"If I start panicking over having enough, then I start eating too much": Understanding the eating behaviors of SNAP recipients in larger bodies during COVID-19.

BACKGROUND/OBJECTIVE: Living in a food-insecure household may increase the risk for disordered eating. Though the Supplemental Nutrition Assistance Program (SNAP) was designed to reduce food insecurity, it may increase risk for disordered eating with the frequency in which benefits are distributed. Limited research has explored the lived experiences of managing eating behaviors while on SNAP, particularly among SNAP participants in larger bodies, and during COVID-19. Thus, the purpose of this study is to examine the experiences with eating behaviors among adults with a BMI ≥ 25 kg/m2, and who received SNAP benefits during the COVID-19 pandemic. METHODS: Eligible adults were recruited to participate in a semi-structured interview. Interviews were transcribed verbatim and analyzed using thematic analysis and content analysis. RESULTS: Participants (N = 16), had a mean (±SD) age of 43.4 ± 10.9 years, and overwhelmingly identified as female (86 %). One-third of the participants were Black. We identified 4 main themes: (1) not having enough money/benefits to cover needs; (2) navigating loss of control and emotional eating; (3) making sure the kids are alright; and (4) still feeling the pressure to manage weight. CONCLUSION: Managing eating behaviors while also navigating SNAP benefits is complex and may exacerbate risk of disordered eating.

Perceptions and experiences with eating disorder treatment in the first year of COVID-19: A longitudinal qualitative analysis.

OBJECTIVE: The COVID-19 pandemic created significant challenges in accessing and receiving treatment for individuals with eating disorders (EDs). The purpose of this study is to explore perceptions of and experiences with ED treatment during the first year of the pandemic among individuals with past and self-reported EDs in the United States. METHODS: Online surveys were administered to adults (N = 510) with a past or current self-reported ED at 13 timepoints between April 2020 and May 2021. Using longitudinal qualitative analysis, 5651 free-text responses were examined to capture experiences with ED treatment and generate inferences of change over time. RESULTS: We categorized results into four sequential, temporal quarters and identified patterns that explained participants' perceptions of facilitators, barriers, and experiences with ED treatment over time: Quarter 1. Treatment Disruption and Reorienting Recovery; Quarter 2. Accumulating COVID-19 Stress and Virtual Treatment Woes; Quarter 3. A Continuation of Inadequate Care; and Quarter 4. Ongoing Adaptation and Adjustment to Uncertainty. Participant experiences were marked by numerous barriers to accessing care, challenges adjusting to virtual treatment, unmet treatment needs, and beginning acceptance of telehealth. DISCUSSION: Our findings present a timeline to help evaluate challenges related to navigating the switch to virtual care which created significant disruption to ED recovery. Participants spent much of the first year trying to adjust to unemployment, loss of insurance, and lack of access to in-person treatment. Future research should identify additional strategies to improve the receipt and experience of care for EDs. PUBLIC SIGNIFICANCE: Our findings suggest that individuals with eating disorders were significantly challenged by accumulating COVID-19 stress, worsening symptomatology, and limited access to effective treatment during the first year of the pandemic. This knowledge can guide clinicians, treatment centers, and policy makers in addressing the behavioral health needs of individuals impacted by disordered eating amidst emergent public health crises.