Coronavirus Chronicles — The Bottom Part of the Iceberg

Aside from the food-related mental/emotional difficulties already mentioned, there is another question, which Dr. Jennifer L. Gaudiani asks: “Are Individuals with Eating Disorders at Greater Risk from COVID-19?” Speaking from “a medical, whole-person, social justice-oriented perspective,” she thinks yes, and goes over the reasons, one specific condition at a time.

Anorexia nervosa, for instance. These patients are frail. They are malnourished and vulnerable to complications like hypoglycemia. With their physiology all out of whack, fever may not be present, which could mislead the medics. While they may compulsively exercise, determined to burn off every possible calorie, they are not strong — and when dealing with respiratory illness, a person needs to produce a muscular cough.

Some high-functioning anorectics look normal, and without understanding such a patient’s history, exhausted hospital staff may misread, or simply miss, important physical indicators. But that is not all:

[T]here’s little chance that an overwhelmed hospital system will have the resources and knowledge base to care for critically ill patients with anorexia nervosa properly, from preventing skin breakdown to nourishing with the thousands of calories these individuals will need due to becoming hypermetabolic when a modality like tube feeding is started.

A patient with bulimia nervosa will likely be dehydrated, increasing the risk of infection (in addition to the virus), and their lab results for electrolytes will be all over the map. A condition called rebound edema can interfere with the already damaged respiratory function, while leaving the staff in the dark about what is going on.

There are, of course, also other reasons for special concern, culminating in Dr. Gaudiani’s conclusion:

I worry profoundly that the population of individuals with eating disorders will be mis-triaged based on body appearance in the moment of truth, no matter where they fall on the weight spectrum.

On this page we see a revealing photo of the upper portion of a floating ice island; and on the water, the detailed reflection of the snowy top; and then beneath, the enormous undercarriage that lies submerged. This lower part can make up as much as 90% of an iceberg, a hunk of frozen matter not to be trifled with.

The significance is, more is going on at present than meets the eye. From some quarters, the portentous suggestion is heard that, for survivors, the long-term effects of the current pandemic might be even worse than the immediate consequences. The prognosis is not reassuring.

In homes across the nation, there are people hanging on to sanity by a thread, holding themselves together for the sake their spouse and/or children, and the question is not whether they will inevitably collapse, but merely when.

People who are accustomed to regular exercise are adversely affected by missing their daily runs on a jogging path. It’s not even a matter of weight maintenance, but of the need to burn off a certain amount of energy to prevent it from expression in other, potentially harmful, ways.

We already know that children who grow up in households where food insecurity predominates are at greater risk not only of obesity, but of behavioral issues that can affect their lives in numerous adverse ways. Of course, not every outcome is dangerously negative. Some might just be annoying. We could be raising a generation of children who grow up with a compulsion to wipe down all household surfaces with sanitizer on an hourly basis.

Serious challenges are evident already, as people stuck in isolation struggle with a wide variety of troublesome circumstances while dealing with eating disorders. Many more problems will remain unseen, like the larger portion of the iceberg, until they manifest in later years.

Your responses and feedback are welcome!

Source: “Are Individuals with Eating Disorders at Greater Risk from COVID-19?,”, 03/17/20
Image by Dr. Mike Goebel/CC BY 2.0

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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