Naomi Boles hit a wall last October. “I wasn’t sleeping at all and I felt like I couldn’t keep going,” she recalls. “I was so stressed, and even when I was in bed my brain was constantly racing as I was worrying so much about my health, about my income, about my children. When I went to the doctor, it was like I’d reached a point where I couldn’t carry on any more.”
Nine months on, she is still recovering from that burnout. “I am finally getting to the point where I can be a bit easier on myself and not constantly be in this fight-or-flight mode,” she says.
Tests have ruled out multiple sclerosis. But Boles, a 29-year-old mother of three from Aylesbury, Buckinghamshire, does have inflammation in her body, which seems to have been caused by stress. “They think I’ve developed an auto-immune disorder,” she says.
She has also discovered a lot about her mind. She has always relied on food to boost her mood and energy, but the comfort eating got out of hand during the pandemic. “When I was at my most stressed, and even as I have been recovering, food has been a real crutch for me,” she says.
This combination of burnout and overeating is far from unusual. Especially as since the start of the pandemic, many of us have been suffering from physical and emotional exhaustion, leaving us listless and overwhelmed, often with headaches and other physical symptoms. As the crisis drags on, we have turned to food for comfort, often choosing unhealthy snacks, takeaways and convenience foods because we are too exhausted to cook.
Boles was working in sales when the pandemic hit. She had just returned from maternity leave when she was furloughed by the luxury garden room company she worked for. Fearing she would eventually lose her job, in July she decided to start her own business. She had always wanted to be her own boss, so in one way Boles Bakery was a dream come true, but the upheaval has taken its toll.
“The stress of losing my job, starting a new business and having to home-school my kids meant I often ate far too much of the things I was baking, even though I have a gluten intolerance.
“I found the lockdowns really isolating and at first my friends and I would do a lot of Zooms but, after a while, they stopped. The further we got into the pandemic, the more it became almost a reflex to reach for food.”
In a recent study of emotional eating during the pandemic, led by Katherine McAtamney of Birmingham City University, a quarter of participants reported that they were consuming more overall, while a third were eating less healthily.
Meanwhile, Europe-wide research led by Aarhus University in Denmark found that the pandemic had left Britons as the biggest comfort eaters in the continent, with the consumption of convenience foods up 29%, alcohol up 29% and so-called “tasty treats” up 34%.
None of this would surprise 22-year-old Liam Skillen, from Mansfield. Now working as a cafe assistant at a supermarket, as well as helping to care for his grandmother, he struggled after he was furloughed from his previous job in a cinema.
“I am trying to save to move out of my parents’ but had to put that on hold,” he says. “I’ve also been worrying about my grandmother as she had to shield on her own and I couldn’t go into the house and do the cleaning for her. With more time on my hands and more things to worry about, I found myself eating more.”
Emotional eating has played a part in his life since he was a child. “Even in primary school if I had a tough day doing Sats, I would go and eat a load of chocolate that I wasn’t meant to eat,” he says. “Now if I have a bad day, I will eat half the cake I made the day before or order a pizza from Domino’s and eat the whole thing. My local Tesco also started selling Krispy Kreme doughnuts, which I love.”
It is not just the taste that makes Skillen reach for the cake or doughnuts. “One thing that I always say to my patients is that eating behaviours have very little to do with food and weight,” says Arti Dhokia, a dietitian with a special interest in mental health. “It’s always to do with how you’re feeling. Our relationship with food is something we begin to form even when we’re weaning.”
As children, many of us are told that chocolate is only for special occasions, Dhokia, who works for Circle Health’s rehabilitation hospital in Birmingham, says. “If you go through periods in your life of immense stress or experience something you feel you can’t control, then you’re going to start tying your emotions to food because food is one thing we can control. And, for some, their go-to will be the chocolate because it’s a treat they didn’t often get as a child.”
But this is an area where our bodies and minds combine to work against us. Carbohydrate-rich foods provide a sugar (glucose) high, Dhokia explains, as glucose is the primary source of energy for brain function, while protein increases the production of dopamine, the so-called feelgood hormone.
“Being stuck in a cycle of using food to fill a void or reduce stress often leads to feelings of guilt and shame afterwards – and periods of restriction to compensate for this,” Dhokia says.
“Restriction of foods, especially carbohydrate, can make us feel irritable, low in mood and cause difficulties with concentration. This is often followed by bingeing, which can lead to a feeling of euphoria due to the increase in glucose and dopamine. This effect can be short-lived, and can quickly become the new “normal”, requiring more and more of the same foods to achieve the effect, creating a mechanism similar to addiction. This further drives emotional eating.”
The tendency to turn to food when experiencing stress, low mood or mental health problems is often overlooked when it comes to public health policy, says Dr Eleanor Bryant, an associate professor of health and eating behaviour at the University of Bradford. In the government’s latest obesity strategy, for example, mental health is mentioned just once, as something that obesity affects, and providing psychological support is not mentioned in the proposals to tackle obesity.
This is despite evidence highlighting the two-way association between depression and obesity. A 2010 study found that people who were obese had a 55% greater risk of becoming depressed, and people with depression were 58% more likely to become obese.
“The government treats mental health and obesity very differently,” says Bryant, who was part of a study that explored burnout eating behaviours, “but they are both so intertwined. They’re aware of [obesity] in psychiatric hospitals because weight problems are a huge issue with people with severe mental health problems – partly due to the medication they are on – but they are not seeing it as a population-level issue. If they [the government] did, they would have to fund it, and they are cutting funding to mental health left, right and centre.
“They tout solutions such as a sugar tax,” she continues, “yet there is so much more that could be done. No public health message can apply to everybody, but one size absolutely does not fit all when it comes to obesity management. There needs to be a much more tailored approach. The government needs to consider psychology more, and more mental health support needs to be rolled out on a free basis.”
This is something Ellen Price (not her real name) would like to see. Now in her 40s, she has struggled with her weight and body image for most of her life and is often on a diet. While numerous doctors have told her she should lose weight, she says they have not helped her to access the necessary psychological support. “They always tell me to lose weight, as if I had never thought of it. They don’t offer any support and would never take into consideration the way food and mood are connected. In their eyes it’s just a simple case of eating less and moving more.”
Her negative feelings about herself have led her to use food “as a coping mechanism”, she says. When she chooses something that’s not very healthy, she feels bad about herself, setting off a vicious cycle. “Even smaller things make me turn to food. I ate three doughnuts yesterday because my car broke down and I thought I wouldn’t be able to go camping.”
She has tried cognitive behavioural therapy, via self-referral, and person-centred counselling, which she paid for privately, but neither has helped. And she gets no comfort from the discourse around body positivity. “I follow a lot of people on social media who are body-positive and post about feeling good whatever your size, as well as a lot of people who are anti-diet culture. I totally get what they are saying, but what if you do want to do something about how you look because you’re really not happy about it? If I don’t try and go on a diet, then am I just meant to accept that this is the way I look?”
Back in Buckinghamshire, Boles says it is “baffling” how little help she has been able to get for her emotional eating. “If I had anorexia or bulimia, I think [healthcare professionals] would make the link more with mental health, but they think that as I’m not starving myself, I must be OK.”
Dhokia says she has a point. “I have treated bariatric patients with BMIs of 50 to 60 who had massive issues with overeating, binge eating disorder and emotional eating, but we just didn’t have access to psychological services, whereas with anorexia you do.
“If you’ve got a BMI of less than 15, it’s very acute and very life-threatening, so you need immediate help, whereas obesity is quite slow-burning.” She suspects this explains the difference in prioritisation and approach.
In the meantime, many emotional eaters are at an all-time low.
“Whenever I’m going through emotional upheaval, food is the one thing I can rely on,” says Price. “The pandemic hasn’t helped things. The third lockdown was really trying for me. I am really close to my family and it was hard not seeing them. I thought my head was going to explode at times from the sheer magnitude of everything I was worrying about.”