Eating in the lockdown during the Covid 19 pandemic; self-reported changes in eating behaviour, and associations with BMI, eating style, coping and health anxiety

[Narratives on changes in health-related behaviours during lockdown in Spain according to gender]

OBJECTIVE

To explore experiences related to health-oriented behaviours during lockdown in the Spanish resident population from a gender perspective.

METHOD

Qualitative research with a critical and feminist approach. Twenty-nine semi-structured interviews (17 women and 12 men) were conducted between June and July 2020 via telephone with people who had previously answered an online survey. The interviews were transcribed and a thematic content analysis was carried out, differentiating between the experiences of women and men. The data were triangulated by the research team.

RESULTS

Among women, greater diversity emerged in terms of health behaviours. Among them, the difficult experiences related to COVID-19, the complexity of living together and doing unpaid care work, as well as the importance of support networks, stood out. Among men, there were different attitudes towards sport, self-care and having time for healthy eating were positively valued, and there was a good assessment of coexistence and organisation in household chores. In both men and women, work overload and economic problems were related to emotional distress and difficulties in carrying out healthy activities.

CONCLUSIONS

Health-oriented behaviours during lockdown differed according to gender. They were mostly limited to COVID-19 experiences, socio-economic conditions and burden of care. It is essential to tailor public health and primary care programmes according to people's life moments, taking into account their social context and questioning traditional gender roles.

Adherence to Mediterranean diet and dietary changes according to the fear of COVID-19 during the pandemic: a cross-sectional study

The coronavirus disease 2019 (COVID-19) has led to the implementation of restrictions to reduce transmission worldwide. The restrictions and measures have affected the psychological health and eating habits. The objective of the present study was to evaluate dietary habits, lifestyle changes, adherence to the Mediterranean diet (MD) and fear of COVID-19 in Turkey during the pandemic. A cross-sectional online survey of socio-demographic characteristics, anthropometric measurements, nutrition, physical activity and lifestyle habits was used for data collection. The fear of COVID-19 levels of the participants was determined by the fear of COVID-19 scale (FCV-19S). The Mediterranean Diet Adherence Screener (MEDAS) was used to evaluate participants' adherence to the MD. The differences between the FCV-19S and MEDAS according to gender were compared. Eight hundred and twenty subjects (76⋅6 % women and 28⋅4 % men) were evaluated within the study. The mean of MEDAS (ranged between 0 and 12) was 6⋅4 ± 2⋅1, and almost half of the participants moderately adhered to the MD. The mean of FCV-19S (ranged between 7 and 33) was 16⋅8 ± 5⋅7, while women's FCV-19S and MEDAS were significantly higher than men's (P < 0⋅001). The consumption of sweetened cereals, grains, pasta, homemade bread and pastries of the respondents with high FCV-19S were higher than in those with low FCV-19S. High FCV-19S was also characterized by decreased take-away food and fast food consumption in approximately 40 % of the respondents (P < 0⋅01). Similarly, women's fast food and take-away food consumption decreased more than men's (P < 0⋅05). In conclusion, the respondents' food consumption and eating habits varied according to the fear of COVID-19.

A cotwin control study of associations between financial hardship and binge eating phenotypes during COVID-19

BACKGROUND

COVID-19 was associated with significant financial hardship and increased binge eating (BE). However, it is largely unknown whether financial stressors contributed to BE during the pandemic. We used a longitudinal, cotwin control design that controls for genetic/environmental confounds by comparing twins in the same family to examine whether financial hardship during COVID-19 was associated with BE.

METHODS

Female twins (N = 158; Mage  = 22.13) from the Michigan State University Twin Registry rated financial stressors (e.g., inability to afford necessities) daily for 49 consecutive days during COVID-19. We first examined whether financial hardship was associated with BE phenotypes across the full sample. We then examined whether cotwins who differed on financial hardship also differed in BE.

RESULTS

Participants who experienced greater mean financial hardship across the study had significantly greater dimensional BE symptoms, and participants who experienced greater financial hardship on a given day reported significantly more emotional eating that day. These results were replicated in cotwin control analyses. Twins who experienced more financial hardship than their cotwin across the study reported greater dimensional BE symptoms than their cotwin, and participants who experienced more financial hardship than their cotwin on a given day reported greater emotional eating that day. Results were identical when restricting analyses to monozygotic twins, suggesting associations were not due to genetic confounds.

CONCLUSIONS

Results suggest that BE-related symptoms may be elevated in women who experienced financial hardship during COVID-19 independent of potential genetic/environmental confounds. However, additional research in larger samples is needed.

PUBLIC SIGNIFICANCE

Little is known regarding how financial difficulties during the COVID-19 pandemic may have contributed to increased binge eating (BE). We found preliminary evidence that financial hardship during COVID-19 may be associated with greater rates of BE-related symptoms even when comparing twins from the same family. While additional research is needed, results suggest that people who experienced financial hardship during COVID-19 may be at increased risk for BE.

Body perceptions, occupations, eating attitudes, and behaviors emerged during the pandemic: An exploratory cluster analysis of eaters profiles

Introduction

COVID-19 pandemic negatively impacted people's mental and physical health. Three areas have been significantly impacted, among others: eating-related behaviors, occupational balance, and exposure to self-image due to videoconferencing. This study aims to explore and document eaters profiles that were reported during the pandemic in the general Canadian population using a holistic perspective, including body perceptions, attitudes, and eating behaviors (i.e., body image, behaviors, attitudes, and motivations regarding food), and occupations (i.e., physical activity and cooking).

Methods

This cross-sectional study was conducted from May to September 2020. Two hundred and seventy-three Canada's residents, French speaking of 18 years of age and older, participated in an online survey on behaviors, attitudes, and motivations regarding food and eating as well as body image and occupations during the COVID-19 pandemic. A hierarchical cluster analysis was used to determine the eaters profiles. One-way ANOVA and Chi-square test were conducted to differentiate occupational characteristics between eaters profiles.

Results

Three distinctive profiles were found during the COVID-19 pandemic and could be placed on a continuum: the Congruent-driven eater is at the functional pole of the continuum, whereas the Incongruent-driven eater is at the dysfunctional pole of the eaters continuum. In the middle of the continuum, the Incongruent-perceptual eater is at a critical crossing point. Significant differences were reported between eaters profiles.

Discussion

The empirical results based on an eaters continuum conceptualization highlight the importance of understanding how people perceive their body to assess and promote food well-being.

The impact of COVID-19 on Black women who binge-eat: a qualitative study

BACKGROUND

Although studies have traced the impact of COVID-19 on those with eating disorders, little is known about the specific impact of the pandemic on Black American women who report disordered eating behaviors and are at risk for eating disorders. Thus, the purpose of this study is to investigate the impact of COVID-19 on Black women who binge-eat.

METHODS

We recruited a purposive sample during the first wave of COVID-19 from the southeastern United States. Participants identified as Black women, reported binge-eating episodes in the last 28 days, and agreed to participate in a semi-structured interview. Prior to the interview, participants were administered a socio-demographic survey and the Eating Disorder Examination-Questionnaire. Interviews were transcribed verbatim and analyzed independently using qualitative content analysis and open coding to identify relevant codes and themes.

RESULTS

On average, participants (N = 20) were 43.05 ± 16.2 years of age and reported 5.6 ± 5.7 binge-eating episodes in the last 28 days. We identified six themes to describe participants' experiences managing their eating behavior during COVID-19: (1) food as a coping strategy; (2) lack of control around food; (3) increased time in a triggering environment (e.g., being at home with an easy availability of food); (4) lack of structure and routine; (5) challenges with limited food availability; and (6) positive impact of the pandemic.

CONCLUSION

In this study, Black women reported challenges managing their eating behavior during COVID-19. Results could inform the development and tailoring of treatments for Black women reporting disordered eating behaviors.

LEVEL OF EVIDENCE

Level V, qualitative interviews.

The impact of the COVID-19 pandemic on individuals with generalized anxiety disorder: assessing COVID-19 media source exposure and behaviour changes

Background

The COVID-19 pandemic that has resulted in social distancing, lockdowns, and increase in media posts has taken a toll on the mental health of many people especially those living with Generalized Anxiety Disorder (GAD). The main objective of this study is to understand whether the source of information people use to receive information about COVID-19 and increase or decrease in personal weekly habits during the pandemic were associated with severity of GAD. 

Methods

This study was a cross sectional design and was based on data from Canada. The Canadian Perspective Survey Series (CPSS) 4, 2020: Information Sourced Consulted During the Pandemic was used for the study. The outcome variable was severity of GAD. Multivariate logistic regression was carried out using STATA IC 13.

Results

Severity of GAD was significantly associated with being a female, the type of information source used to find out about COVID-19 and change in weekly habits (consuming alcohol, consuming cannabis spending time on the internet and eating junk foods or sweets).

Conclusion

The results indicate that getting information from credible sources about the pandemic, staying connected with family and friends, seeking virtual mental health services, and learning positive coping strategies can help reduce the severity of GAD.

Symptoms of mental illness among university student-athletes during the second wave of the COVID-19 pandemic lockdown in Canada

The COVID-19 pandemic lockdown disrupted the university sports season and had negative consequences on the academic and personal life of university student-athletes, resulting in several psychological challenges. The goal of this study is to document the symptoms of mental illness among university student-athletes during the second wave of the COVID-19 pandemic lockdown in Canada. It aims to (a) assess the prevalence of mental illness symptoms (anxiety, depression, disordered eating, and dangerous drinking) among university student-athletes and (b) identify which sociodemographic and sports characteristics, pandemic impacts, and levels of perceived stress most influence these symptoms. A total of 424 university student-athletes completed an online survey, which included questions on mental illness and the impact of the pandemic lockdown. The results revealed a notable prevalence of the symptoms of mental illness; depressive symptoms are reported by 37.9% of the participants, anxiety symptoms by 24.9%, dangerous drinking symptoms by 10.1%, and disordered eating by 8.6%. In addition, being female [OR = 0.56, 95% CI (0.33, 0.95)] or a member of a visible minority group [OR = 2.63, 95% CI (1.02, 6.78)] are significantly associated with the presence of depressive symptoms. Low academic motivation has a significant negative influence on the presence of depressive [OR = 3.37, 95% CI (1.82, 6.25)] and anxiety symptoms [OR = 2.75, 95% CI (1.35, 5.62)]. However, the presence of perceived stress was strongly associated with depressive [OR = 7.07, 95% CI (3.26, 15.35)], anxiety [OR = 6.51, 95% CI (3.30, 12.84)], and dangerous drinking symptoms [OR = 5.74, 95% CI (2.51, 13.14)]. This study advocates for specific mental illness prevention and treatment resources tailored to the unique needs of university student-athletes. Accordingly, partnerships and practical interventions to support university student-athletes' mental health are presented.

Changes in lifestyle behaviors during COVID-19 isolation in Argentina: A cross-sectional study

OBJECTIVE

Our aim was to identify changes in population habits induced by COVID-19 confinement in Argentina.

METHODS

An internet-based cross-sectional survey was conducted among adults in Argentina on December 2020, requesting possible changes occurring during the COVID-19 outbreak. It included 26 questions regarding general information (age, gender, location), eating habits, desire/anxiety for food or to eat between meals, weight gain, physical activity, and hours of sleep. We ran a descriptive statistical analysis of changes in habits and lifestyle during the confinement, followed by a logistic regression analysis to explore the relation between these changes and weight gain. Results: Out of 1536 survey participants, 57.1% were female, aged 38.8 ± 13.1 years. Data showed that during the outbreak, people experienced significant changes in food intake, physical activity, nutritional supplement consumption, anxiety, and sleeping disorders. These changes in behavior resulted in an elevated percentage of people (39.7%) that gained weight (average 4.8 ± 2.8 kg). Weight gain was associated with more food consumption (OR: 9.398), increased snacking between meals (OR: 1.536), anxiety about food (OR: 3.180), less practice of physical activity (OR: 0.586) and less consumption of nutritional supplements (OR: 0.762). Conclusions: COVID-19 outbreak was associated with unhealthy lifestyle changes and body weight increase. These adverse side effects could be prevented by active promotion of nutritional advice and physical activity, implementing virtual activities associated with regular mass promotion campaigns.

High fat diet blunts stress-induced hypophagia and activation of Glp1r dorsal lateral septum neurons in male but not in female mice

OBJECTIVE

While stress typically reduces caloric intake (hypophagia) in chow-fed rodents, presentation of palatable, high calorie substances during stress can increase caloric consumption (i.e. "comfort feeding") and promote obesity. However, little is known about how obesity itself affects feeding behavior in response to stress and the mechanisms that can influence stress-associated feeding in the context of obesity.

METHODS

We assessed food intake and other metabolic parameters in lean and obese male and female mice following acute restraint stress. We also measured real-time activity of glucagon-like peptide-1 (Glp1) receptor (Glp1r)-expressing neurons in the dorsal lateral septum (dLS) during stress in lean and obese mice using fiber photometry. Glp1r activation in various brain regions, including the dLS, promotes hypophagia in response to stress. Finally, we used inhibitory Designer Receptors Activated Exclusively by Designer Drugs (DREADDs) to test whether activation of Glp1r-expressing neurons in the LS is required for stress-induced hypophagia.

RESULTS

Lean male mice display the expected hypophagic response following acute restraint stress, but obese male mice are resistant to this acute stress-induced hypophagia. Glp1r-positive neurons in the dLS are robustly activated during acute restraint stress in lean but not in obese male mice. This raises the possibility that activation of dLS Glp1r neurons during restraint stress contributes to subsequent hypophagia. Supporting this, we show that chemogenetic inhibition of LS Glp1r neurons attenuates acute restraint stress hypophagia in male mice. Surprisingly, we show that both lean and obese female mice are resistant to acute restraint stress-induced hypophagia and activation of dLS Glp1r neurons.

CONCLUSIONS

These results suggest that dLS Glp1r neurons contribute to the hypophagic response to acute restraint stress in male mice, but not in female mice, and that obesity disrupts this response in male mice. Broadly, these findings show sexually dimorphic mechanisms and feeding behaviors in lean vs. obese mice in response to acute stress.

Emotional eating experiences of individuals with severe mental disorders: A qualitative study

PURPOSE

The aim of this study is to understand the emotional eating experiences of individuals with severe mental disorders.

DESIGN AND METHODS

The study used a descriptive qualitative design. Data were collected from 19 individuals who displayed emotional eating behavior and a severe mental disorder.

FINDINGS

The main themes of this study are "Triggers," "Emotional Eating Process," and "Feelings after Emotional Eating." Participants stated that negative emotions and certain initiating factors were the triggers of their emotional eating; they also experienced feelings of regret and guilt after emotional eating.

PRACTICE IMPLICATIONS

It was concluded that programs for regulating the eating behaviors of individuals with severe mental disorders should be organized and that psychosocial interventions to prevent emotional eating among these individuals should be integrated into the programs' contents.

Nutritional behavior during the COVID-19 pandemic: the association of fear and sleep quality with emotional eating

PURPOSE

Even though it is known that fear and poor sleep quality trigger emotional eating, whether fear and poor sleep quality are associated with emotional eating during the COVID-19 pandemic is not clear. This study aimed to evaluate the association of fear of COVID-19, sleep quality, and some sociodemographic characteristics with emotional eating during the COVID-19 pandemic.

METHOD

This cross-sectional descriptive study was completed with 495 participants in Turkey. The participants filled out a questionnaire that asked about sociodemographic characteristics, fear of COVID-19, nutritional behaviors, sleep quality, and self-reported weight and height through email or social media.

RESULTS

The fear of COVID-19 score (β: 0.090, p < 0.05) and sleep quality score (β: 0.289, p < 0.001) were associated with the emotional eating score at the rate of 0.8% and 8.3%, respectively. The association of fear of COVID-19 with emotional eating disappeared when combined with various factors. The collective association of all factors, fear of COVID-19 (β: 0.042, p > 0.05), sleep quality (β: 0.246, p < 0.001), BMI (β: 0.275, p < 0.001), age (β:  - 0.259, p < 0.001) and gender (β:  - 0.169, p < 0.001) were associated with the emotional eating score at the rate of 18.3%.

CONCLUSIONS

These findings suggest that fear of COVID-19, sleep quality, BMI, age, and gender were associated with emotional eating during the pandemic. We hope that this study will help in the development of guidelines and strategies through understanding the factors associated with nutritional behavior during the pandemic period.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Relationship between Mental Health and Emotional Eating during the COVID-19 Pandemic: A Systematic Review

Obesity is one of the most dangerous epidemics of the 21st century. In 2019, the COVID-19 pandemic began and caused many deaths among patients with obesity with and without complications. Simultaneously, the lockdown related to the COVID-19 pandemic caused a host of emotional problems including anxiety, depression, and sleep disturbances. Many people began to cope with their emotions by increasing food (emotional eating) and alcohol consumption and in combination with decreased physical activity, promoted the development of overweight and obesity. Emotional eating, also known as stress eating, is defined as the propensity to eat in response to positive and negative emotions and not physical need. It should be noted that emotional eating may be the first step in the development of binge eating disorder and its extreme subtypes such as food addiction. Interestingly in some post-bariatric surgery patients, an increased frequency of addictive disorders has been observed, for example food addiction replaced by alcohol addiction called: “cross addiction” or “addiction transfer”. This data indicates that obesity should be treated as a psychosomatic disease, in the development of which external factors causing the formation of negative emotions may play a significant role. Currently, one of these factors is the COVID-19 pandemic. This manuscript discusses the relationships between the COVID-19 pandemic and development of emotional eating as well as potential implications of the viral pandemic on the obesity pandemic, and the need to change the approach to the treatment of obesity in the future.

Cognitive restraint, emotional eating and uncontrolled eating: Exploring factors associated with the cycle of behaviors during the COVID-19 pandemic

The objective of this study was to analyze the factors associated with Cognitive Restraint, Emotional Eating, and Uncontrolled Eating behaviors with perceptions of life habits, body image, eating habits, and food consumption during the COVID-19 pandemic. Sociodemographic data, eating behavior, perceptions about life and eating habits, body image, and food consumption were collected. Factors associated with each of the three eating behaviors were accessed through three multiple linear regressions controlled for age, sex, BMI, education level, and monthly income. Cognitive restraint was associated with being active during the pandemic (β = 5.85), attempted weight loss (β = 11.89), perception of overweight (β = 9.10), better eating habits in the pandemic (β = 6.55), and decreased consumption of refined cereals (β = 5.60) and fast foods (β = 8.23). Emotional eating was associated with increased stress during the pandemic (β = 7.10), worse sleep (β = 4.74), body dissatisfaction (β = 4.85), perception of overweight (β = 7.45), attempted weight loss (β = 4.19), increase in the amount of food consumed (β = 9.34), increased food delivery purchase (β = 5.13), increase in consumption of sweets and desserts (β = 7.17) and reduction in consumption of vegetables (β=- 5.26). Uncontrolled eating was associated with working>8 h/day (β = 4.04), increased stress during the pandemic (β = 3.65), body dissatisfaction (β = 6.59), worse eating habits in the pandemic (β = 5.21), and an increase in the amount of food consumed (β = 8.73). Cognitive restraint behavior was associated with healthy life habits and negative body image variables. In contrast, emotional eating and uncontrolled eating were associated with negative body image and unhealthy eating habits.

How did the COVID-19 pandemic influence health-related behaviour? An online survey on food choice, physical activity and changes in body weight among Swiss adults

The COVID-19 pandemic has affected all aspects of our everyday lives. To investigate these behaviour changes, an online survey was conducted with 1'028 individuals (51% female) in Switzerland between June and July 2020. The questions referred in particular to the lockdown in spring 2020. We put specific focus on the pandemic's impact on health-related behaviour, which includes food choice, physical activity and body weight management. For instance, participants reported whether and how their consumption of different foods changed during the lockdown. As a measure of healthy food choice, we chose consumption of vegetables and salad and in contrast, sweet snacks and alcohol consumption was used as a measure for unhealthy food choice. For physical activity and body weight, participants indicated whether it decreased, increased or did not change during the lockdown as compared before. In a next step, we investigated the influence of various predictors on health-related behaviour using multinomial logistic regression models. We find that the possibility to work remotely led to healthier food choices, that is, a reported increase in vegetable consumption and decrease in sweet snack consumption, but also to more unhealthy food choices and lifestyles, that is, a reported increase in alcohol consumption as well as an increase in sweet snack consumption. For weight change, the data indicated that individuals who worked remotely were more likely to gain or lose weight than individuals working from the office. Our findings demonstrate how individuals are affected differently by the pandemic and how complex the whole picture is. Further, these results are crucial in developing health recommendations for possible future lockdowns or health crises in general.

Time estimation and passage of time judgment predict eating behaviors during COVID-19 lockdown

Poor eating habits often lead to health concerns. While mental health conditions such as stress and anxiety have been linked as predictors for eating behaviors, cognitive factors may also contribute to eating practices during the early stages of the mandatory COVID-19 lockdown. In the current study, participants responded to a survey that asked them to judge the passing of time (PoTJ) and to produce short intervals (via a time production task) as an index of the internal clock speed. Additionally, they responded to questions about snacking frequency and the tendency to overeat during lockdown. We observed that those who judged time to pass slowly also reported a greater tendency to snack and overeat during the pandemic. Additional analysis also revealed that the effect of PoTJ on snacking is moderated by the internal clock speed such that those who felt time was passing by slowly, and in combination with a faster internal clock (as indexed by shorter duration production), had a greater tendency to snack. The results suggest that different aspects of temporal cognition play potential roles in influencing different types of eating behaviors. Our findings therefore have implications for eating disorders, along with the potential of time-based intervention or behavioral modification approaches.

Changes in dietary patterns among Bangladeshi adult population during the COVID-19 pandemic: A web-based cross-sectional study

Background

The home confinement induced by the COVID-19 pandemic affects individuals' mental wellbeing and increases unhealthy behaviors, such as minimum to no physical activity, overeating, and substance use.

Objective

This study aimed to assess the changes in dietary patterns among the Bangladeshi adult population during the COVID-19 pandemic and identify their determinants.

Methods

This web-based cross-sectional survey was carried out from 10-17 December 2020 using an e-questionnaire based on Google Forms. A semi-structured e-questionnaire was forwarded to the participants - Bangladesh citizens aged above 18 years - through social media platforms and email in order to collect information about socio-demographic issues and multidimensional dietary patterns. From the initial 817 responses gathered through snowball sampling, 748 responses were retained. Bivariate and multivariate analyses were executed.

Results

The findings suggest that 50% of the participants reported a reduction in weight and physical activities, while approximately 52% experienced increased sleep time. One in three participants (31.4%) experienced a decrease in food buying capacity. The findings further indicate that women were 1.65 times more likely to reduce food consumption than men. Meanwhile, employed people were about 34% less likely to increase food consumption than their unemployed counterparts. People who were getting more than 6 h of sleep per day were nearly 61% less likely to increase food consumption than people who slept for less than 6 h per day. People struggling to buy food items were 2.31 times more likely to reduce food intake than people with no such limitations.

Conclusions

The study shows that COVID-19 has substantially affected Bangladeshi people's common food consumption patterns. Being confined within the household, primarily due to countrywide lockdowns and 'general holidays', has affected both the dietary patterns and the financial wellbeing of people. Therefore, the concerned authorities should promote effective nutrition education and healthy dietary behaviors; meanwhile, financial support or incentives for people in need are also strongly advocated.

The associations among psychological distress, stressors of the COVID-19 pandemic, and disinhibited eating of parents of three- to five-year-old children

Individuals' psychological distress is associated with disinhibited eating (external and emotional eating). The aim of the current study was to examine the moderating associations of COVID-19-related stress on parents' psychological distress (anxiety, hostility, depression) and external and emotional eating. One hundred and sixty U.S. parents of three- to five-year-old children (Mage = 34.08, SD = 6.76; 89 females) completed an online survey. After accounting for participant characteristics (i.e., age, BMI, sex), regression analyses showed that COVID-19 stress moderated the effects of anxiety, hostility, and depression on external eating. Additionally, findings showed that COVID-19 stress moderated hostility (but not anxiety or depression) on emotional eating. These findings suggest that unexpected stressors from the COVID-19 pandemic may exacerbate disinhibited eating among those individuals who experience psychological distress. This presents support for providing interventions that focus on healthy coping strategies and family well-being, support groups, and community resources (e.g., financial assistance) to alleviate external pressures during unprecedented times.

Comparison of Pregnancy and Birth Outcomes Before vs During the COVID-19 Pandemic

Importance

Little is known about changes in obstetric outcomes during the COVID-19 pandemic.

Objective

To assess whether obstetric outcomes and pregnancy-related complications changed during the COVID-19 pandemic.

Design, Setting, and Participants

This retrospective cohort study included pregnant patients receiving care at 463 US hospitals whose information appeared in the PINC AI Healthcare Database. The relative differences in birth outcomes, pregnancy-related complications, and length of stay (LOS) during the pandemic period (March 1, 2020, to April 31, 2021) were compared with the prepandemic period (January 1, 2019, to February 28, 2020) using logistic and Poisson models, adjusting for patients' characteristics, and comorbidities and with month and hospital fixed effects.

Exposures

COVID-19 pandemic period.

Main Outcomes and Measures

The 3 primary outcomes were the relative change in preterm vs term births, mortality outcomes, and mode of delivery. Secondary outcomes included the relative change in pregnancy-related complications and LOS.

Results

There were 849 544 and 805 324 pregnant patients in the prepandemic and COVID-19 pandemic periods, respectively, and there were no significant differences in patient characteristics between periods, including age (≥35 years: 153 606 [18.1%] vs 148 274 [18.4%]), race and ethnicity (eg, Hispanic patients: 145 475 [47.1%] vs 143 905 [17.9%]; White patients: 456 014 [53.7%] vs 433 668 [53.9%]), insurance type (Medicaid: 366 233 [43.1%] vs 346 331 [43.0%]), and comorbidities (all standardized mean differences <0.10). There was a 5.2% decrease in live births during the pandemic. Maternal death during delivery hospitalization increased from 5.17 to 8.69 deaths per 100 000 pregnant patients (odds ratio [OR], 1.75; 95% CI, 1.19-2.58). There were minimal changes in mode of delivery (vaginal: OR, 1.01; 95% CI, 0.996-1.02; primary cesarean: OR, 1.02; 95% CI, 1.01-1.04; vaginal birth after cesarean: OR, 0.98; 95% CI, 0.95-1.00; repeated cesarean: OR, 0.96; 95% CI, 0.95-0.97). LOS during delivery hospitalization decreased by 7% (rate ratio, 0.931; 95% CI, 0.928-0.933). Lastly, the adjusted odds of gestational hypertension (OR, 1.08; 95% CI, 1.06-1.11), obstetric hemorrhage (OR, 1.07; 95% CI, 1.04-1.10), preeclampsia (OR, 1.04; 95% CI, 1.02-1.06), and preexisting chronic hypertension (OR, 1.06; 95% CI, 1.03-1.09) increased. No significant changes in preexisting racial and ethnic disparities were observed.

Conclusions and Relevance

During the COVID-19 pandemic, there were increased odds of maternal death during delivery hospitalization, cardiovascular disorders, and obstetric hemorrhage. Further efforts are needed to ensure risks potentially associated with the COVID-19 pandemic do not persist beyond the current state of the pandemic.

Snapshot of health-related behaviours in adults living with disabilities 1 year into the COVID-19 pandemic: a cross-sectional survey study

OBJECTIVES

This survey aimed to assess the status of a range of health-related behaviours 1 year after the coronavirus outbreak was declared a pandemic in adults living with disabilities comparative with those with no disabilities.

DESIGN

This cross-sectional study reports findings from an online survey conducted in March 2021. Mann-Whitney U and Χ2 tests were used to compare a range of health behaviours including time spent self-isolating, smoking, alcohol consumption, exercise frequency and diet in adults with and without disabilities.

SETTING

A convenience sample of UK adults was recruited through the researchers' personal and professional networks including UK-based sight loss sector charities, social media platforms and professional forums.

PARTICIPANTS

A total of 123 UK participants completed the survey.

OUTCOME MEASURES

COVID-19 diagnosis, time spent self-isolating, alcohol consumption frequency, exercise frequency, change in smoking habit and eating habits.

RESULTS

No significant differences were found in alcohol consumption, smoking, water intake, breakfast, or fruit and vegetable intake. There were statistically significant differences in the time spent self-isolating (U=2061, p=0.001), exercise frequency (U=1171.5, p=0.005) and the amount of food eaten (χ2 (2)=9.60, p=0.008, Cramer's V=0.281). Although the majority in both groups reported exercising three to four times per week and eating what they should, those with disabilities were more likely to eat less than they should, not exercise at all and to have been self-isolating for over 6 months than participants with no disabilities.

CONCLUSIONS

The data in this study present some key differences between the two groups, with those living with disabilities being more likely to report that they had been self-isolating for prolonged periods of time, not exercising at all, and not eating as much as they should . This raises concerns for the health and well-being of individuals with disabilities.

Change of Dietary and Lifestyle Habits during and after the COVID-19 Lockdown in Cyprus: An Analysis of Two Observational Studies

Background: People’s dietary and lifestyle habits appeared to be influenced by restrictive measures imposed in response to the COVID-19 pandemic. This study examines the differences in dietary and lifestyle habits during and after the lockdown measures in Cyprus. Methods: Two online cross-sectional surveys were conducted, using a self-administered, anonymous questionnaire to collect information on sociodemographic and anthropometric characteristics, smoking habits, physical activity, and dietary habits. The first survey was conducted between 6 April 2020 and 20 June 2020 (during national lockdown) while the second survey was conducted between 27 October 2021 and 20 January 2022 (post-lockdown). Results: A total of 2503 individuals participated in the study. A higher consumption of fruits, vegetables, legumes/pulses, fish, and poultry was identified during lockdown compared to the period after the lockdown. Moreover, a greater daily intake of olive oil and a lower consumption of alcohol was found during the confinement period compared to the post-confinement period. During lockdown, most participants (43.0%) never or rarely used delivery services, while the largest proportion of the participants after lockdown used delivery services 1−3 times per month (37.0%) (p < 0.001). During lockdown, around 66% of the participants were physically active, compared to 55.5% after lockdown (p < 0.001). Furthermore, when compared to those with a normal BMI, more overweight and obese respondents ordered food 1−2 times per week in both periods (p < 0.001). Conclusions: Dietary and lifestyle habits of the participants were healthier throughout the lockdown period than after the end of the restrictive measures due to the COVID-19 pandemic. It is critical to encourage the Cypriot population to maintain the healthy dietary and lifestyle habits established during the lockdown in their daily lives after the confinement.

Health and health inequalities impact assessment for non-clinical measures to control COVID-19 in the Basque Country and Navarre (Spain)

This article describes the results of a health and health inequalities impact assessment of the COVID-19 pandemic control measures in the regions of the Basque Country and Navarre in Spain. A literature review was conducted on Pubmed and Web of Science (WoS) databases, in addition to individual semi-structured interviews and focus groups with experts, key informants and different profiles of citizens. A wide variety of social determinants of health have been affected by the measures, which included individual health-related behaviors, service disruption in formal care, educational settings, and health care provision. These changes have particularly affected certain population groups including children and adolescents, older people, those with health conditions and disabilities together with caregivers, women, as well as people with low levels of education, income, and resources. In future scenarios it will be necessary to pay attention to the potential impacts of policy responses on health inequalities to avoid an increase in existing health gaps.

Subjective socioeconomic disadvantage is indirectly associated with food portion selection through perceived disruption of personal resources during a nationwide COVID-19 stay-at-home order

In addition to its public health implications, the global COVID-19 pandemic has also produced significant disruptions to individuals' socioeconomic resources and opportunities. Prior research has suggested that low subjective socioeconomic status (SSES) may stimulate appetite and motivate increased energy intake. Here, we tested whether individuals experiencing lower levels of SSES (SSES disadvantage) during a nationwide stay-at-home order for COVID-19 exhibited preferences for larger food portion sizes through perceived disruptions to personal financial and material resources. Data was collected near the conclusion of a nationwide partial lockdown (Singapore's “Circuit-Breaker” from April to June 2020). Participants (N = 295) completed an online survey involving a measure of SSES, the Coronavirus Impacts Questionnaire, and a food portion selection task where participants estimated the portion size they prefer to consume for a range of common foods. SSES disadvantage was associated with selection of smaller average portion sizes. Yet, a significant indirect effect of coronavirus impact was observed in this relationship, such that participants experiencing greater SSES disadvantage selected larger portion sizes through the effect of greater perceived impacts of COVID-19 to one's financial/material resources (controlling for one's actual level of income). These findings further support the idea that perceived deprivation and insecurity of important resources (financial, social, material) may influence intentions to consume greater amounts of energy. Consequently, systematic societal disruptions to such resources may reinforce and perpetuate potentially obesogenic eating behaviors of populations that are especially vulnerable to such shocks (i.e., people experiencing SSES disadvantage).

Changes in patterns of eating habits and food intake during the first German COVID-19 lockdown: results of a cross-sectional online survey

Purpose

The COVID-19 pandemic and public measures have a direct impact on the nutrition situation; studies show changes in food consumption, eating behavior or body weight but complex pattern analyses of changes rarely exist.

Methods

During the first German lockdown, a web-based survey was conducted among adults. It included 33 questions about changes in food intake, eating habits and physical activity, as well as anthropometrics and sociodemographic factors. Patterns of change were calculated based on changes in food intake and eating habits using two-step cluster analysis. To identify influencing factors for assignment to the patterns of change, binary logistic regression analyses were performed.

Results

Data from 2103 participants (81% female, 40 ± 14 years) were considered for analysis. Increased stockpiling, cooking, and variation in preparation was reported by 50–70%. The constant pattern (C-P, 36%) reported little change besides the above. The health-oriented pattern (HO-P; 37%) reported eating more healthy foods, avoiding unhealthy foods, and eating less and less frequently. The emotional-driven pattern (ED-P; 28%) exhibits higher influence of emotions on eating behavior, less avoidance of unhealthy foods, and increased consumption of sweets, pastries, and alcohol. The odds of changing eating behavior either to HO-P or ED-P were higher in women, people with migration background, younger participants, and increased with BMI categories.

Conclusion

Both, the ED-P and HO-P, exhibit distinctive reactions in eating habits and food intake when dealing with a distressing experience. In subgroups, these may lead to disturbances in eating behavior and increase the risk for eating disorders and obesity.

Impacts of COVID-19 Sanitary Cues on Hedonic Appreciation of Foods

The COVID-19 pandemic led to several lifestyle changes, including eating behavior. Herein, we aimed to evaluate how pandemic-related sanitary cues presented in food videos impact food appraisal and desire to eat, and their priming after-effects on subsequent food pictures presented without such cues. In two online sessions, separated by 4 to 7 days, participants watched either a Non-Pandemic or a Pandemic video of a woman eating, the latter containing sanitary elements adopted during the pandemic. The order of the videos was counterbalanced across participants over the two experimental sessions. Videos were followed by images of food from different categories. After observing both videos and each picture, participants were instructed to evaluate the visual aspect, expected smell and flavor, and rate their desire to eat. Our study demonstrated (1) higher hedonic responses to the Non-Pandemic compared to the Pandemic video, (2) a priming effect showing higher appreciation for sweet foods after the Non-Pandemic compared to the Pandemic video, (3) that food exposure gradually increases one's desire to eat, but such effects are impacted by pandemic sanitary cues, and (4) greater hedonic responses are given for sweet and high-calorie foods compared to salty and low-calorie ones, irrespective of pandemic priming. Finally, depression and anxiety symptoms were associated with lower smell evaluations only in the Pandemic condition.

Design of experiments meets immersive environment: Optimising eating atmosphere using artificial neural network

Design of experiments (DOE) is a family of statistical tools commonly used in food science to optimise recipes and facilitate new food development. In a novel cross-disciplinary twist, we propose to adapt DOE approach to the optimisation of restaurant atmosphere. In this study, an artificial neural network (ANN) with particle swarm optimisation algorithm (PSO; hereafter ANN-PSO) was selected and compared with classical Response Surface Method (RSM) as ANN-PSO has been reported to yield better reliability and predictability compared to RSM. Recent research has increasingly demonstrated that perceived food quality, enjoyment, and willingness to pay are influenced by contextual factors such as lighting, decoration, and background noise/music. Moreover, virtual reality (VR) technology, which has become increasingly accessible, sophisticated, and widespread over the past years, presents a new way to study scenarios which may be otherwise too expensive/implausible to test in real life this includes delivering immersive environment. We hereby demonstrate a novel proof-of-concept study by varying the degree of illumination and of background sound level in an immersive restaurant setup. Participants (N = 283) watched immersive 360° videos while rating situational appropriateness and food wanting for two different dishes in various ambient conditions as determined by DOE's Central Composite Design (CCD). Participants did not actually consume the foods but rather only viewed them. Optimal restaurant lighting and sound levels were then estimated using ANN-PSO model which was found to be at 289 lux and -21.38 Loudness Unit Full Scale (LUFS) for burger and 186.9 lux and -30 LUFS for pizza. While the results of our study are of obvious interest to those in the hospitality industry, this work further highlights the transferability of methods across different disciplines and the applicability of time-tested methods to new emerging areas.

Food Insecurity, Dietary Diversity, and Coping Strategies in Jordan during the COVID-19 Pandemic: A Cross-Sectional Study

The 2019 coronavirus disease (COVID-19) is an emerging respiratory infection with severe impacts on the nutritional status of the worldwide population. This cross-sectional study was conducted to assess the food insecurity, dietary diversity, and food-related coping strategies in Jordan during the pandemic using an online, self-administered questionnaire. Among the 740 adults who completed the survey, the prevalence of food security was 84.1%, whereas 2% and 13.9% were moderately and severely food-insecure, respectively. The determinants of food insecurity were educational level, monthly income, marital status, availability of health insurance, and type of residence. In addition, food insecurity was significantly higher among the participants who consumed two or fewer meals per day (p = 0.015). Moreover, an acceptable food consumption score was shown among 76.2% of the participants, and the remaining participants were at borderline (14.1%) or had poor scores (9.7%), with a significant association between food insecurity and food consumption scores (p < 0.001). The food-related coping strategies studied were significantly associated with food insecurity at both levels (p < 0.001) and were more evident in the severely food-insecure group. These findings highlight the adverse effects of COVID-19 restrictions on nutritional status, especially among food-insecure households, which might reduce food accessibility due to economic difficulties.

Women's health status before and during the COVID-19 pandemic in rural Bangladesh: A prospective longitudinal study

The coronavirus disease (COVID-19) pandemic has widely spread worldwide since 2020. Several countries have imposed lockdown or stay-at-home policies to prevent the infection. Bangladesh experienced a lockdown from March 2020 to May 2020, and internal travel was restricted. Such long and strict confinement may impact women's health. Herein, we aimed to assess the impact of the COVID-19 pandemic on women's health by comparing their health status before and during the pandemic. We conducted a prospective longitudinal study in two zones in the Chhaygaon union, rural district Shariatpur, Bangladesh. The study population comprised non-pregnant women aged 15-49 years. We visited the household of all eligible women and invited them for health checkups. The survey staff examined their health status at the checkup camps and conducted questionnaire interviews. In total, 121 non-pregnant women received health checkups both from June 2019 to July 2019 and in October 2020, before and during the COVID-19 pandemic, respectively. Compared with those during the 2019 health checkup, the medians of body mass index, systolic blood pressure, and diastolic blood pressure were significantly higher (22.7 kg/m2 to 23.6 kg/m2; 110.0 mmHg to 111.0 mmHg; and 73.0 mmHg to 75.0 mmHg, respectively, p<0.05) during the 2020 health checkup. In contrast, urine glucose levels were significantly lower (10.1% to 3.4%, p = 0.021). The lack of physical activity and other inconvenience accumulation caused by the prolonged confinement might have affected their health status. This necessitates local health workers to promote physical activity to prevent health deterioration during the pandemic.

How has physical distancing impacted on health and well-being during the COVID-19 pandemic? A Scottish longitudinal qualitative study

OBJECTIVES

This study provides an in-depth understanding of the impact of physical distancing restrictions and other quarantining measures during the first 6 months of the COVID-19 pandemic on physical and mental health and well-being.

DESIGN

Longitudinal qualitative research using semistructured interviews at two time points (21 May to 10 June 2020 when the first restrictions were eased, and 2 to 26 August 2020 when many restrictions had been eased, but physical distancing measures remained) and framework analysis.

SETTING

Interviews by telephone or video call in Scotland.

PARTICIPANTS

Thirty participants: 16 women, 93% reporting white ethnicity, 18+ years, 47% from deprived areas, 47% reported mental and/or physical health conditions.

RESULTS

Four main themes described the impact of physical distancing restrictions on (1) health behaviours; (2) healthcare access; (3) physical health; and (4) mental health. Changes in impact over the two time points were compared. For example, health behaviours in May/June, such as reduced physical activity and increased calorie intake, appeared to improve by August. From May/June to August, an increasing number of participants expressed dissatisfaction with healthcare they received. Participants with existing physical health conditions reported continued negative impact of restrictions on their physical health. All participants reported some negative mental health impact, mostly anxiety. An increasing number reported mental health improvements in August, with those with mental health conditions or under 30 years reporting improvement most frequently.

CONCLUSIONS

In line with previous research, our participants felt able to return to prepandemic health habits. Our findings corroborate evidence of reduced preventive healthcare use and help-seeking behaviours. People with existing health conditions appear to be most vulnerable to negative mental and physical health impacts of physical distancing. These negative impacts and periods of unhealthy behaviours have potential long-term consequences, especially among already underserved groups. We recommend public health and policy strategies to mitigate long-term impacts of physical distancing.

Lifestyle changes during the coronavirus disease 2019 pandemic impact metabolic dysfunction-associated fatty liver disease

BACKGROUND AND AIMS

The coronavirus disease 2019 (COVID-19) pandemic precipitated lifestyle changes. We aimed to clarify whether COVID-19-induced lifestyle changes affected the development of metabolic dysfunction-associated fatty liver disease (MAFLD).

METHODS

This retrospective longitudinal study included 973 participants who underwent health check-ups between 2018 and 2020. We used data from the MedCity21 health examination registry. Participants' clinical characteristics and lifestyle habits were investigated. Independent lifestyle predictors of MAFLD development before the pandemic (2018-2019) and during the pandemic (2019-2020) were identified using logistic regression analysis.

RESULTS

In 2018, 261 (27%) patients were diagnosed with MAFLD. Before the pandemic, 22 patients developed new MAFLD. During this time, routine late-night meals were identified as an independent lifestyle predictor of MAFLD development (hazard ratio [HR] 2.54, 95% confidence interval [CI] 1.02-6.36, P = .046). In contrast, 44 patients developed new MAFLD during the pandemic. During this time, higher daily alcohol intake was identified as an independent lifestyle predictor of MAFLD development (HR 1.03, 95% CI 1.01-1.05, P = .008). In participants aged <60 years, daily alcohol intake and the proportion of participants who ate 2 times/day were significantly higher in patients who developed MAFLD during the pandemic than in those who did not. In participants aged ≥60 years, no lifestyle habits were associated with MAFLD development before or during the pandemic.

CONCLUSIONS

New MAFLD diagnoses increased during the COVID-19 pandemic. Changes in lifestyle factors, particularly in those aged <60 years, must be monitored and addressed as the pandemic continues.

Is Covid‐19 changing sustainable consumer behavior? A survey of Italian consumers

Since the beginning of 2020, the world has been hit by the SARS‐CoV‐2 virus that causes Covid‐19. To hamper its spread, policymakers of many countries have put in place strong countermeasures, including lockdowns, that have led to significant changes in people's lifestyles and daily routines. This article aims at assessing the changes caused by Covid‐19 in sustainable consumer behavior under multiple perspectives, contributing to advance knowledge at the intersection between consumer dynamics and sustainable consumer behavior literature. A survey was conducted on 1.535 Italian consumers between December 2020 and February 2021. Respondents were asked to assess the extent to which their consumption behavior—purchase frequency, willingness to pay a premium price, sense of moral duty to purchase, social influence to purchase—related to several categories of sustainable products changed due to the pandemic, as well as the extent to which the pandemic impacted on many other aspects, including their environmental awareness, concern, and habits. Results show that Covid‐19 generated relevant changes. Consumers have increased their purchase frequency and willingness to pay for sustainable products, show growing attention to environmental issues, and behave more sustainably. Further, the extent of change is strongly affected by socio‐demographic variables, such as gender, age, income, and education. For instance, women reported a higher shift towards sustainable consumption and behavior than men. Understanding these changes is important to guide marketers and policymakers to respond promptly and effectively to them and to leverage on them to foster a transition towards a more sustainable society.

Psychological impact of the quarantine during the COVID-19 pandemic on the general European adult population: a systematic review of the evidence

AIMS

Due to the coronavirus disease 2019 (COVID-19) different countries implemented quarantine measures to limit the spread of the virus. Many studies analysed the mental health consequences of restrictive confinement, some of which focused their attention on specific populations. The general public's mental health also requires significant attention, however. This study aimed to evaluate the effects of the COVID-19 quarantine on the general population's mental health in different European countries. Risk and protective factors associated with the psychological symptoms were analysed.

METHODS

A systematic search was conducted on four electronic databases (PubMed, PsycINFO, Scopus and Google Scholar). Studies published up until 20th April 2021, and following eligibility criteria were selected for this review. One thousand three hundred thirty-five (1335) studies were screened, 105 of which were included. Via network analysis, the current study investigated the pathways that underlie possible risk factors for mental health outcomes.

RESULTS

Anxiety, depression, distress and post-traumatic symptoms are frequently experienced during the COVID-19 quarantine and are often associated with changes in sleeping and eating habits. Some socio-demographic and COVID-19-related variables were found to be risk factors for an individual's wellbeing. In particular, being female, young, having a low income, being unemployed and having COVID-19-like symptoms or chronic disorders, were found to be the most common risk factors for mental health symptoms.

CONCLUSIONS

The COVID-19 pandemic represented an unprecedented threat to mental health globally. In order to prevent psychological morbidity and offer support tailored to short-, medium- and long-term negative outcomes, it is essential to identify the direct and indirect psychosocial effects of the lockdown and quarantine measures, especially in certain vulnerable groups. In addition to measures to reduce the curve of viral transmission, policy makers should urgently take into consideration provisions to alleviate hazards to mental health.

Adherence to the Mediterranean Diet and COVID-19: A Segmentation Analysis of Italian and US Consumers

The COVID-19 pandemic has led many countries to implement restrictions on individual freedom to stop the contagion. The imposition of lockdowns has affected many socio-economic aspects and, in particular, eating habits, highlighting the need to analyse the healthiness of new consumption patterns. The aim of our study was to investigate the changes in adherence to the Mediterranean diet, a dietary model universally recognized as healthy, that have occurred both during and since the lockdown. The subsequent profiling of consumers allowed us to understand which sociodemographic and psychographic factors favoured the development of more or less adherence to Mediterranean diet consumption patterns. The study was conducted by administering a questionnaire to a representative sample of Italians and New Yorkers. Both groups, defined by deep socio-economic differences and by their own eating habits compared to the Mediterranean diet model, were affected by similar lockdown measures. The data collected were processed by cluster analysis that allowed to identify four homogeneous groups with respect to the adherence to the Mediterranean diet model. The results highlight a worrying situation with respect to the impacts of the pandemic on maintaining a proper dietary style according to the principles of the Mediterranean diet. In fact, there has been a general worsening trend due to an increase in consumption, in part linked to emotional eating, which is a cause for concern about the potential future impacts on the health of consumers. The study highlights the need, therefore, to implement actions by public decision-makers aimed at raising the awareness of citizens on the issue of correct eating habits and at developing adequate food policies to stem the trend towards unhealthy diets.

Nutritional and health behaviour predictors of the weight gain during the COVID-19 pandemic

Purpose

This study aims to examine the effects of the COVID-19 pandemic on the body weight, nutritional habits, physical activity, and food consumption of adults living in Turkey and evaluate the effects of changes in these health behaviours on body weight.

Methods

A cross-sectional study was conducted with an online questionnaire. Data were collected through social media platforms using the snowball sampling method. A self-reported questionnaire included socio-demographic information, anthropometric data, dietary habits, food consumption, and lifestyle changes. In this study, 4181 people were included. Logistic regression analysis was used to evaluate the variables associated with the increase in body weight.

Results

The findings obtained in this study showed that the bodyweight of 58.5% of the participants increased during the COVID-19 pandemic, and this increase was the highest (66.3%) among the obese. The rate of those who stated that their physical activity decreased was 69.5%. The foods consumed the most by individuals were homemade desserts (54%), nuts (53.8%) and fresh fruits (52.3%). Those whose serving size increased [OR = 4.98 (3.76–6.60)], those whose physical activity decreased or increased [OR = 2.94 (2.38–3.63) or 2.52 (1.84–3.45), respectively], and those whose number of main meals consumed increased [OR = 2.17 (1.72) − 2.75)], those with increased consumption of white bread (OR = 1.63 (1.20–2.22) and those with increased consumption of packaged sweet products [OR = 1.53 (1.23–1.89)] were more likely to gain weight.

Conclusion

The results of this study show that there are significant changes in the body weight, physical activities, and eating habits of the participants during the COVID-19 pandemic. It is necessary to provide and follow-up specific guidance and support services for different groups to protect public health, improve and prevent nutrition-related diseases.

Individual and Interpersonal Factors Affecting Dietary Intake of Community-Dwelling Older Adults during the COVID-19 Pandemic

OBJECTIVE

As older adults are at higher risk for severe illness and mortality from SARS-CoV-2 infection, social distancing has been a primary means of mitigating risk. However, this lifestyle change may impact eating habits and food choices. The aim of this study was to explore individual and interpersonal factors affecting the eating behaviors and dietary intake of community-dwelling older adults during the COVID-19 pandemic.

DESIGN

Semi-structured individual interviews were conducted. All interviews were audio-recorded and transcribed verbatim. Qualitative data were analyzed using a deductive content analysis approach to identify themes.

SETTING

Southeastern United States.

PARTICIPANTS

Twenty-three men and women, 60 years of age and older (mean age 71.9 ± 7.7, 22% male) completed both the interview and questionnaire.

RESULTS

Themes that emerged at the individual level included changes in eating habits and foods eaten, with most participants reporting healthier food choices during the pandemic. Participants also reported more frequent cooking, improved cooking skills, and cooking as a form of stress relief. Although some older adults described increased snacking and consumption of "comfort foods", others noted no influence of mood on food choices. At the interpersonal level, an increased use of technology for social interaction and the importance of social support were identified as influencing factors.

CONCLUSIONS

Findings provide insight on how to help older adults maintain good nutrition amidst lifestyle changes imposed by social distancing. Nutrition educators may capitalize on positive behavior changes that occurred during the pandemic such as increased cooking and increased use of technology for social interaction.

A mixed-studies systematic review of the experiences of body image, disordered eating, and eating disorders during the COVID-19 pandemic

OBJECTIVES

This systematic review assessed the influence of the COVID-19 pandemic and associated restrictions on body image, disordered eating (DE), and eating disorder outcomes.

METHODS

After registration on PROSPERO, a search was conducted for papers published between December 1, 2019 and August 1, 2021, using the databases PsycINFO, PsycARTICLES, CINAHL Plus, AMED, MEDLINE, ERIC, EMBASE, Wiley, and ProQuest (dissertations and theses).

RESULTS

Data from 75 qualitative, quantitative, and mixed-methods studies were synthesized using a convergent integrated approach and presented narratively within four themes: (1) disruptions due to the COVID-19 pandemic; (2) variability in the improvement or exacerbation of symptoms; (3) factors associated with body image and DE outcomes; (4) unique challenges for marginalized and underrepresented groups. Disruptions due to the pandemic included social and functional restrictions. Although most studies reported a worsening of concerns, some participants also reported symptom improvement or no change as a result of the pandemic. Factors associated with worse outcomes included psychological, individual, social, and eating disorder-related variables. Individuals identifying as LGBTQ+ reported unique concerns during COVID-19.

DISCUSSION

There is large variability in individuals' responses to COVID-19 and limited research exploring the effect of the pandemic on body image, DE, and eating disorder outcomes using longitudinal and experimental study designs. In addition, further research is required to investigate the effect of the COVID-19 pandemic on body image and eating concerns among minoritized, racialized, underrepresented, or otherwise marginalized participants. Based on the findings of this review, we make recommendations for individuals, researchers, clinicians, and public health messaging.

PUBLIC SIGNIFICANCE

This review of 75 studies highlights the widespread negative impacts that the COVID-19 pandemic and associated restrictions have had on body image and disordered eating outcomes. It also identifies considerable variations in both the improvement and exacerbation of said outcomes that individuals, researchers, clinicians, and other public health professionals should be mindful of if we are to ensure that vulnerable people get the tailored support they require.

Changes in Food Purchasing Practices of French Households During the First COVID-19 Lockdown and Associated Individual and Environmental Factors

Background

To limit the spread of COVID-19, a strict lockdown was imposed in France between March and May 2020. Mobility limitations and closure of non-essential public places (restaurants, open-air markets, etc.) affected peoples' food environment (FE) and thus their food purchasing practices (FPPs). This study aimed to explore changes in FPPs of French households during lockdown and associations with individual and environmental factors.

Methods

In April of 2020 households from the Mont'Panier cross-sectional study (n = 306), a quota sampling survey conducted in the south of France, were asked to complete an online questionnaire about their FPPs during lockdown and related factors, including perceived FE (distance to closest general food store, perception of increased food prices, etc.). Objective FE (presence, number, proximity, and density of food outlets) was assessed around participant's home using a geographical information system. Multiple correspondence analysis based on changes in frequency of use and quantity of food purchased by food outlet, followed by a hierarchical cluster analysis, resulted in the identification of clusters. Logistic regression models were performed to assess associations between identified clusters and household's sociodemographic characteristics, perceived, and objective FE.

Results

Five clusters were identified. Cluster “Supermarket” (38% of the total sample), in which households reduced frequency of trips, but increased quantity bought in supermarkets during lockdown, was associated with lower incomes and the perception of increased food prices. Cluster “E-supermarket” (12%), in which households increased online food shopping with pickup at supermarket, was associated with higher incomes. Cluster “Diversified” (22%), made up of households who reduced frequency of trips to diverse food outlet types, was associated with the perception of increased food prices. Cluster “Organic Food Store” (20%), in which households did not change frequency of trips, nor quantity purchased in organic food stores, was associated with being older (35–50 y vs. <35 y). Finally, cluster “Producer” (8%), which includes households who regularly purchased food from producers, but mostly reduced these purchases during lockdown, was associated with the presence of an organic food store within a 1-km walking distance around home.

Conclusion

This study highlighted diverse changes in FPPs during lockdown and overall more significant associations with perceived than with objective FE indicators.

Impact of Nationwide Lockdowns Resulting from the First Wave of the COVID-19 Pandemic on Food Intake, Eating Behaviors, and Diet Quality: A Systematic Review

The lockdowns resulting from the first wave of the coronavirus disease 2019 (COVID-19) pandemic impacted deeply on all life activities, including diet. We performed a systematic review to investigate changes in food intake, eating behaviors, and diet quality during lockdown as compared with before the lockdown. A literature search was performed using 3 electronic databases from inception until 13 June 2021. Observational studies evaluating changes in general populations during the COVID-19 pandemic lockdown were eligible. Of 1963 studies retrieved from the search strategy, 95 met inclusion criteria (85 in adults, 10 in children/adolescents), and the majority were of high quality (72.6%). Most of the studies were web-based surveys using convenience sampling, mainly focused on variations in the consumption of foods and eating behaviors during lockdown, whereas only 15 studies analyzed diet quality through dietary indices. On the basis of the definition of a healthful diet as reflected by a traditional Mediterranean diet, an increase in recommended foods such as fruit and vegetables, legumes, cereals, and olive oil was observed, although a sharp decrease in fish intake and an increase in dairy products were documented. Accordingly, a reduction in foods that should be eaten less frequently was reported-namely, red and processed meat. However, a higher consumption of unhealthy foods (e.g., snacks and sweets) was also observed. Results indicated improved diet quality in Europe, especially among Mediterranean countries, with the exception of France, while a switch to poor nutrient patterns was observed in Colombia and Saudi Arabia. Analyses of eating behaviors suggest an increase in food intake, number of daily meals, and snacking. In conclusion, changes in intake of major food groups, apart from fish intake, were in line with the definition of a traditional Mediterranean diet, indicating a consistent moderate improvement in dietary habits worldwide. This review protocol was registered at https://www.crd.york.ac.uk/prospero/ as CRD42020225292.

Assessing the effects of stress on feeding behaviors in laboratory mice

Stress often affects eating behaviors, increasing caloric intake in some individuals and decreasing it in others. The determinants of feeding responses to stress are unknown, in part because this issue is rarely studied in rodents. We focused our efforts on the novelty-suppressed feeding (NSF) assay, which uses latency to eat as readout of anxiety-like behavior, but rarely assesses feeding per se. We explored how key variables in experimental paradigms - estrous and diurnal cyclicity, age and duration of social isolation, prandial state, diet palatability, and elevated body weight - influence stress-induced anxiety-like behavior and food intake in male and female C57BL/6J mice. Latency to eat in the novel environment is increased in both sexes across most of the conditions tested, while effects on caloric intake are variable. In the common NSF assay (i.e., lean mice in the light cycle), sex-specific effects of the length of social isolation, and not estrous cyclicity, are the main source of variability. Under conditions that are more physiologically relevant for humans (i.e., overweight mice in the active phase), the novel stress now elicits robust hyperphagia in both sexes . This novel model of stress eating can be used to identify underlying neuroendocrine and neuronal substrates. Moreover, these studies can serve as a framework to integrate cross-disciplinary studies of anxiety and feeding related behaviors in rodents.

Eating Habits during the COVID-19 Pandemic and the Level of Antibodies IgG and FRAP-Experiences of Polish School Staff: A Pilot Study

The coronavirus 19 (COVID-19) pandemic has brought many changes in terms of lifestyle, education, stress levels, and social contacts. The aim of our research was to evaluate changes in eating habits, physical activity, and selected lifestyle elements in a group of school staff, as well as their immune response to vaccination against COVID-19, and FRAP (ferric reducing antioxidant power) level. In total, 108 primary school teachers and other school staff with integration departments were included in the study. An original survey was conducted with the school staff. Of the study group, 45.4% chose to be vaccinated against COVID-19. In this group, the level of IgG antibodies was assessed, as well as the level of FRAP before vaccination, and after the first and second dose. An original questionnaire was also carried out. A decrease in physical activity and an increase in the time spent in front of the computer have been demonstrated, but a positive observation was a favorable change in most eating habits. After the second dose of vaccination, all subjects achieved the appropriate level of IgG antibodies (above 22 U/mL), with the maximum level recorded in 51%. There was also a significant increase in FRAP levels in the group after the first and second dose of the vaccine compared to the baseline level; an issue that requires further observation.

Impact of the COVID-19 Pandemic on Diet Behaviour Among UK Adults: A Longitudinal Analysis of the HEBECO Study

COVID-19 pandemic restrictions impacted dietary habits during the initial months of the pandemic, but long-term effects are unclear. In this longitudinal study, self-selected UK adults (n = 1,733, 71.1% female, 95.7% white ethnicity) completed three online surveys (May-June, August-September, and November-December 2020, with a retrospective pre-pandemic component in the baseline survey), self-reporting sociodemographics, lifestyle, and behaviours, including high fat, salt, and sugar (HFSS) snacks, HFSS meals, and fruit and vegetable (FV) intake. Data were analysed using generalised estimating equations. Monthly HFSS snacks portion intake increased from pre-pandemic levels (48.3) in May-June (57.6, p < 0.001), decreased in August-September (43.7, p < 0.001), before increasing back to pre-pandemic levels in November-December (49.2, p < 0.001). A total of 48.5% self-reported increased [25.9 (95% confidence interval: 24.1, 27.8)] and 47.7% self-reported decreased [24.1 (22.4, 26.0)] monthly HFSS snacks portion intakes in November-December compared with pre-pandemic levels. Monthly HFSS meals portion intake decreased from pre-pandemic levels (7.1) in May-June (5.9, p < 0.001), was maintained in August-September (5.9, p = 0.897), and then increased again in November-December (6.6, p < 0.001) to intakes that remained lower than pre-pandemic levels (p = 0.007). A total of 35.2% self-reported increased [4.8 (4.3, 5.3)] and 44.5% self-reported decreased [5.1 (4.6, 5.6)] monthly HFSS meals portion intakes in November-December compared with pre-pandemic levels. The proportion meeting FV intake recommendations was stable from pre-pandemic through to August-September (70%), but decreased in November-December 2020 (67%, p = 0.034). Increased monthly HFSS snacks intake was associated with female gender, lower quality of life, and - in a time - varying manner - older age and higher HFSS meals intake. Increased monthly HFSS meals intake was associated with female gender, living with adults only, and higher HFSS snacks intake. Reduced FV intake was associated with higher body mass index (BMI) and lower physical activity. These results suggest large interindividual variability in dietary change during the first year of the pandemic, with important public health implications in individuals experiencing persistent increases in unhealthy diet choices, associated with BMI, gender, quality of life, living conditions, physical activity, and other dietary behaviours.

Consumption of selected food products by adults representing various body mass categories, during Covid-19 lockdown in Poland

OBJECTIVES

The study aimed to assess consumption of selected food products by adults with a range of body mass before and during the outbreak of the Covid-19 pandemic as well as identify factors impacting the consumption of selected foods.

METHODS

The study was conducted in a group of 690 subjects during the most severe lockdown due to Covid-19 in Poland ([Formula: see text] = 23 years of age). The dietary assessment was carried out by means of an online survey based on the Food Frequency Questionnaire (FFQ-6). The respondents were asked to provide two answers to each question, one covering a 7-day period before the lockdown and one related to a 7-day period during the lockdown.

RESULTS

During lockdown in the study group there was increase in consumption of sweets and snacks (p = 0.010), grain products (p = 0.050), fat (p = 0.007) as well as alcohol (p < 0.001). During the lockdown respondents with normal BMI increased consumption of sweets and snacks (p = 0.011), dairy products and eggs (p = 0.034), grain products (p = 0.029) and alcohol (p = 0.00). The group of overweight respondents was found to consume significantly more alcohol (p = 0.022), while those with obesity tended to consume more meat (p = 0.002), fish (p < 0.001) and lower amounts of dairy products (p = 0.003). The factors which affected intake of selected food products include age, smoking, place of residence, obesity and education.

CONCLUSIONS

Covid-19 pandemic is significantly related to the change in the frequency of intake of selected products by all adults, irrespective of their BMI. The adverse changes were particularly observed in respondents with overweight and obesity.

Poor sleep quality and unhealthy lifestyle during the lockdown: an Italian study

Background

The lockdown measure implemented to face the 2019 Coronavirus Disease (COVID-19) first wave deeply modified the lifestyle of the Italian population. Despite its efficacy in limiting the number of infections, forced home confinement was paralleled by sleep/wake cycle disruptions, psychological distress and maladaptive coping strategies (i.e., unhealthy behaviours, such as tobacco and alcohol consumption). Under these unprecedented stress conditions, we explored a possible association between poor sleep quality and increased likelihood of engaging in an unhealthy lifestyle.

Methods

A cross-sectional study was conducted by disseminating an online survey via social networks and e-mail. We collected information on demographics, COVID-19-related data, sleep quality, chronotype, circadian misalignment, and lifestyle before and during the lockdown (i.e., consumption of cigarettes, alcoholic beverages, coffee, hypnotics, comfort food and fresh food; practice of physical activity). A global healthiness score was computed to assess participants’ modifications in lifestyle since the beginning of the lockdown.

Results

1297 respondents were included in the study: 414 (31.9%) from Northern Italy, 723 (55.8%) from Central Italy, 160 (12.3%) from Southern Italy. The following variables were found to be significant predictors of the adoption of an unhealthy lifestyle since the beginning of the lockdown: poor sleep quality, high BMI and considering the measures adopted by the government to fight the pandemic as excessive. Living in Northern Italy, instead, was associated with healthier habits compared to living in Central Italy.

Conclusions

Poor sleepers may represent the share of the general population who paid the highest price for social isolation. Further investigations are required to explore the role of sleep quality assessment in the identification of individuals vulnerable to unhealthy behaviours under stressful conditions.

Do COVID-19-Related Stress, Being Overweight, and Body Dissatisfaction Contribute to More Disordered Eating in Polish Women?-A Cluster Analysis Approach

We hypothesized that women who are overweight, experiencing COVID-19-related stress, and with high body dissatisfaction would have significantly greater disordered eating than those of healthy weight, without stress, and with low body dissatisfaction. Participants (N = 1354 women; Mage= 31.89 years, SD = 11.14) filled in the Contour Drawing Rating Scale, the Emotional Overeating Questionnaire, the Eating Motivation Survey, the Mindful Eating Questionnaire, and a COVID-19-related stress measure and sociodemographic survey. The cluster analysis technique revealed four distinct clusters: (a) Cluster 1 (N = 314): healthy body weight, no COVID-related stress, and low body dissatisfaction (M = 1.19); (b) Cluster 2 (N = 131): overweight, no COVID-related stress, and high body dissatisfaction (M = 2.41); (c) Cluster 3 (N = 597): healthy body weight, COVID-related stress, and low body dissatisfaction (M = 1.27); (d) Cluster 4 (N = 312): overweight, COVID-related stress, and high body dissatisfaction (M = 2.84). Generally, our outcomes partially support our hypothesis, as higher levels of some types of disordered eating were observed in women who were overweight with COVID-related stress and high body dissatisfaction (Cluster 4) as compared with women with healthy body weight, no COVID-related stress, and with low levels of body dissatisfaction (Cluster 1). Our results indicate that both body weight status, as well as COVID-19-related stress and body dissatisfaction, may contribute to the intensity of disordered eating. During future epidemic-related quarantines, this may be an argument in favor of organizing support regarding emotional functioning, body image, and eating behaviors, particularly for the most vulnerable groups-including overweight and obese women.

No lockdown in the kitchen: How the COVID-19 pandemic has affected food-related behaviours

The COVID-19 pandemic and especially the lockdowns coming with it have been a disruptive event also for food consumption. In order to study the impact of the pandemic on eating habits, self-reported changes in food-related behaviours were investigated in ten European countries by means of an online survey. A latent class cluster analysis distinguished five clusters and showed that different types of consumers can be distinguished based on how they react to the pandemic as regards their eating habits. While food-related behaviours were resilient for 60% of the sample, another 35% reported more enjoyment in cooking and eating, more time in the kitchen and more family meals. Among those, a slight majority also showed signs of more mindful eating, as indicated by more deliberate choices and increased consumption of healthy food, whereas a slight minority reported more consumption of indulgence food. Only 5% indicated less involvement with food. As the COVID-19 pandemic is a disruptive event, some of these changes may have habit-breaking properties and open up new opportunities and challenges for food policy and food industry.

Factors associated with the weight change trend in the first year of the COVID-19 pandemic: the case of Turkey

BACKGROUND/OBJECTIVES

To determine the weight change trend among the adult Turkish population after 1 yr of the coronavirus disease 2019 (COVID-19) pandemic and factors associated with weight change.

MATERIALS/METHODS

This cross-sectional study was conducted between 26 February and 6 March 2021 using an online questionnaire that included questions for sociodemographic variables, eating habits, stress level, and the Three-Factor Eating Questionnaire-R18. Those who weighed themselves 1-2 weeks before the pandemic was declared in Turkey and remembered their weight were invited to participate in the study. Trends in weight and body mass index (BMI) change were calculated. The variables associated with a 1% change in BMI were assessed using hierarchical regression analysis.

RESULTS

The study was conducted with 1,630 adults (70.25% female) with a mean age of 32.09 (11.62) yrs. The trend of weight change was found to increase by an average of 1.15 ± 6.10 kg (female +0.72 ± 5.51, male +2.16 ± 7.22 kg) for the first year of the COVID-19 pandemic. The rate of participants with a normal BMI (18.50-24.99 kg/m2) decreased to 51.91% from 55.75%. Consuming an "Increased amount of food compared to before the pandemic" was found to be the independent variable that had the strongest association with a 1% increase in BMI (β = 0.23 P < 0.001). The average change in the BMI was higher in older individuals than in those who were younger. A high stress level was associated with a decrease in BMI (β = -0.04 P = 0.048).

CONCLUSIONS

In this study, the factors associated with weight change after 1 yr of the pandemic in the Turkish population was reported for the first time. A high stress level and increased weight gain trend still occur in Turkey after 1 yr of the pandemic.

Impacts of COVID-19 on changing patterns of household food consumption: An intercultural study of three countries

In light of COVID-19's effects on individuals' social, economic, political, and psychological values, this paper aims to investigate the pandemic's role in possible changes to people's food consumption and meal habits in three countries, namely China, Portugal, and Turkey. The sample includes individuals from the three countries, exploratory factor analysis and non-parametric tests were used to test the differences. Results suggest that coronavirus has played a strong part in altering households' food consumption and meal habits within these countries. The pandemic has particularly led to greater consumption of fresh fruits and vegetables and spending more time eating meals at home. Portugal appears to be consuming more seafood, bread, and butter whereas China features higher consumption of rice and meat products; Turkey is consuming more meat and eggs. The study closes with a set of recommendations for the society and future research.

Is Physical Activity Protective against Emotional Eating Associated Factors during the COVID-19 Pandemic? A Cross-Sectional Study among Physically Active and Inactive Adults

Physical activity levels during the COVID-19 pandemic have been decreasing and this may be a risk factor for development of emotional eating and its associated factors. The aim of the study was to analyze the factors associated with emotional eating among individuals with different physical activity levels during the COVID-19 pandemic. Data relating to the pandemic on physical activity, emotional eating, sociodemographic data, perceptions about lifestyle habits, body satisfaction, and perceptions about eating habits and food consumption were collected. Factors associated with emotional eating in the group of active and inactive individuals were observed using multiple linear regression controlled for age, sex, BMI, and monthly income. Emotional eating for the active group was associated with perceived stress, body dissatisfaction, and increased consumption of sweets and desserts. In addition to these factors found among the active group, working or studying >8 h/day, sleep worsening, increased amount of food consumed, increased purchase of food through delivery, and increased vegetable consumption were also associated with emotional eating for the inactive group. These findings suggest a potential protective role of physical activity in the appearance of factors associated with emotional eating during the COVID-19 pandemic.