As an urgent measure to limit the spread of COVID , many governments around the world have established a quarantine, forcing millions of people to stay inside their homes and remain in isolation for a long period. This situation of confinement can lead to weight gain and have negative consequences on the metabolism. The main causes are reduced leisure and outdoor activities, boredom, increased television viewing time, and easy access to food, which can lead to snacking and overeating. In addition, as a result of confinement, regular physical activity may be more difficult to maintain. This contributes to a positive energy balance, in other words, more calories are consumed than burned.
On the other hand, social isolation due to COVID-19 has been associated with psychological, mood, and sleep disorders which, in turn, may negatively influence eating behaviours. In fact, most surveys of the general public have revealed a significant decrease in physical activity and the adoption of negative dietary patterns, with a negative impact on health. According to data obtained from a survey carried out by the Spanish Obesity Society, 44% of Spaniards gained between 1 and 3 kg in weight during lockdown. In addition to poor diet and a sedentary lifestyle, other social aspects showed a relationship with the observed weight gain, for example, income level, size of housing, and educational level. The lower the figures for these data, the greater the weight gain observed.
It is currently estimated that in Spain 60% of the population is overweight, of which more than 20% are obese. People with obesity may be more susceptible to negative health impacts during lockdown. This population is especially vulnerable to psychological distress, eating disorders, and emotional eating. This latter behaviour is defined as a compelling need to eat food, usually something rich in sugars and fats (unhealthy), to quell an emotion, such as anger, fear, stress, or worry. For these reasons, people who are already obese may be the most likely to gain weight. There is an additional disadvantage for some patients, as they have had to interrupt their usual chronic treatment due to changes in hospital activity.
A recent study of patients treated in the Obesity Department at Hospital Clínic, showed that a high level of concern about being infected with SARS-CoV-2 adversely affected the psychological and dietary response to confinement. Participants who were the most concerned showed the worst performance, not only in social and family relationships, mood, and sleep, but also in terms of eating habits and physical activity.
The existence of complex two-way relationships between mental health, loneliness, sleep quality, eating habits, and physical activity is well accepted and demonstrated by numerous research studies. These findings, however, point to the need to provide greater psychological support to people with obesity during this time, especially those with anxiety and reduced family or social support networks. Telemedicine could be a valuable alternative at this time, or under other circumstances where face-to-face contact is not possible, as this communication strategy is rapidly gaining prominence. Appointments via phone call have proven to be effective for obese patients and, in view of the current circumstances and the new normality, everything seems to indicate that this kind of medical practice is here to stay.
Authors: Dr. Violeta Moizé and Alba Andreu, Dieticians-Nutritionists at Hospital Clínic, Barcelona.