DOI: https://doi.org/10.26758/15.1.8
(1) Faculty of Sociology and Social Work, “Babeș-Bolyai” University, Cluj-Napoca, Romania; e-mail: cristina.faludi@ubbcluj.ro
(2) Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States; e-mail: sargese@sph.emory.edu
(3) Legal Medicine Institute, Cluj-Napoca, Romania; e-mail: mihaelacimpianu@yahoo.com
(4) “1st December 1918” University of Alba Iulia – Faculty of Law and Social Sciences, Department of Social Sciences, Alba Iulia, Romania; e-mail: mihaelacimpianu@yahoo.com
(5) Romanian Institute for Evaluation and Strategy, Cluj-Napoca, Romania; e-mail: sergiu.rusu.ibc@gmail.com
Address correspondence to: Cristina FALUDI, Faculty of Sociology and Social Work, “Babeș-Bolyai” University, Str. M. Kogălniceanu, nr. 1, 400084, Cluj-Napoca, Romania. Ph.; Fax: 00-40-264-424674; E-mail: cristina.faludi@ubbcluj.ro
Abstract
Objectives: Eating disorders negatively affect the health and the quality of the human’s life. Data on eating patterns and on mental health are scarce in the Eastern European region. The pandemic caused by the SARS-CoV-2 virus seriously affected all dimensions of life, including the dietary habits and the mental health status of the people. The aim of this study was to investigate which psychosocial factors were associated with disordered eating among Romanian adults during the COVID-19 pandemic.
Material and methods: A nationally representative sample of 1102 adults participated in 2021 in a telephone-based survey about eating practices and psychosocial wellbeing. Descriptive and inferential statistics were used to estimate the prevalence and correlates of disordered eating among Romanian adults in the midst of the COVID-19 lockdown.
Results: Sixty-five percent of adults reported some type of disordered eating. Men, people with more education and older adults more frequently reported overeating; women and young adults more frequently reported undereating and oscillating between over- and under-eating. There were no consistent patterns of disordered eating according to education or place of residence. People who reported undereating were also more likely to report a low quality of life, a low mood and loneliness. Undereating was also associated with adverse life events – suicide ideation, abuse, depression and prolonged sadness – except for self-harm.
Conclusions: Disordered eating is a common custom. Programs are needed to prevent the initiation of disordered eating. Eating too little could be related to poverty rather than to a mental health issue; therefore, future research should include measures related to food insecurity.
Keywords: Disordered eating, mental health, Romania.
Suggested citation (APA)
Faludi, C., Cunningham, S. A., Cîmpianu, M. E., & Rusu, I. S. (2025). Disordered eating practices among Romanian adults during the COVID-19 pandemic. Anthropological Researches and Studies, 15, 131-139. https://doi.org/10.26758/15.1.8
Introduction
Overweight and obesity affect 60% of the European (WHO). Sedentary lifestyles and high caloric intake are implicated in the tripling of the prevalence of obesity over the past half a century (WHO, 2020).
While obesity is a major risk factor for diabetes and cardiovascular diseases, but it is also a condition surrounded by substantial stigma. People of all ages, and young people especially, are under great social pressure to be slim (Herpertz-Dahlmann, Wille, Hölling, Vloet, Ravens-Sieberer, & BELLA study group, 2008). Popular diets and dieting schemes promote various schemes to manage and reduce eating in order to prevent or reverse obesity, often through prolonged fasting, under-eating, or avoiding specific food groups. These weight-loss strategies often develop into disordered eating and do not result in sustained weight-loss; indeed, they often result, ultimately, in consuming more, binge eating, unhealthy nutritional intake, and disassociation of eating from hunger cues (Zuraikat, Roe, Sanchez, & Rolls, 2018). Even initially successful weight loss treatments do not result in lasting weight loss, as people regain their previous weight shortly after treatment cessation (Gearhardt et al., 2011). Abnormal eating behaviours can develop into eating disorders, with negative implications for health and quality of life. Both overeating and under-eating have negative consequences for physical and mental health. Indeed, disordered eating, characterized by abnormal eating behaviours that adversely affect a person’s physical or mental health, is itself considered a mental disorder (American Psychiatric Association [APA]. DSM-5 Task Force, 2013). These conditions include binge eating disorder (BED), characterised by eating large amounts of food in a short period of time, anorexia nervosa, which involves restrictions on eating due to fear of gaining weight, bulimia nervosa, characterised by binging eating followed by purging, and avoidant/restrictive food intake disorder (ARFID), which involves limiting the amount or variety of items consumed (National Institute of Mental Health [NIMH], n.d.).
Eating behaviours can manifest as addiction (Berenson, Laz, Pohlmeier, Rahman, & Cunningham, 2015). Addiction more broadly is a chronic mental health disorder defined by compulsive behaviour patterns activating the reward system networks and neurotransmitter pathways, persistent in spite of harmful consequences. Addictive behaviours are associated with dysregulation of reward processes and impaired capacity to exert cognitive control. The dopamine release in mesolimbic regions correlates with subjective reward, which can be from drugs but also from food (Gearhardt et al., 2011; National Institute on Drug Abuse [NIDA], 2011). Repetitive engagement in such rewarding behaviours leads to loss of control and physical dependence paralleling substance addiction (Chamberlain et al., 2016).
People who have overweight or obesity are especially likely to engage in severe dieting, which may lead to developing binge eating (Herpertz-Dahlmann et al., 2008) and may ultimately lead to more excess weight gain. BED is especially prevalent among people with obesity (Ágh et al., 2015; Mond, Hay, Rodgers, Owen, & Beumont, 2005). Indeed, food cues generate higher activity in the orbitofrontal cortex, anterior cingulate cortex, amygdale or the mediodorsal thalamus in persons with obesity compared to normal-weight individuals (Gearhardt et al., 2011).
Eating disorders frequently co-occur with other mental health problems, most notably depressive and anxiety disorders. Indeed, the lifetime prevalence of major depression ranges from 50% to 71% in people with anorexia nervosa and 50% to 65% in people with bulimia nervosa.
Research on eating disorders has primarily been conducted in North America and other populations with high levels of obesity; many studies are based on patients rather than population-based data, limiting generalizability. This study characterizes eating disorders using population-representative data on adults living in Romania. This Eastern European country of 20 million inhabitants has relatively low prevalence of metabolic conditions, with obesity affecting 23.7% of women and 26.3% of men and diabetes affecting 7.0% of adult women and 8.5% of men (EC, 2022). Information on eating patterns and on mental health has been scant in this region. The study is set during the Covid-19 lockdown. Worldwide, the pandemic caused by the SARS-CoV-2 virus seriously affected all aspects of life, including the dietary habits and the mental health status of people. Romania experienced a very stringent Covid-related lockdown, severely limiting people’s social contact, mobility, and access to food choices and healthcare. It is expected that these circumstances may have affected people’s wellbeing and may have aggravated disordered eating. Indeed, a study set in Romania during the COVID-19 pandemic reported that 12% of participants had frequently experienced depressive symptoms during the pandemic. Additionally, over a third of normal-weight respondents (34.7%) and half of overweight and obese participants (49.7%, and 52.5% respectively) believed that they had gained weight during the pandemic (Năstăsescu et al., 2022).
Material and methods
Study design and participants
This is a secondary data analysis. Data were collected by the Romanian Institute for Evaluation and Strategy (IRES) in June 2021 using random digit dialling. The sample was obtained by randomly generating telephone numbers with a valid format in Romania and 1102 adults were recruited. Response rates were calculated using AAPOR methodology (The American Association for Public Opinion Research. 2023. Survey Outcome Rate Calculator 5.1.). Post-stratification weights by gender, age, region, urbanicity and education were used, based on the National Institute of Statistics’ population estimates to adjust the sample to be representative of the non-institutionalized adult population residing in Romania. Theoretical margin of error for analyses was +/- 2.95%, at a 95% confidence interval.
Ethics
The Ethics Commission of the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca approved the study (No. 270/ 30.07.2019). As part of recruitment, prospective participants were informed of the name of the interviewer and the research institute, the topic of the research, and about confidentiality, anonymity, and data protection. If they agreed to participate in the study, they were requested to provide verbal informed consent.
Variables and measurements
The data collection instrument consisted of closed-ended questions and psychosocial scales and was developed from several previous questionnaires, with the main research question being about genetic markers for suicidal behaviour.
Eating behaviour was measured using the following dichotomous questions: ‘Please tell me if ever had periods when you ate too much’, and ‘Please tell me if you ever had periods when you ate too little’. The answers were combined to create a categorical variable: overeating, undereating, both eating too much and too little, and neither eating too much nor too little.
Respondents were also asked about their gender, age, education, area of residence and a series of questions about psychosocial wellbeing, specifically: ‘How do you rate these aspects of your life’: a) health; b) nutrition; c) physical activities; d) recreation; e) wealth; f) emotions; g) sex life; h) family relationships; i) social relationships; j) income. Possible responses were on a ten-point scale from 0 (very dissatisfied) to 10 (very satisfied). The responses were summed up and the median value was computed to create a psychosocial index variable with the categories low (under or equal to the median value) and high (over the median value). Respondents were asked: ‘How satisfied are you with your life?’ and ‘How happy are you in general?’, with possible responses on a ten-point scale ranging from 0 (very dissatisfied/ unhappy) to 10 (very satisfied/happy). After calculating the median, two variables were created for ‘life satisfaction’ and ‘overall happiness’, each consisting of a low and a high category relative to the median. Respondents were asked whether they had experienced psychological problems: repetitive obsessive ideas; prolonged sadness; suicide ideation; trauma; abuse; deception; depression; and self-harm with possible answers being ‘yes’ or ‘no’. Loneliness was measured in terms of social and emotional loneliness using statements about recent experiences, with possible responses being ‘yes’, ‘more or less’ and ‘no’. Social loneliness questions were formulated in positive terms: ‘There are plenty of people I can lean on in case of trouble.’; ‘There are enough people that I can count on completely.’ and ‘There are enough people that I feel close to’ and emotional loneliness questions were expressed in negative terms: ‘I experience a general sense of emptiness.’; ‘I miss having people around.’; ‘Often, I feel rejected’ (De Jong Gierveld and Tilburg, 2010). A score ranging from 0 to 6 was created, with values 0 and 1 considered not lonely, and all higher scores indicating loneliness.
Data analysis
Data analysis was done using SPSS IBM program, the 19 version. Percentages and frequency distributions were calculated. Also, cross-tabulations with Pearson’s chi-square (χ2) tests were used to examine the relationship between the psychosocial variables and the eating behaviours. Levels of significance were two-tailed, and the values below 0.1 were considered statistically significant.
Results
The socio-demographic characteristics and the eating habits are described in Table 1. Among Romanian adults, 35% did not report any disordered eating practices; 27% reported a mix of overeating and undereating, 18% reported overeating, and 20% reported undereating.
Table 1
Socio-demographic and self-assessed eating habits data (to see Table 1, please click here)
Figure 1 illustrates the distribution of disordered eating practices by socio-demographic characteristics. Distributions across groups are statistically significant at the 0.1 level except of urbanicity.
Figure 1
Distributions of eating practices (to see Figure 1, please click here)
Men and people over 65 years old were the most least likely to report any disordered eating practices. Men, people aged 51-65 years old, and those with higher level of education most commonly reported overeating. Women, people over age of 65 and those with a low educational level were more likely to report undereating. Women, young adults, and people with low or high levels of education also most frequently reported having both periods of over-eating and under-eating. People from urban areas reported eating too much somewhat more frequently than those from rural areas.
Figure 2 presents the distribution of eating practices by psychosocial measures. Distributions across groups are statistically significant at the 0.1 level, with the strongest difference being for overall happiness.
Figure 2
Distributions of eating practices and psychosocial measures (to see Figure 2, please click here)
People who reported low levels of psychosocial wellbeing, life satisfaction, happiness, or loneliness most frequently also reported eating too little. People who reported low life satisfaction and loneliness also most frequently reported engaging in both over- and under-eating.
Figure 3 shows correlations of eating practices and psychological problems. Distributions across groups are statistically significant below the value of 0.001.
Figure 3.
Distributions of the different adverse life antecedents by the type of self-perceived eating behaviour (to see Figure 3, please click here)
People who did not experience obsessive ideas, prolonged sadness, or suicide ideation and those who did not report adversities other than self-harm more frequently reported episodes of overeating or eating too little. People with histories of obsessive ideas, suicide ideation, abuse and self-harm most often reported episodes of both overeating and undereating.
Discussions
This study explored disordered eating practices among Romanian adults during the time of COVID-19 pandemic. Only one third of adults reported no disordered in eating practices. A previous analysis reported that altered eating behaviours are a growing problem in Romania (Bacârea et al., 2021). People who reported being happy, having high life satisfaction, and psychosocial wellbeing least frequently reported disordered eating practices.
Women and young adults frequently reported both undereating and overeating. These practices could be related to weight control attempts. Perhaps relatedly, young women have higher shares of underweight and normal weight than same-aged men (Rada, 2016).
A previous study concluded that the highest frequency of unhealthy eating in Romania was at ages 18-39 years (Roman, Bala, Craciun A, Craciun, C. I., & Rusu, 2016). The diets of young adults may have worsened further during the Covid-19 lockdown, with 21% of young adults reporting healthy diets (Mititelu et al., 2024).
Highly educated people more frequently reported overeating and less educated people more frequently reported undereating. There were no differences by urbanicity.
Multiple types of psychological problems were associated with all three types of disordered eating. As a worrying fact, the suicidal ideas were associated with undereating but not with overeating.
Adverse life events, self-harm and abuse were associated with undereating and with a mixture of over- and undereating.
This study used a nationally representative sample of adults in Romania in order to provide estimates of the prevalence of disordered eating practices during the Covid-19 lockdown period. It also examined association with psychological problems and psychosocial wellbeing.
The study has several limitations. Causal inferences from these cross-sectional descriptive results cannot be drawn. Thus, it is not possible to establish if the eating practices were the result or the cause of the psychological problems. Measures of eating practices were not collected using a validated questionnaire. Also, it cannot be concluded whether eating behaviours changed during the COVID-19 pandemic period.
Conclusions
Studies on the health and social contexts in Romania are scarce. An important issue is that questioning about eating habits could elicits responses about food insecurity, not disordered eating, that is people could not eat enough because they did not have enough to eat. This would be a social issue related to poverty rather than to a behavioural or mental health issue. Such interpretation is supported by the patterns reported in the results of this study. Future studies may include both objective and subjective measures of health-related behaviours and also measures related to the food insecurity.
Programmes designed to improve nutrition should consider links between eating practices and psychosocial wellbeing, negative life events, and socio-demographic, cultural, economic, and environmental factors. Remedial interventions should also pay attention to the social and psychological factors related to eating practices.
Consent to participate
Participants were informed of the name of the interviewer and the research institute, the topic of the research, and about confidentiality, anonymity, and data protection. If they agreed to participate in the study, they were requested to provide verbal informed consent.
Competing interests
The authors declare no competing interests.
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