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Josie Lesmeister knew her bulimia had reached a crisis point during the start of the Covid-19 pandemic when the University of Hawaii student went into her bathroom to make herself vomit, and nothing would come out, because she had been puking so often.

“My mom had to take me to the emergency room when she found me lying on the ground in my bathroom,” said Lesmeister.

Over the course of the pandemic, Lesmeister was admitted to the hospital twice for her eating disorder.

“I was sort of screaming for help because I didn’t have that good of a support group,” Lesmeister said. “I think it was the stress of the pandemic on top of having no sort of support, which is why I lost a total of around 70 pounds.”

For many who developed mental health disorders due to – or amplified by – the pandemic, treatment options they desperately needed were hard to find.

The state of Hawaii considered addressing urgent mental-health issues, like eating disorders, through , but it died in the crossover to the House on March 17. Though the bill didn’t pass, the problem it sought to address persists.

A survey done by the found that almost 7 in 10 psychologists nationwide with a waitlist reported that it had grown longer since the start of the pandemic.

Since the pandemic, the National Eating Disorders Association reported that there was a 58% increase in calls and texts from people who were utilizing their hotline. have the second highest risk of death of any mental illness, after opioid addiction. Someone in the U.S. dies from an eating disorder every 52 minutes, according to the National Eating Disorder Association.

Hawaii’s mental health care system became overwhelmed with new clients because psychiatrists and therapists were in high demand. According to a survey conducted by , there has been a 21.1% increase of young adults who have developed symptoms of an eating disorder since 2019.

Mental health disorders, such as , have been a global issue among young adults for many years but according to the federal Centers for Disease Control and Prevention, the number of hospitalizations for eating disorders has doubled since the pandemic.

Legislative Efforts Stalled

In order to address the growing rate of eating disorders among young adults in Hawaii, lawmakers have considered restructuring the mental health system.

Sen. Stanley Chang believes that one way to improve this issue is to change the stigma of how mental health is viewed as well as including annual mental health exams for everyone in Hawaii.

“If everyone were to go to a psychiatrist or a psychologist on an annual basis, and everyone were to be getting some mental health care to begin with through those annual checkups, then I think that would greatly de-stigmatize the problem,” Chang said.

Mental health concerns, like anorexia and bulimia, have reached the crisis point, and legislators are trying to force insurance companies to cover annual mental health screenings. But they are getting push back from those companies, who do not want to cover the costs.

, which passed the state Senate but died in the House, requested that one annual mental health screening would be included in health insurance coverage for diagnosis or mental health disorders, including eating disorders.

Chang said that “each year we try to pass this bill, and this year it is the furthest it has ever gotten.”

In the meantime, Sen. Jarrett Keohokalole, Senate Health Committee chairman, said the group is working toward tackling this issue, as well as other mental health issues, by “restructuring the system around crisis.”

“The approach we’ve taken this year is to restructure the system, so that it’s easier to navigate if you are an individual in crisis or if you’re trying to help someone who is going through a mental health crisis,” Keohokalole said.

An initial step is the introduction of the 988 hotline, which will connect a caller to a service provider or social worker who can assess the situation and get someone to help. “It’s basically 911 but for mental health crisis,” Keohokalole said.

Another tactic, Keohokalole said, is to build capacity in Hawaii’s health care systems, including restoring positions in the state Department of Health’s adult mental health divisions.

For Lesmeister, she said the stress of the pandemic pushed her into the eating disorder.

“I’ve always had girlfriends that were so tiny, and so I always felt like I was so huge all the time, and then I think that’s when I started to develop a bulimia disorder,” she said.

UH students Nicole Taylor and Emma Cullen also began suffering from mental health concerns and eating disorders during the pandemic. Before they knew it, they felt out of control.

“I remember I ate so much to the point where I could not physically get out of bed,” Taylor said, “and this was a cycle that happened almost everyday. I think it sort of stemmed from being stressed with everything I had going on, and I think the pandemic made it worse, because, I mean, we were all living in fear, and I started to think we would be in lockdown forever.”

As a result, Taylor said that she turned to food and started to binge eat more than usual, gaining almost 20 pounds since the pandemic first started.

“The clients that I have that struggled with distorted eating behaviors started to struggle more intensely after the pandemic,” said Nikki Moravec, a licensed clinical psychologist who specializes in eating disorders. “Even some clients that I had who were in recovery reached out to me after the pandemic started because they felt it was a really hard time for them and they started engaging in those behaviors again.”

She said eating disorders are a mental struggle people deal with that is incredibly hard on the body, both mentally and physically.

UH student Cullen said that the stay-at-home mandate affected her weight and caused her to fall into a depressive state.

“Because I was always at home watching movies, I was always constantly eating snacks,” Cullen said. “I was just around food more, and it was right in front of me, therefore I put on like 20 pounds during Covid, and that really messed me up for sure.”

Moravec explained that although body image may be one reason young adults begin to engage in habits that can lead them to developing symptoms of an eating disorder, often eating disorders stick around due to their effectiveness in numbing feelings.

“Very often, eating disorders actually start as a diet,” Moravec said. “Then it becomes something that a person may recognize what they’re doing, or not doing, with food that serves as coping functions.”

Cullen said, “When I am in a lower episode, I will eat until my stomach is absolutely killing me, and I think that I’ve always used food as a coping mechanism throughout my entire life. For example, if I’m pissed off and I’ve had a bad night, I want to come home and eat a bag of chips because I feel like that will make me happy.”

Social Media Use

Social media use may also contribute to the increase in reports of eating disorders during the pandemic.

“Here in Hawaii it is an even bigger problem because we are continuously exposing our bodies,” Moravec said. “One of the amplifiers of eating disorders is comparison, and most of the time people are comparing themselves to something that is unattainable.”

“I think I’ve always compared myself to others when it comes to my physical appearance,” Taylor said. “One time I was invited to a party on the beach, and I chose not to go, because I knew I was going to have to be in a bathing suit, and I didn’t feel confident.”

For Cullen, she said she stopped going to the beach because she felt she had developed a double chin.

“I remember I was driving with my friend to Diamond Head, while I was in the passenger seat and I kept looking in the mirror,” Cullen said, “and I told her to turn around because I didn’t want anyone to look at me.”

Lesmeister said at one point she wanted to transfer to a school in Oregon, where she thought she could wear clothes that covered her body more.

“I remember calling my mom and telling her I didn’t want to go to school in Hawaii,” she said, “because I felt like every day I was forced to put on a bathing suit and socialize even though I wasn’t happy with how I looked.”

Researchers have also found links between the mental-health crisis, smartphone use, and body dysmorphia.

A conducted by the National Library of Medicine, for example, showed “that about 70 percent of internet users, especially the young generation worldwide, were using their smartphones or mobile phones more as a direct result of lockdown due to the coronavirus outbreak.”

Lesmeister said smartphone overuse contributed to her condition, adding, “I was always on my phone because I had nothing else to do, and numerous Instagram models would continuously pop up on my feed, and I think everyone tries to live up to an unrealistic standard.”

Taylor and Cullen said that social media definitely impacted the way they looked at their bodies.

“When I got the heaviest, I didn’t want anyone to see me,” Cullen said. “I stopped posting on Instagram for months at a time, and then I would start going on Tik Tok, which was 10 times worse.”

Taylor said she spent hours scrolling through her phone instead of being productive or even moving around.

“One time I started crying, because I saw so many people that I believed were more attractive than me,” Taylor said, “and I realized I had been in my room for hours rather than trying to look like them.”

Moravec, who cares for patients with eating disorders, also chalked up the increased rate of eating disorders to social media.

As young adults were unable to engage in activities such as school, work, etc., she said the rate of their screen time usage increased.

Apps such as Twitter, Instagram, Snapchat and TikTok saw an during the beginning of the pandemic, according to a .

“I really think that stepping away from social media made me a much happier person overall because it definitely made me be more okay with my body,” Cullen said.

Although Cullen has lost 15 pounds since the start of her weight loss journey last year, she said that once she stopped comparing herself to other people online, it allowed her to become more happy with herself.

These UH students — and they say they definitely aren’t alone in these struggles — said that working on their mental state has helped them to become more content with their body image.

“I know that a lot of people my age deal with this sort of problem,” Taylor said. “I think it’s also important to know that nobody judges you more than yourself.”

Lesmeister said she hasn’t forced herself to throw up in more than a year.

“Although I’m not at my skinniest anymore, I’ve learned that these expectations everyone tries to live up to are not real,” she said.

“I’ve learned to be more happy with myself by going to therapy as well as reminding myself that as long as I’m happy with myself, it shouldn’t matter what anyone else thinks of me.”