Have you observed a trend of people becoming more self-conscious about their own appearances since the beginning of lockdown? If so, what would you identify as the main drivers of this trend?

During the COVID-19 lockdown, we all had to adjust to a new form of life, one which resided mostly indoors. Our social and work lives disappeared and everyday activity was greatly reduced.

There are obvious downsides to this, especially for those living alone, with medical or mental health conditions, in economic deprivation, or with large families and little space. But one of the upsides for many was a cocoon-like feeling of safety. Within the confines of our own homes, very little was unexpected or abnormal, few social interactions needed to be managed, and everyday life (beyond the worry and stress related to the pandemic itself) became simple and certain. Our personal appearance and body language became short-lived behaviours, which we would wheel out just for Zoom calls.

Most of us have experienced significant changes in our day-to-day routine since lockdown, including changes to our diet and how much we move about or exercise. This may have an impact on our bodies and, potentially, our own body image. A new King’s College London and Ipsos MORI survey of 2,254 people discovered that 48% had put on weight during lockdown, the same percentage reported feet more anxious or depressed than usual and 29% say they have drunk more alcohol. Naturally, periods of uncertainty can increase anxiety, negative patterns of thinking and lower self-confidence.

Now that we are moving back into society, there are going to be widespread implications for everyone. The period of adjusting back into social life and the workplace environment is going to be mentally testing, especially when added to the rising unemployment and anxiety related to a possible second wave of COVID-19. Many of us are leaving the cocoon and suddenly it matters again - at least in our minds - how we look and what we are wearing, how we carry ourselves physically, how our voice comes across, and how we deal with social interactions.

Therefore, feelings of self-consciousness and low self-esteem are rising. After such a long period of relative solitude, group interactions are now tiring, work meetings are more stressful than before, and everyday life feels overwhelming. The hope is that in the same way we adapted to lockdown life, we will readjust to the new normal.

Do you think the growing reliance on technologies like Zoom and social media for communication is going to have a negative impact on people's body image? What advice would you give to people who use these platforms a lot to help them avoid developing an unhealthy fixation on their own appearance?

If a friend told us they couldn’t help but stare at their reflection for hours every day, we would begin to worry about their relationship with body image. And yet now many of us are now reliant on webcam-based communication, which broadcasts our own faces back at us for long periods of time.

These constant Zoom, House Party and Skype calls can make us too preoccupied with our appearance, fixate on a certain part of our face, and lead us to compare ourselves to others. We suddenly notice a wrinkle, the bags under our eyes, or the angle of our teeth. For those suffering with body dysmorphic disorder (BDD) - an anxiety disorder in which an individual develops obsessive thoughts about an element of their appearance which they perceive to be a flaw - this can be very damaging.

There are deeper issues at play here, related to self-worth, which are aggravated by the false images of perfection we are constantly barraged with on social media. So, reducing the use of technology to a reasonable and manageable time each day is a good idea.

However, there are some other simple exercises you can use right now to counteract these behaviours. If you feel your attention being drawn to your own appearance during video calls, then catch that thought pattern before it develops, and patiently try to draw your focus back to the conversation at hand and the work you are involved in. Focus on the words being said rather than the images on screen. On certain applications, like Zoom, there are even options to turn off self-view.

Pre-lockdown, how often did you encounter individuals who would be tempted to use cosmetic surgery and beauty procedures as a means of addressing their own body confidence issues? Are you expecting this trend to get better or worse as a result of lockdown?

Before lockdown, it was common to encounter people who were tempted to use cosmetic surgery as a means of addressing body confidence issues, and there are screening processes and questionnaires in place to help understand a patient’s motivations. We try to understand whether the decision for cosmetic surgery comes from a genuine desire to change a part of their physical appearance that they dislike, or whether it relates to underlying issues of emotional pain and distress.

COVID-19 has accelerated many of the issues that turn body insecurities into a decision to seek cosmetic surgery. Increased solitude and working from home has exacerbated loneliness and increased the amount of time we have for personal reflection. This can lead to a preoccupation with issues related to the way we see ourselves. In that sense, medical professionals need to be wary of the surge in requests for procedures.

However, there are also simpler reasons for this rise. Many individuals who have put off having cosmetic surgery due to the recovery time needed for visible healing are taking advantage of the fact they are now working from home, or able to leave the house wearing a mask without feeling anxious.

For those who are considering getting cosmetic surgery - what kind of questions would you recommend that they ask themselves before agreeing to surgery, in order to make sure that they are not doing so from a mentally unhealthy place?

Cosmetic surgery shouldn’t be a first resort and should come after a patient has tried other avenues to help them understand their thoughts around body image. One of these avenues could be something like therapy, but they could also read some of the many patient-authored accounts of using cosmetic surgery to address body image issues, and see if there are similarities to their own thought patterns and feelings.

There were two powerful recent articles on this topic, one published by VICE in 2017 and another by the Independent in 2020. It is also worth considering whether the unique issues caused by lockdown may be luring you into a spontaneous decision. Instead, you could decide to review your decision three to six months down the line, rather than booking an appointment straight away.

With COVID-19 still a major threat and future lockdowns an ongoing possibility, what actions can people take to improve their self-image and body confidence at this current time? For those who are particularly struggling, what support measures and services would you recommend for them to explore?

Reintegrating ourselves back into socialising is difficult after so much time alone, but it’s important that we do. There is such a thing as too much time to think, and loneliness can seriously aggravate self-image and body confidence problems. Start making plans with friends that adhere to social distancing guidelines.

Eating healthily and exercising are just as important. It’s vital to remember that exercise isn’t just about losing weight or getting toned; how your body feels is more important than how it looks. Taking part in physical activity helps us feel more connected to our bodies and more confident about what it can do. It doesn’t always have to be running or weights, it could be raking leaves in the garden or walking to the park.

However, for some individuals, the severity of their issues will require outside help and support. Your GP can be a good first port of call, and there are many therapies they may direct you to which have proven success in helping patients with body image issues, such as cognitive behavioural therapy (CBT). Elsewhere, numerous charities (like Young Minds, Mind and CALM) can direct you to helpful advice and counselling.