of control” with food
• Difficulty concentrating
• Anxiety and irritability
• Social isolation

Nationally known, the Center for Eating Disorders Care at Penn Medicine Princeton Medical Center provides inpatient treatment for adults, adolescents, and children as young as eight years old who are suffering from anorexia, bulimia and other eating disorders. We provide the foundation for a full recovery by combining psychosocial treatment, nutritional support, family involvement and the latest advances in clinical care – together with an atmosphere of understanding, safety, respect, and support throughout the recovery process. Patients and families benefit from our ability to address eating disorders in those with additional medical complications, and to treat individuals who have extremely low body weight. Princeton Center for Eating Disorders welcomes patients of all genders. For more information, visit