A new study using a global online survey demonstrates that COVID-19 stay-at-home orders resulted in a dramatic increase in unhealthful lifestyle changes.
According to the study — which appeared in the journal Obesity — there were significant increases in sedentary leisure behaviors, declines in physical activity, and increases in anxiety and weight gain, especially in people with obesity.
On the upside, lockdown resulted in substantial improvements in healthful eating.
On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic, with the United States announcing a national emergency on March 13.
The impact of stay-at-home orders
The U.S. implemented different strategies to limit person-to-person contact in order to mitigate the spread of the virus. Although stay-at-home, quarantine, and social distancing measures diminish transmission of SARS-CoV-2, other health ramifications of these actions are not entirely understood.
The abrupt closures of fitness clubs, restaurants, and places of employment alter eating and physical activity habits. The fear of developing COVID-19, in addition to stay-at-home orders, may provoke added feelings of loneliness and isolation, further exacerbating stress and anxiety.
Stress during a pandemic may result in:
- anxiety and fear about health, loss of support services, finances, or unemployment
- sleep disruption or altered sleeping patterns
- changed eating habits
- trouble concentrating
- worsening of chronic health problems, including mental health conditions
- increased use of alcohol, tobacco, and other substances
Stress associated with altered sleeping patterns, more frequent snacking, and consuming sweet foods may also lead to weight gain.
Researchers at Louisiana State University’s (LSU’s) Pennington Biomedical Research Center designed an innovative online global survey study to quantify changes in physical activity, sedentary behaviors, sleep, mental health, and dietary habits in adults aged 18 and older before and during the initial phase of the COVID-19 lockdown.
The anonymous online survey, accessed through Facebook, the research center’s web page, and an email listserv, ran from April 3, 2020, to May 3, 2020. More than 12,000 individuals looked at the survey, with a total of 7,753 surveys included for analysis.
About 95% of the participants resided in the U.S., United Kingdom, Australia, and Canada. The participants were predominantly white, female, and living in a two-person household, with an average age of 51.
Approximately 32% of the participants had overweight, 34% had obesity, and 32% had a healthy weight. The results of the online survey demonstrated substantial lifestyle changes during the pandemic.
Significant lifestyle behavior changes
Eating out four or more times per week declined by 10%, whereas cooking at home six or more times per week increased by 26% during the pandemic. The validated questionnaire also indicated significant increases in overall healthful eating.
About 44% of the participants reported an increase in unhealthful snacking, while approximately 26% reported increased healthful snacking. The study reported that 36% of the individuals perceived declines in healthful eating, and 21% perceived increases.
A perceived increase in unhealthful eating accompanied trouble falling asleep, decreased physical activity, increased sedentary habits, and nearly twice the reported anxiety levels than in those eating more heathfully.
Sedentary leisure activities increased by 21 minutes on weekdays and 17 minutes on weekends. Physical activity significantly decreased by 18 minutes per week and declined by 112 minutes per week in terms of metabolic equivalents after adjusting for exercise intensity.
The results also showed that sleep onset and wake time increased substantially by 42 minutes and 59 minutes, respectively. Additionally, about 44% of the participants reported worse sleep quality, while 10% experienced improved sleep quality.
As many as 75% of the participants reported being concerned or moderately concerned for their health or their family members’ health (87.5%) due to COVID-19. Reported symptomatic anxiety also significantly increased — by 14% — compared with before the pandemic.
The study results demonstrated incredibly disproportionate changes in health behaviors in individuals with obesity that stemmed from COVID-19 stay-at-home orders.
“Overall, people with obesity improved their diets the most. But they also experienced the sharpest declines in mental health and the highest incidence of weight gain,” says Dr. Leanne Redman, associate executive director for Scientific Education at Pennington Biomedical Research Center.
A total of 24% of the participants with obesity reported symptomatic anxiety compared with 17% for both the individuals with a healthy weight and those with overweight. However, symptomatic anxiety was similar among all three groups before the pandemic.
During lockdown, weight gain occurred in 33% of the individuals with obesity compared with 25% of the participants with a healthy weight and 21% of those with overweight.
Even though the participants with obesity had a lower baseline physical activity than the participants with a healthy weight and the participants with overweight, the change in physical activity was the same across the three groups. The individuals with obesity also had greater sleep onset increases than the people in other two groups, but wake time remained the same.
The self-reported survey study design was a significant limitation due to the possible introduction of recall bias. Another drawback of the study was the lack of diversity of the study population, which primarily comprised older white adult women from similar geographic locations.
Understanding the impact
According to Dr. John Kirwan, executive director of LSU’s Pennington Biomedical Research Center:
“This study is the first to survey thousands of people across the globe on lifestyle behavior changes in response to stay-at-home orders. […] The study demonstrates that chronic diseases like obesity affect our health beyond the physical.”
“Dr. Redman’s study is just one of many initiatives the center launched to help understand COVID-19’s impact and to slow its spread,” he adds.
The lead author of the study, Dr. Emily Flanagan, also notes that the research team would like physicians and scientists to change how they manage patients with obesity by:
- making mental health screenings more frequent during and following the pandemic
- staying in contact with patients and study participants, respectively, with the help of remote visits and telehealth to prevent irreversible changes to health that the pandemic may cause
She also suggests that so-called virtual visits could alleviate the concerns patients may have about the safety of traditional, face-to-face visits.