Eating Disorders Spectrum During the COVID Pandemic: A Systematic Review

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of the 29,108 subjects, 6,216 were men, 22,703 were women, and 189 were gender fluid or not declared.

“In selected studies, a total number of 29,108 subjects were enrolled (range: 10–11,391; mean/SD: 1,386 ± 2,800), 6,216 were men (21.4%), 22,703 were women (77.9%), and 189 (0.7%) were gender fluid or not declared.”

• Also stated in: § Results · plain

  “In the 21 selected studies, a total number of 29,108 subjects were enrolled (range: 10–11,391; mean/SD: 1,386 ± 2,800), 6,216 were men (21.4%), 22,703 were women (77.9%), and 189 (0.7%) were gender fluid or not declared.”

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The mean age of subjects was 30.2 ± 7.7 years.

“The mean age/SD of subjects was 30.2 ± 7.7.”

• Also stated in: § Results · plain

  “The mean age/SD of subjects was 30.2 ± 7.7.”

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Of the 21 included studies, 12 (57.1%) were online surveys, 4 (19.0%) were retrospective studies, 2 (9.5%) were qualitative studies, 2 (9.5%) were longitudinal cohort studies, and 1 (4.8%) was a social media survey.

“About 12 studies (57.1%) were online surveys, 4 (19.0%) were retrospective studies, 2 (9.5%) were qualitative studies, 2 (9.5%) were longitudinal cohort studies, and 1 was a social media survey (4.8%).”

• Also stated in: § Results · plain

  “About 12 studies (57.1%) were online surveys; 4 (19.0%) were retrospective studies; 2 (9.5%) were qualitative studies; 2 (9.5%) were longitudinal cohort studies, and 1 was a social media survey (4.8%) (Figure 1).”

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Of 172 papers, 21 (12.2%) were eligible and included in the review.

“A systematic search allowed the initial selection of 172 papers; 21 (12.2%) papers were eligible and included in the review.”

• Also stated in: § Results · plain

  “After analyzing their titles and abstracts according to the eligibility criteria, 21 of 172 (12.2%) papers were included in the review, whereas 151 of 172 papers (87.8%) were excluded for the following reasons: 119 papers (69.1%) were not pertinent to the topic; 19 papers (11.0%) were excluded as these were editorials, letters to the editor, case reports, or methodological papers; 8 papers (4.6%)”

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The systematic search initially selected 172 papers.

“A systematic search allowed the initial selection of 172 papers; 21 (12.2%) papers were eligible and included in the review.”

• Also stated in: § Information Source and Strategy · plain

  “leading to a total of 172 papers.”

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No randomized controlled trials or long-term follow-up studies derived from RCTs were found.

“We found no randomized controlled trials (RCTs) or long-term follow-up studies derived from RCTs, therefore, the assessment of the risk of bias of individual studies was not performed.”

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In Al-Musharaf (2020) sample, 42% reported depressive symptoms, 27.0% high anxiety, and 12.5% severe stress.

“Moreover, 42% of the interviewed subjects reported depressive symptoms, together with high levels of anxiety (27.0%), and severe stress (12.5%).”

• cites Al-Musharaf (2020) sourceNot checked yet

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Of 172 papers, 151 (87.8%) were excluded from the review.

“After analyzing their titles and abstracts according to the eligibility criteria, 21 of 172 (12.2%) papers were included in the review, whereas 151 of 172 papers (87.8%) were excluded for the following reasons: 119 papers (69.1%) were not pertinent to the topic; 19 papers (11.0%) were excluded as these were editorials, letters to the editor, case reports, or methodological papers; 8 papers (4.6%)”

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In Ammar et al. (2020) survey of 1,047 participants from Asia, Africa, and Europe, participants increased consumption of unhealthy food, frequency of main meals, and snacking between meals, with a subjective sense of eating out of control.

“Participants increased the consumption of unhealthy food, and the frequency of main meals, together with snacking between meals, with a subjective sense of “eating out of control.””

• cites Ammar et al. (2020) sourceNot checked yet

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The majority of the included studies collected data through online platforms.

“The majority of the studies collected data through online platforms (an online survey).”

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Restriction in healthcare facilities contributed to increased anxiety levels and to modified treatment compliance.

“(3) restriction in healthcare facilities contributed to increase anxiety levels and to modify treatment compliance;”

• AssumptionRests on an assumption: The findings of the included non-randomized studies are reliable enough to support the review's conclusions despite the absence of a risk-of-bias assessment.

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In Ammar et al. (2020), time spent for physical activity decreased under confinement (days/week 24%; min/day 33.5%), while sedentary behavior increased from 5 to 8 h/day.

“The time spent for physical activity decreased under the confinement condition (days/week, 24%; min/day, 33.5%), whereas sedentary behavior (such as the daily sitting time) significantly increased (from 5 to 8 h/day).”

• cites Ammar et al. (2020) sourceNot checked yet

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In Al-Musharaf (2020) sample, highly perceived stress, BMI, fat intake, number of meals per day, sugary food consumption, and frequent fast food intake were positively correlated with emotional eating scores.

“Highly perceived stress, body mass index (BMI), fat intake, the number of meals per day, sugary food consumption, and frequent fast food intake are positively correlated with the EE scores.”

• cites Al-Musharaf (2020) sourceNot checked yet

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In Haddad et al. (2020), physical exercise during confinement, female gender, BMI, and high anxiety levels were positively associated with higher severity of EDs, both in diet clinic clients and in the general population.

“Physical exercise during confinement, female gender, BMI, and high anxiety levels were positively associated with higher severity of EDs, both in the clients of a dietician and in the general population.”

• cites Haddad et al. (2020) sourceNot checked yet

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In Rolland et al. (2020), use/abuse of caloric foods was underrepresented compared with screen use/abuse (64.6%), tobacco (35.6%), and cannabis use (31.2%), and more represented than alcohol use (24.8%).

“However, the use/abuse of caloric foods was underrepresented if compared with screen use/abuse (64.6%), or tobacco (35.6%) and cannabis use (31.2%), and more represented than alcohol use (24.8%).”

• cites Rolland et al. (2020) sourceNot checked yet

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In Baenas et al. (2020) sample of 74 patients with EDs, a significant proportion experienced worsening of ED symptoms, but this finding was only in 19 patients (25.7%).

“Thus, the authors concluded that a significant proportion of patients experienced the worsening of ED symptoms, even if this finding was only in 19 patients (25.7%).”

• cites Baenas et al. (2020) sourceNot checked yet

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In Scharmer et al. (2020) sample of 295 undergraduate women, state anxiety and state intolerance of uncertainty were positively related to EDs but not with compulsive exercise.

“The results showed that both the state anxiety and the state of intolerance of uncertainty were positively related to EDs but not with compulsive exercise.”

• cites Scharmer et al. (2020) sourceNot checked yet

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In Barrea et al. (2020), smart working negatively influenced sleep quality in all participants, with a greater worsening effect in men.

“Smart working negatively influenced sleep quality in all participants, with a greater worsening effect in men.”

• cites Barrea et al. (2020) sourceNot checked yet

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In Phillipou et al. (2020) non-ED sample, 34.8% showed an increase in physical exercise routine, 43.4% reported a decrease, and the remaining reported no changes.

“One-third of the sample (34.8%) showed an increase in the physical exercise routine, whereas 43.4% reported a decrease and the remaining reported no changes.”

• cites Phillipou et al. (2020) sourceNot checked yet

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In Puhl et al. (2020) C-EAT survey, the majority of the overall sample reported that COVID-19 negatively affected mood and anxiety levels, raised stress, and exacerbated problems with food intake.

“In agreement with the original assumption, majority of the overall sample reported that COVID-19 negatively affected mood and anxiety levels, raising stress, and exacerbating problems with food intake.”

• cites Puhl et al. (2020) sourceNot checked yet

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In Puhl et al. (2020), pre-pandemic experiences of weight stigma predicted higher levels of stress, depressive symptoms, eating to cope with stress, and increased likelihood of binge eating during the COVID-19 pandemic.

“The comparison between the two samples (stigma perceived before COVID vs. stigma perceived during COVID) revealed that pre-pandemic experiences of weight stigma predicted higher levels of stress, depressive symptoms, eating to cope with stress, and an increased likelihood of binge eating, during the COVID-19 pandemic.”

• cites Puhl et al. (2020) sourceNot checked yet

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In Rolland et al. (2020), female gender aged <29 years, being locked down in a more confined space, being locked down alone, and current or past psychiatric treatment were factors of increased caloric/salty food intake.

“Not surprisingly, female gender who were aged <29 years were locked down in a more confined space, were locked down alone, and reported to have current or past psychiatric treatment all were the factors of increased caloric/salty food intake.”

• cites Rolland et al. (2020) sourceNot checked yet

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In Phillipou et al. (2020) Australian sample, subjects with a positive history of EDs (n = 180) noted a significant change in eating and exercise behaviors, with an increase in restricting behaviors (67.1%), binge eating (20.5%), or purging (18.2%).

“Indeed, these subjects noted a significant change in their eating and exercise behaviors, with an increase in restricting behaviors (67.1%), in binge eating (20.5%), or in purging (18.2%).”

• cites Phillipou et al. (2020) sourceNot checked yet

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In Elmacıoğlu et al. (2021) sample of 1,036 volunteers, there was an increase in emotional eating and uncontrolled eating behaviors as assessed with TFEQ-R18, and a change in BMI in approximately 35% of the sample.

“They found an increase in EE and uncontrolled eating behaviors as assessed with the “revised three factor nutrition questionnaire” (TFEQ-R18) (Karlsson et al., 2000), and found a change in BMI in approximately 35% of the sample.”

• cites Elmacıoğlu et al. (2021) sourceNot checked yet

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In Castellini et al. (2020), comparing baseline to T1, patients with EDs reported an improvement of general psychopathology and ED-specific symptoms, objective binge eating, and compensatory physical exercise.

“While comparing baseline to T1, patients with EDs reported an improvement of general psychopathology and ED-specific symptoms, objective binge eating and compensatory physical exercise.”

• cites Castellini et al. (2020) sourceNot checked yet

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In Branley-Bell and Talbot (2020), participants with EDs in remission exhibited higher mental well-being, lower perceived stress, higher social support, and perceived control compared to participants with current ED.

“As expected, participants with EDs in remission exhibited higher mental well-being, lower perceived stress, higher social support, and perceived control when compared to participants with current ED.”

• cites Branley-Bell and Talbot (2020)Not checked yet

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In Fernández-Aranda et al. (2020), patients with OSFED reported the highest impairment in psychopathology although changes between pre- and post-confinement did not reach statistical significance.

“Patients with OSFED deserved special attention: although the changes between pre- and post-confinement did not reach the statistical significance, they reported the highest impairment in psychopathology.”

• cites Fernández-Aranda et al. (2020) sourceNot checked yet

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In Castellini et al. (2020), patients with AN reported an improvement in BMI and specific ED psychopathology, whereas patients with BN exhibited an increase of objective binge eating.

“Some specific differences between diagnostic subgroups emerged: patients with AN reported an improvement in BMI and specific ED psychopathology, whereas patients with BN exhibited an increase of objective binge eating.”

• cites Castellini et al. (2020) sourceNot checked yet

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In Castellini et al. (2020), BMI increased significantly in patients with AN while remaining stable in patients with BN.

“Moreover, BMI increased significantly in patients with AN while remaining stable in patients with BN.”

• cites Castellini et al. (2020) sourceNot checked yet

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In Castellini et al. (2020), the main factor of increase in pathological physical exercise was household arguments, while fear of safety for loved ones predicted a higher increase in binge eating episodes.

“Interestingly, the main factor of increase in pathological physical exercise was household arguments, while the fear of safety for the loved ones predicted a higher increase in binge eating episodes.”

• cites Castellini et al. (2020) sourceNot checked yet

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In Fernández-Aranda et al. (2020) sample of 87 patients with EDs and 34 with obesity, disordered eating improved in almost all participants during confinement.

“In contrast with previous studies, the disordered eating improved in almost all participants during confinement.”

• cites Fernández-Aranda et al. (2020) sourceNot checked yet

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In Fernández-Aranda et al. (2020), patients with obesity showed a significant decrease in BMI and in eating symptomatology.

“patients with obesity showed a significant decrease in BMI and in eating symptomatology;”

• cites Fernández-Aranda et al. (2020) sourceNot checked yet

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In Fernández-Aranda et al. (2020), patients with AN reported a decrease in ED symptoms and in emotion dysregulation.

“Surprisingly, patients with AN reported a decrease in ED symptoms and in emotion dysregulation;”

• cites Fernández-Aranda et al. (2020) sourceNot checked yet

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In Schlegl et al. (2020a), worsening of symptoms was related to the interruption of face-to-face therapies in more than half of patients, with only 20% opting for alternative treatment modalities such as videoconference-based therapies.

“The worsening of symptoms was also related to the interruption of face-to-face therapies in more than half of patients, with only 20% opting for alternative treatment modalities such as videoconference-based therapies.”

• cites Schlegl et al. (2020a)Not checked yet

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In Schlegl et al. (2020a), binge eating increased as well as self-induced vomiting, laxative use, and diuretic abuse.

“Binge eating increased as well as self-induced vomiting, laxative use, and diuretic abuse.”

• cites Schlegl et al. (2020a)Not checked yet

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In Termorshuizen et al. (2020) two-site online study, patients with AN described mainly fears about the availability of foods chosen for their special meals and reported an exacerbation of food restriction.

“Patients with AN described mainly fears about the availability of foods chosen for their “special” meals. Moreover, they reported an exacerbation of food restriction.”

• cites Termorshuizen et al. (2020) sourceNot checked yet

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In Richardson et al. (2020), the most relevant issues in 2020 were difficulties in accessing treatments because of the pandemic and an urgent need for support due to worsening symptoms.

“The most relevant issues in 2020 were related to the difficulties in accessing treatments because of the pandemic, and to an urgent need for support, due to the worsening of symptoms.”

• cites Richardson et al. (2020) sourceNot checked yet

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In Termorshuizen et al. (2020), positive effects of the pandemic were described on both the interpersonal side (greater connection with relatives) and the motivational side.

“Positive effects of the pandemic were described also in this survey on both the interpersonal (greater connection with relatives) and the motivational side.”

• cites Termorshuizen et al. (2020) sourceNot checked yet

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In Richardson et al. (2020), subjective feelings of losing control over eating symptoms and behaviors and significant changes in food intake were described.

“Subjective feelings of losing control over eating symptoms and behaviors and with significant changes in food intake were also described.”

• cites Richardson et al. (2020) sourceNot checked yet

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In Schlegl et al. (2020b), videoconference therapy was used by 26% and telephone contacts by 35% of patients.

“Moreover, videoconference therapy was used by 26% and telephone contacts was used by 35% of patients.”

• cites Schlegl et al. (2020b)Not checked yet

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As a consequence of intense media reports on COVID-19, levels of anxiety increased, with an exacerbation of fear of contamination and washing compulsions.

“As a consequence of the intense media reports on COVID-19 (the so-called “infodemic”), the levels of anxiety increased, with an exacerbation of the fear of contamination and washing compulsions (Clark Bryan et al., 2020).”

• cites Clark Bryan et al., 2020 sourceNot checked yet

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Lockdown measures might have a positive effect and lead to recovery in some individuals with eating disorders, depending on their working and living situation and eating disorder progression.

“Brown et al. (2020) pointed out that lockdown measures might also have a positive effect and lead to recovery, depending on the working and living situation of participants (alone vs. with a family or a partner or friends), and ED progression.”

• cites Brown et al., 2020 sourceNot checked yet

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The introduction of lockdown measures and social isolation was associated with negative mental health outcomes, sense of loneliness, tendency to become more focused on food, rumination over food intake, disordered eating behaviors such as restrictions or binge eating, and compulsive physical exercise.

“The introduction of lockdown measures and social isolation was associated with negative mental health outcomes, sense of loneliness, the tendency to become more focused on food, rumination over food intake, disordered eating behaviors, such as restrictions or binge eating, and compulsive physical exercise (Branley-Bell and Talbot, 2020; Brown et al., 2020; Clark Bryan et al., 2020).”

• cites Branley-Bell and Talbot, 2020Not checked yet

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• cites Brown et al., 2020 sourceNot checked yet

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• cites Clark Bryan et al., 2020 sourceNot checked yet

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Continuation of treatments through online delivery was described as a positive factor but was not seen as a valuable alternative, only as the only possibility.

“Although the continuation of treatments through online delivery was described as a positive factor, this was not seen as a “valuable alternative” but just as the “only possibility” (Branley-Bell and Talbot, 2020).”

• cites Branley-Bell and Talbot, 2020Not checked yet

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Patients with eating disorders complained about discrepancies in service provision, premature discharge, and suspension of treatments that increased anxiety and feelings of being abandoned.

“These studies highlighted the role of the accessibility to professional support as a crucial determinant of mental well-being: patients complained about discrepancies in service provision, premature discharge, and suspension of treatments that increased anxiety, and feelings of being abandoned (Branley-Bell and Talbot, 2020; Brown et al., 2020; Clark Bryan et al., 2020).”

• cites Branley-Bell and Talbot, 2020Not checked yet

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• cites Brown et al., 2020 sourceNot checked yet

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• cites Clark Bryan et al., 2020 sourceNot checked yet

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Uncertainty and anxiety due to the pandemic contributed to an increase in subjective discomfort and raised the risk of compulsory eating as a strategy to cope with stress.

“We found that uncertainty and anxiety due to pandemic contributed to an increase in subjective discomfort and raised the risk of compulsory eating as a strategy to cope with stress (Flaudias et al., 2020; Puhl et al., 2020).”

• cites Flaudias et al., 2020 sourceNot checked yet

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• cites Puhl et al., 2020 sourceNot checked yet

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Disruption in physical activities and routines was relevant in general population samples and in clinical samples from endocrinology units.

“Disruption in physical activities and routines was relevant also in general population samples or in clinical samples from endocrinology units (Ammar et al., 2020; Barrea et al., 2020; Haddad et al., 2020; Scharmer et al., 2020).”

• cites Ammar et al., 2020 sourceNot checked yet

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• cites Barrea et al., 2020 sourceNot checked yet

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• cites Haddad et al., 2020 sourceNot checked yet

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The Puhl et al. (2020) study was on secondary school students enrolled in a 10-year longitudinal cohort study, with a mean age of 24 years in pandemic.

“The study by Puhl et al. (2020) was on secondary school students, enrolled in a 10-year longitudinal cohort study, with a mean age of 24 years in pandemic (Puhl et al., 2020).”

• cites Puhl et al., 2020 sourceNot checked yet

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The type of home confinement modified both subjective well-being and addiction-related habits, including caloric/salty food.

“The type of home confinement (with family members, in small places, alone, or with a partner, etc.) modified both subjective well-being and addiction-related habits, including caloric/salty food (Rolland et al., 2020).”

• cites Rolland et al., 2020 sourceNot checked yet

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The systematic review was conducted according to the PRISMA guidelines.

“Literature search, study selection, methods, and quality evaluation were performed according to the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines.”

• Also stated in: § Materials and Methods · plain

  “We adhered to the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines in the completion of a systematic review (Moher et al., 2009).”

• cites Moher et al., 2009 sourceNot checked yet

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Patients with AN and BN may foster skipping meals and restricting calories or, conversely, may increase binge eating due to the availability of food at home brought about by food insecurity and hoarding.

“Patients with AN and BN may foster skipping meals and restricting calories or, conversely, may increase binge eating due to the availability of food at home brought about by food insecurity and hoarding (Touyz et al., 2020; Weissman et al., 2020).”

• cites Touyz et al., 2020 sourceNot checked yet

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• cites Weissman et al., 2020 sourceNot checked yet

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Two authors independently screened the resulting articles for methodology and appropriateness for inclusion, and consensus discussion was used to resolve disagreements.

“Two authors (MM and FM) independently screened the resulting articles for their methodology and appropriateness for inclusion. A consensus discussion was used to resolve the disagreements of reviewers.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The literature search was designed and performed independently in duplicate by two authors.

“A search of literature studies was designed and performed independently in duplicate by two authors (MM and FM).”

May combine two claims.

The assessment of risk of bias of individual studies was not performed because no RCTs or long-term follow-up studies derived from RCTs were found.

“We found no randomized controlled trials (RCTs) or long-term follow-up studies derived from RCTs, therefore, the assessment of the risk of bias of individual studies was not performed.”

• Also stated in: § Risk of Bias in Individual Studies · plain

  “As already anticipated in Section Eligibility Criteria, the risk of bias of individual studies was not performed considering that no RCTs or systematic follow-up studies derived from RCTs were found.”

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A series of factors may have a detrimental impact on psychological well-being, eating habits, and the onset or recovery of EDs, including disruption to living situations, social distancing restrictions, difficult access to healthcare, and societal changes to food behaviors and technology usage.

“A series of factors may have a detrimental impact on psychological well-being, eating habits, and the onset or recovery of EDs, including: disruption to living situations, social distancing restrictions, difficult access to healthcare, and societal changes to food behaviors and technology usage (Ammar et al., 2020).”

• cites Ammar et al., 2020 sourceNot checked yet

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Probably not a substantial claim: may not pass S4 (based).

A vulnerable population such as ED patients is at high risk of acute and long-term consequences from the COVID-19 pandemic.

“A vulnerable population of subjects, such as EDs patients, is at high risk of acute and long-term consequences from COVID-19 pandemic.”

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Psychosocial stressors stemming from the COVID-19 pandemic and the resulting stay-at-home confinement may exacerbate ED-related triggers and represent a challenging environment for individuals with AN, BN, and BED.

“Psychosocial stressors stemming from the COVID-19 pandemic and the resulting stay-at-home confinement may exacerbate ED-related triggers and represent a challenging environment for individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) (Hensley., 2020; McMenemy., 2020).”

• cites Hensley., 2020Not checked yet

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• cites McMenemy., 2020Not checked yet

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Two independent authors assessed the language suitability and subject matter of each paper and extracted the data.

“Two independent authors (MM and FM) assessed the language suitability and subject matter of each paper and extracted the data reported in Table 2.”

Classified as probably not a substantial claim.

Al-Musharaf (2020) authors concluded that emotional eating was an attempt to manage negative emotions during the stressful circumstances of the COVID-19 pandemic.

“The authors concluded that EE made an attempt to manage negative emotions during the stressful circumstances of the COVID-19 pandemic.”

• cites Al-Musharaf (2020) sourceNot checked yet

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Changes in everyday activities and lifestyle due to the COVID-19 pandemic and related quarantine measures strongly affected the mental health of the general population and of special populations.

“Changes in everyday activitiesand in lifestyle due to severe acute respiratory syndrome CoV2 (SARS-COV2) [coronavirus disease 2019 (COVID-19)] pandemic and related quarantine measures strongly affected the mental health of the general population (Marazziti et al., 2020; Poli et al., 2020), and of special populations (Conversano et al., 2020; Orrù et al., 2021).”

• cites Marazziti et al., 2020 sourceNot checked yet

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• cites Poli et al., 2020 sourceNot checked yet

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• cites Conversano et al., 2020 sourceNot checked yet

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The psychometric properties of the CIES were analyzed, and a factor analysis confirmed the rational structure of the CIES.

“The psychometric properties of the CIES were analyzed, and a factor analysis confirmed the rational structure of the CIES.”

May combine two claims.

The disruption and distress associated with lockdown led to the exacerbation of ED symptoms and to engagement in disordered eating behaviors.

“This led to the exacerbation of ED symptoms and to the engagement in disordered eating behaviors (Branley-Bell and Talbot, 2020).”

• cites Branley-Bell and Talbot, 2020Not checked yet

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• AssumptionRests on an assumption: The observed changes in eating behaviors and symptoms during the COVID-19 period are attributable to the pandemic and lockdown measures rather than to other concurrent factors.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Eating disorder stereotyped behaviors play a role in controlling anxiety levels and in managing negative emotions.

“It is well-known that ED-stereotyped behaviors play a role in controlling anxiety levels and in managing negative emotions (Kesby et al., 2017).”

• cites Kesby et al., 2017 sourceNot checked yet

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Unstable or disrupted daily routines might lead to circadian rhythm instability and, in vulnerable individuals, to mood instability, sleep disorders, and dietary disruptions.

“As postulated in the “social zeitgeber” hypothesis, unstable, or disrupted daily routines might lead to circadian rhythm instability and, in vulnerable individuals, to mood instability, sleep disorders, and dietary disruptions (Frank et al., 2005, 2008).”

• cites Frank et al., 2005, 2008Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

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The Baenas et al. study was focused on a small sample (n = 74) using 32 different domain/dimensions belonging to four different scales.

“However, this study was focused on the evaluation of a small sample (n = 74) using 32 different domain/dimensions, which belongs to four different scales.”

• cites Baenas et al., 2020 sourceNot checked yet

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Classified as probably not a substantial claim.

Psychosocial factors interact with chronobiological mechanisms to create and/or facilitate a pathway toward psychopathology.

“According to this model, psychosocial factors would interact with chronobiological mechanisms to create and/or facilitate a pathway toward psychopathology.”

• cites Frank et al., 2005, 2008Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

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Telemedicine check-ups have been proposed as an alternative approach, but monitoring weight changes or vital signs was limited in long-distance follow-up.

“Telemedicine check-ups have been proposed as an alternative approach, but monitoring weight changes or vital signs was limited in a long-distance follow-up.”

• AssumptionRests on an assumption: Patients with eating disorders might have unstable physical conditions requiring frequent medical monitoring and laboratory tests.

Probably not a substantial claim: may not pass S3 (load-bearing).

Patients with eating disorders might show higher levels of intolerance for uncertainty compared to the general population.

“Several studies before pandemic highlighted how patients with EDs might show higher levels of intolerance for uncertainty compared to the general population (Brown et al., 2017).”

• cites Brown et al., 2017 sourceNot checked yet

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May combine two claims.

Fernández-Aranda et al. (2020) studied a sample of patients with eating disorders and subjects with obesity, with limitations including retrospective design, wide age range (13 to 77 years), and gender distribution (104 women vs. 17 men).

“Fernández-Aranda et al. (2020) studied on a sample of patients with EDs and subjects with obesity, with several limitations, such as the retrospective design, the wide age range (from 13 to 77 years), and the gender distribution (104 women vs. 17 men).”

• cites Fernández-Aranda et al., 2020 sourceNot checked yet

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McCombie et al. (2020) was conducted on a very small sample (n = 32) recruited with posts on Twitter.

“A third study (McCombie et al., 2020) found non-univocal results, but was conducted on a very small sample (n = 32) recruited with posts on Twitter.”

• cites McCombie et al., 2020 sourceNot checked yet

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Participants were mostly recruited online via social media, resulting in samples biased toward those familiar with technology.

“Participants were mostly recruited online, via social media, resulting in samples being biased toward those who were familiar with the use of technology.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Before the pandemic, 50-60% of adolescents reported disturbed eating behaviors such as fasting, taking diet pills or laxatives, vomiting, and binge eating.

“Before pandemic, ~85% of adolescents were unhappy with their body (Ricciardelli and McCabe, 2001), and 50–60% reported “disturbed eating behaviors” (e.g., fasting, taking diet pills or laxatives, vomiting, and binge eating) (Croll et al., 2002; Quick and Byrd-Bredbenner, 2013).”

• cites Croll et al., 2002 sourceNot checked yet

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• cites Quick and Byrd-Bredbenner, 2013Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Before the pandemic, approximately 85% of adolescents were unhappy with their body.

“Before pandemic, ~85% of adolescents were unhappy with their body (Ricciardelli and McCabe, 2001), and 50–60% reported “disturbed eating behaviors” (e.g., fasting, taking diet pills or laxatives, vomiting, and binge eating) (Croll et al., 2002; Quick and Byrd-Bredbenner, 2013).”

• cites Ricciardelli and McCabe, 2001Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Brown et al. (2020) studied only 15 subjects who consented to take part in a Skype interview.

“Brown et al. (2020) studied only on 15 subjects who consented to take part in a Skype interview.”

• cites Brown et al., 2020 sourceNot checked yet

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In some studies, eating disorder diagnoses were self-reported and specific information on disorders was not collected.

“Moreover, in some studies, the ED diagnoses were self-reported, and the specific information on disorders was not collected.”

May combine two claims.

Across studies, the main weaknesses were limited assessment of pre-lockdown eating disorder symptoms and absence of comparison groups.

“Across studies, the main weaknesses were due to the limited assessment of pre-lockdown ED symptoms and to the absence of comparison groups.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Maladaptive eating behaviors in adolescents were associated with depressive symptoms and low self-esteem before the pandemic.

“Maladaptive eating behaviors in adolescents were associated with depressive symptoms and low self-esteem, before the pandemic (Stice and Whitenton, 2002; Neumark-Sztainer et al., 2006).”

• cites Stice and Whitenton, 2002Not checked yet

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• cites Neumark-Sztainer et al., 2006 sourceNot checked yet

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Fifty different outcome measures or psychological questionnaires were used, raising questions on how to compare findings from such a number of scales.

“Finally, 50 different outcome measures or psychological questionnaires were used, raising questions on how to compare findings from such a number of scales.”

May combine two claims.

Only two longitudinal cohort studies compared pre- vs. post-pandemic behaviors or tried to find predictors of negative outcomes during pandemic.

“There are only two longitudinal cohort studies (Castellini et al., 2020; Puhl et al., 2020) that compared pre- vs. post-pandemic behaviors or tried to find predictors of negative outcomes during pandemic.”

• cites Castellini et al., 2020 sourceNot checked yet

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• cites Puhl et al., 2020 sourceNot checked yet

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The studies varied in study design and population sample, and no structured intervention was proposed.

“As summarized previously, we found the studies that varied in terms of study design, population sample, and with no structured intervention proposed.”