Sharp Increase in Eating Disorders among University Students since the COVID-19 Pandemic

Abstract Background The COVID-19 pandemic has caused stress, required lockdowns, curfews and social restriction and thus may have altered physical activity and eating habits among university students. The objectives were to determine the impact of the COVID-19 pandemic on Eating Disorders (ED) among university students. Methods Between 2009 and 2021, five repeated on line cross-sectional studies were conducted among university students. ED were identified using the French version of the five-item “Sick, Control, One stone, Fat, Food” (SCOFF) questionnaire. The ExpaliTM-validated algorithmic tool, combining SCOFF and body mass index, was used to screen EDs into four diagnostic categories: bulimic, hyperphagic and restrictive ED. Results With the five studies, 8981 university students were included in total, 67.3% female with a mean age of 20.7 years. The prevalence of ED was stable between 2009 and 2018 and significantly increased from 31.8% in 2018 to 51.8% in 2021 for women (p trend < 0.0001), and from 13.0% in 2009 to 31.3% in 2021 for men (p trend < 0.0001). Lower food security scores were associated with a higher risk for all ED categories. Depression and academic stress due to COVID-19 were associated with ED regardless of category. Regarding health behaviors, a high adherence to the National nutrition recommendation was a protective factor for the risk of bulimic ED, hyperphagic ED and restrictive ED. A lower frequency of moderate and vigorous physical activity was associated with a higher risk of hyperphagic ED. Discussion Our study has shown a high screening of ED among the students of a French university fourteen months after the beginning of the COVID-19 pandemic. By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED. Initiatives to reinforce early screening of ED to implement targeted interventions in the student population are urgently needed. Key messages • This finding underlines the need to extensively screen for ED in students population and identify vulnerable individuals at risk of ED. • By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED.


Issue:
It is estimated, that 11000 -14000 people that live in Zurich do not have health insurance. For the vaccination against Covid-19 in Switzerland one had to register oneself on a website (Vacme) with your address and a Swiss health insurance number was required. This systematically excluded any people without insurance or Sans Papiers. Description: To address this issue the city physician service Zurich organized a vaccination program for the uninsured from 14.06.2021 onward. To achieve this a code which could be used instead of the regular insurance number was organized and the staff recorded personal information of patients on site to remove language and technological barriers. Furthermore, the Police department was informed and agreed not to circulate the area of the vaccination service on vaccination days to minimize access-barriers for patients without legal residency. Results: Between 14.06.2021 and 19.02.2022, 880 people came for vaccination of which 603 were clearly identifiable as individuals from vulnerable populations with no insurance. After initial organization, other vaccination centers in Switzerland were able to use the substitute number to vaccinate people without health insurance as well..

Lessons:
There is a sizeable amount of people living without registration or/and health insurance. It is therefore critical not to forget these people when organizing public health measures, especially when addressing a pandemic or other infectious diseases (HIV, Hep C). Non-insurance is a known issue for universal access to care.

Background:
The COVID-19 pandemic has caused stress, required lockdowns, curfews and social restriction and thus may have altered physical activity and eating habits among university students. The objectives were to determine the impact of the COVID-19 pandemic on Eating Disorders (ED) among university students.

Methods:
Between 2009 and 2021, five repeated on line cross-sectional studies were conducted among university students. ED were identified using the French version of the five-item ''Sick, Control, One stone, Fat, Food'' (SCOFF) questionnaire. The ExpaliTM-validated algorithmic tool, combining SCOFF and body mass index, was used to screen EDs into four diagnostic categories: bulimic, hyperphagic and restrictive ED.

Results:
With the five studies, 8981 university students were included in total, 67.3% female with a mean age of 20.7 years. The prevalence of ED was stable between 2009 and 2018 and significantly increased from 31.8% in 2018 to 51.8% in 2021 for women (p trend < 0.0001), and from 13.0% in 2009 to 31.3% in 2021 for men (p trend < 0.0001). Lower food security scores were associated with a higher risk for all ED categories. Depression and academic stress due to COVID-19 were associated with ED regardless of category. Regarding health behaviors, a high adherence to the National nutrition recommendation was a protective factor for the risk of bulimic ED, hyperphagic ED and restrictive ED. A lower frequency of moderate and vigorous physical activity was associated with a higher risk of hyperphagic ED.

Discussion:
Our study has shown a high screening of ED among the students of a French university fourteen months after the beginning of the COVID-19 pandemic. By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED. Initiatives to reinforce early screening of ED to implement targeted interventions in the student population are urgently needed.

Key messages:
This finding underlines the need to extensively screen for ED in students population and identify vulnerable individuals at risk of ED.

Background:
Unhealthy dietary patterns pose a major public health challenge. Individual-level efforts to promote heathy diets (e.g. nutrition education) have limited effect on the long term.
Context-specific interventions focussing on point-of-purchase may create opportunities for sustainable dietary changes. We evaluated real-life effects of nudging and pricing strategies in supermarkets on dietary intake.

Methods:
In this parallel cluster-randomised controlled trial, we randomized 12 Dutch supermarkets in socially deprived neighbourhoods to a control group (n = 6), or intervention group (n = 6). Healthy food nudges were implemented in intervention stores across 13 food groups, combined with healthy product price decreases and unhealthy product price increases. Eligible participants were aged 30-80 years and regular shoppers at participating stores. The primary outcome was dietary guideline adherence measured via an index score (0-150), at baseline and after 3, 6 and 12 months. Secondary outcomes included parameters of cardiometabolic health (HbA1c, lipid profile, and waist circumference), the percentage of healthy food purchases in the supermarket, socio-cognitive factors, and supermarket customer satisfaction. Effects were analysed with linear mixed models.

Results:
This study included 173 participants from intervention clusters and 220 from control clusters. Preliminary evaluation of the 3month follow-up data revealed no effectiveness of the nudging and pricing strategies compared to the control supermarkets in terms of dietary guideline adherence (b -0.8, 95%CI -4.2; 2.7). Results on all outcomes will be available at time of the conference.

Conclusions:
This novel supermarket trial is the first to evaluate real-life long-term effects of nudging and pricing strategies based on a comprehensive set of study outcomes and using a strong methodological design. Findings can direct future design of context-specific interventions focussing on the promotion of healthy diets. Meal timings and daily night-time fasting periods can synchronise the circadian system, which regulates the cardiovascular system. The present study aims to evaluate the prospective associations between circadian nutritional behaviours, defined by meal timing and frequency, and the risk of cardiovascular diseases. We used data from 103,389 adults (79% females) in the French NutriNet-Santé study, 2009-2021. Circadian nutritional behaviours were assessed using repeated 24h food records during the first two years of follow-up. We examined the associations between circadian eating behaviours and risk of cardiovascular, coronary heart and cerebrovascular diseases by multivariable Cox proportional hazard models. During a median follow-up of 7.2 years, 2036 incident cardiovascular diseases were diagnosed. A later first meal of the day was associated with a higher risk of cardiovascular diseases (HR per hour increase = 1.06, 95% CI 1.01 -1.12). A later last meal of the day was associated with a higher risk of cerebrovascular diseases (HR per hour increase = 1.08, 95% CI 1.01 -1.15). Among women, a later last meal was also associated with a higher risk of cardiovascular disease (HR per hour increase = 1.08, 95% CI 1.01 -1.15). We found no evidence for an association between night-time fasting duration nor meal frequency, with risk of cardiovascular diseases. This study suggests that the habit of eating a later first meal, and a later last meal (in women) could be associated with a higher risk of developing circulatory diseases. These results need to be confirmed in other largescale studies before they can be transferable to clinical practice.

Key messages:
Beyond nutritional quality of meals, meal timing could also be a risk factor for cardiovascular disease. If confirmed in other largescale studies, early breakfast and dinner could be considered in preventive strategies of cardiovascular diseases.