This story discusses eating disorders and mental health.

MILWAUKEE — For Anna Zaleski, it hasn’t always been easy to have a good time at Thanksgiving.

After being diagnosed with anorexia in high school, Zaleski spent years working to recover from her eating disorder. The holidays brought extra challenges, like gathering for big meals and navigating conversations about what she’d been up to (“A lot of times the answer was, ‘Well, I went to treatment, and I withdrew from college’”).

Now, Zaleski said she’s in “very solid recovery.” She’s looking forward to celebrating with her family — one day late, because she’ll spend Thanksgiving working as a nurse in the emergency department.

“I can go to family holidays, and I can enjoy the holidays,” Zaleski said. “Rather than panicking about what is going to be on the table or what conversations I'm going to be faced with.”

For many, the upcoming holidays may be a bright spot for many after a tough couple of years. But the festive season can be a burden for those who are already struggling with eating, mental health experts said — especially after the COVID-19 pandemic has already ramped up eating disorder concerns.

“All of our holidays, but especially Thanksgiving, are food-centric,” said David Drajkowski, clinical director for the Eating Recovery Center in Milwaukee. “People with eating disorders, this is their most stressful time.” 

* * *

It’s important to be mindful that “not every part of the holiday is fun” for everyone at the table, Drajkowski said.

The constant focus on “turkey and stuffing and gravy” during Thanksgiving can be triggering for patients, said Dr. Stacey Nye, a clinical psychologist who specializes in treating eating disorders.

Someone with a binge-eating disorder might be worried that they’ll eat too much and gain weight, Nye said. And someone with a restrictive eating disorder, like anorexia, might feel like people will be judging what they eat — or what they leave on the plate.

Zaleski said the way a lot of people see holiday treats as an indulgence, or something to feel bad about, also made the festive season tough. Food shouldn’t be a “moral issue,” she said — it’s something your body needs, “whether it’s a holiday or whether it’s a random Tuesday.”

“Everybody always talks about how guilty they feel after eating certain meals,” Zaleski said. “Those are difficult conversations for me to hear, because for me, in recovery, I need to view food as fuel.”

Plus, many eating disorder patients use food as a way to deal with stress — maybe finding comfort in eating more, or feeling control by eating less, Nye said. Zaleski, who described herself as a “very anxious person,” said her eating disorder was often a way for her to cope with any sense of uncertainty: “To hide away from the world in a way, and just retreat.”

While we may love our families, getting them together for the holidays can bring a lot of that stress along with it, Nye said.

“I had a client say to me today, ‘Well, I want the picture-perfect Hallmark holiday. But that's not what my family is like,’” she said. “It’s often a very stressful time.”

* * *

Of course, as we enter another pandemic holiday, there’s another big source of stress hanging around: The threat of COVID-19. 

“People have gotten ill. People have died. People are afraid of getting ill,” Nye said. “There have been family conflicts, you know — ‘Are you vaccinated? Do you believe in it? Are you wearing a mask?’ So there's been a tremendous amount of stress around that.”

Along with other mental health issues, eating disorders have seen a big uptick during the COVID-19 pandemic. Research has suggested that more people have been getting diagnosed with diseases, like anorexia and bulimia, and those who already struggled with eating disorders have seen their symptoms get worse.

Over the course of the pandemic, Drajkowski said he’s seen his waitlist for treatment pile up at the Eating Recovery Center (which recently relaunched from its former name as the REDI Clinic). Nye, who leads the eating disorder clinic at UW-Milwaukee, said their patient list is full, and “everyone I know is booked.”

“The need is huge,” Drajkowski said.

The pandemic has created a lot of anxiety in many different areas of life — “with schools, with jobs, with the economy,” Drajkowski said. And it’s also led to a great deal of social isolation, Zaleski pointed out, which makes it that much harder for people to find the support they need.

“Recovery, I think a huge portion of it is connection,” Zaleski said. “And I think during the pandemic, all of us have felt isolated at some point.”

For many young people, social media may have become a main source of connection early on in the pandemic, experts said. And while that’s not all bad, Drajkowski said there can be a lot of unhelpful talk on social media — like posts pushing diet culture or warning about gaining the “COVID 15.”

A lot of people did gain weight during the pandemic: One study found that nearly half of Americans had put on unwanted pounds over a year with COVID-19. Generally, we’ve been less active, spending a lot of time indoors and working on Zoom, Nye pointed out.

But a lot of people have been “overcompensating” for gaining a little bit of weight during quarantine, she said.

“It’s like you're driving down the street, and you see something on the road. And you might swerve a little bit to get out of its way,” Nye said. “But what a lot of my clients have done is, they’ve overcorrected. And they've swerved into the wrong lane.”

* * *

Even once the COVID-19 pandemic comes to a close, the impacts on mental health and eating disorders could stick around for a long time, Drajkowski said.

“I don’t see things getting better, sadly,” he said.

Still, there are ways to support loved ones who might be struggling, experts said — during the holidays, the pandemic and beyond. One good rule of thumb for any upcoming gatherings: “Mind your own plate,” Nye said.

Commenting on how much (or how little) others are eating can be a trigger for someone who’s struggling with an eating disorder, she said. The same goes for talking about someone’s weight, even if you think you’re giving a compliment.

Generally, if you’re celebrating with someone who struggles with eating, try to make the gathering more about the people and less about the food, Drajkowski suggested.

Though the pandemic has been a tough time for eating disorders, Drajkowsi is hopeful that these discussions could lead to more awareness and less stigma. Being aware of warning signs — like significant weight change, a pattern of going to the bathroom right after eating or having very rigid routines around food — can help people get the support they need quickly, experts said.

Zaleski stressed that you don’t have to look a certain way, or “be knocking on death’s door,” to deserve treatment. 

Though it was frustrating when she had to leave college and take time off from her life to focus on recovery — getting treated at an Eating Recovery Center location in Colorado almost a decade ago — Zaleski said her recovery allowed her to live the life she wanted.

“For a long time, I felt like I was imprisoned by my eating disorder,” Zaleski said. “I really felt like I didn't have a choice. My illness was telling me what I had to do, and I had to do that all the time.”

During her recovery, though, she realized that following her eating disorder was keeping her from following her values — like helping other people by working in health care, or taking good care of her dog Moose. Now, she’s able to be all of those things.

“For the longest time, I was Anna. I was the girl with the eating disorder,” Zaleski said. Now, she defines herself in different ways: “I'm a nurse, and I'm a fiancee, and I'm a daughter, and I’m Moose’s mom. And I have so many other things about me.”