COVID-19 pandemic and weight gain in American adults: A nationwide population-based study

Norms and attributions about weight gain during the COVID-19 pandemic

Objective. Weight gain was common during the first year of the COVID-19 pandemic, potentially creating a new descriptive norm about weight gain. The unique context of a global pandemic may have influenced situational attributions for weight gain that were not typical prior to the pandemic. We examined the effects of the new norm on people's views about responsibility and blame for weight gain.

Methods. In two preregistered surveys, we aimed to manipulate the salience of weight gain during COVID-19, and measured views about responsibility and blame for weight gain.

Results. Among participants who gained weight, the more common they perceived weight gain to be, the more they felt their own weight gain was understandable (b = 0.09, se = 0.04, p = 0.02), but perceived commonness didn't relate to their feelings of responsibility and blame for weight gain. For participants who didn't gain weight, the perceived commonness of weight gain was associated with less blame towards people who gained weight (b = 0.11, se= 1.46, p = 0.044), but not with responsibility for weight gain.

Conclusion. Participants believed weight gain was common during COVID, but this descriptive norm had mixed associations with attributions for one's own and others' weight gain.

Trajectory of primordial follicle depletion is accelerated in obese mice in response to 7,12-dimethylbenz[a]anthracene exposure†

Both obesity and exposure to environmental genotoxicants, such as 7,12-dimethylbenz[a]anthracene, negatively impair female reproductive health. Hyperphagic lean KK.Cg-a/a (n = 8) and obese KK.Cg-Ay/J (n = 10) mice were exposed to corn oil as vehicle control (CT) or 7,12-dimethylbenz[a]anthracene (1 mg/kg/day) for 7d intraperitoneally, followed by a recovery period. Obesity increased liver and spleen weight (P < 0.05), and 7,12-dimethylbenz[a]anthracene exposure decreased uterine weight (P < 0.05) in obese mice. Primordial follicle loss (P < 0.05) caused by 7,12-dimethylbenz[a]anthracene exposure was observed in obese mice only. Primary (lean P < 0.1; obese P < 0.05) and secondary (lean P < 0.05, obese P < 0.1) follicle loss initiated by 7,12-dimethylbenz[a]anthracene exposure continued across recovery. Reduced pre-antral follicle number in lean mice (P < 0.05), regardless of 7,12-dimethylbenz[a]anthracene exposure, was evident with no effect on antral follicles or corpora lutea number. Immunofluorescence staining of DNA damage marker, γH2AX, did not indicate ongoing DNA damage but TRP53 abundance was decreased in follicles (P < 0.05) of 7,12-dimethylbenz[a]anthracene-exposed obese mice. In contrast, increased (P < 0.05) superoxide dismutase was observed in the corpora lutea of 7,12-dimethylbenz[a]anthracene-exposed obese mice and reduced (P < 0.05) TRP53 abundance was noted in preantral and antral follicles of 7,12-dimethylbenz[a]anthracene-exposed obese mice. This study indicates that obesity influences ovotoxicity caused by a genotoxicant, potentially involving accelerated primordial follicle activation and hampering normal follicular dynamics.

Weight gain, new-onset overweight or obesity, and their influencing factors during the social distancing era of the COVID-19 pandemic

The prevalence of obesity is gradually increasing in South Korea, and the coronavirus disease 2019 (COVID-19) pandemic has accelerated the weight gain. In response to COVID-19, South Korea implemented targeted distancing measures based on the number of COVID-19 cases, rather than a full lockdown. This study focused on two subgroups that influence the rise in obesity prevalence during the early stages of the COVID-19 pandemic and explored the factors contributing to rapid weight gain in this group during this period. This cross-sectional study involved 3,462 participants recruited through the MicroEmbrain Inc. Online survey panel. Participation emails were sent by the research company to the online survey panel, and individuals who voluntarily agreed to participate responded to the survey. The participants consisted of residents aged 19 and above from Seoul, with sample distribution taking considering sex, age, and region. Height, and weight before and during the COVID-19 pandemic were self-reported. The analysis revealed that compared with that of pre-COVID-19 statistics, 11 % of all participants entered the overweight or obese categories post COVID-19, and among those who were overweight or obese before COVID-19, 42.5 % reported weight gain. Both groups had relatively younger individuals, higher stress levels, spent more time alone, and had increased usage of online platforms including online food purchasing. Post-COVID-19 wt gain among individuals with pre-existing overweight or obesity status was associated with a higher frequency of solitary drinking (odds ratio [OR] = 1.407, 95 % confidence interval [CI] = 1.024-1.932), increased online leisure time (OR = 1.336, 95 % CI = 1.063-1.678), and increased use of meal delivery services (OR = 1.307, 95 % CI = 1.026-1.664). The prevalence of obesity has continued to rise after COVID-19 pandemic, highlighting the need for interventions that mitigate the negative impact of the pandemic on health behavior.

Eating disorders and COVID-19 - different or just more?

BACKGROUND

COVID-19 saw an increase in child mental health presentations internationally. Clinicians analogised the exponential increase in anorexia nervosa to a 'tsunami' or 'outbreak', raising parallel concerns regarding medical and psychological risks (Marsh in The Guardian, 2021; Leask in NZ Herald, 2021; Monteleone et al. in Eat Weight Disord 26(8):2443-2452, 2021) . It is unclear whether Ireland emulated this picture of increased referrals with increased medical compromise.

AIMS

This paper examines both rates and clinical profiles of child eating disorder presentations in the Republic of Ireland (ROI), across different clinical settings.

METHODS

Following ethical approval, retrospective chart reviews were conducted in a community eating disorder service and in two paediatric hospital settings. The time frame of the different studies ranged from January 2016 to December 2022.

RESULTS

Community eating disorder services saw significantly higher referral rates post COVID-19 (3.78/month vs. 2.31/month, p = 0.02), with a shorter duration of illness (4.8 months vs. 7.4 months, p = 0.001), but no significant difference in ideal body weight % (IBW%) at referral (85.32% vs. 83.7%, p = 0.1). Both paediatric hospitals witnessed significantly increased referrals post-COVID-19 (hospital 1; 4.38/month vs. 1.93/month, p = 0.0001; hospital 2; 2.8/month vs. 0.92/month, p < 0.0001), but no significant difference in IBW% at assessment (hospital 1; 82.7% vs. 81.39%, p = 0.673; hospital 2; 81.5% vs. 83%, p = 0.563). There was no significant difference in clinical profile, management, or duration of hospital stay.

CONCLUSIONS

This study supports the growing consensus of a pandemic specific increase in eating disorder referrals to both medical and psychiatry services. However, there was little to indicate a change in clinical profile or severity. Ongoing monitoring of referrals is necessary to ensure adequate service availability and expertise.

Changes in Obesity Prevalence Among U.S. Adults After the COVID-19 Pandemic by State and Territorial Stay-at-Home Order Level and Sociodemographic Characteristics

PURPOSE

To examine changes in obesity prevalence among US adults after the COVID-19 pandemic by level of stay-at-home order and sociodemographic characteristics.

DESIGN

Quasi-experimental study using repeated cross-sectional data.

SETTING

Behavioral Risk Factor Surveillance System (BRFSS).

SAMPLE

Pooled data for US adults ages ≥26 years (n = 1,107,673) from BRFSS (2018-2021).

MEASURES

States/territories were classified into three levels of stay-at-home order: none, advisory/only for persons at risk, or mandatory for all. Individual-level sociodemographic characteristics were self-reported.

ANALYSIS

The difference-in-differences method was conducted with weighted multiple logistic regression analysis to examine obesity (body mass index ≥30 kg/m2) prevalence by stay-at-home order level and sociodemographic characteristics before/after the COVID-19 pandemic (January 2018-February 2020 vs March 2020-February 2022).

RESULTS

After adjusting for a secular trend and multiple covariates, adults in states/territories with mandatory stay-at-home orders experienced a larger increase in obesity prevalence (adjusted odds ratio: 1.05; 95% confidence interval: 1.01, 1.11) than adults in states/territories with no stay-at-home order. Younger adults (vs ≥65 years) and individuals with

CONCLUSION

Increases in obesity prevalence were perpetuated 2 years after implementation of stay-at-home orders, indicating that longer-term health implications are co-occurring during the pandemic recovery period. Future research should focus on successful methods for staying active and healthy during social distancing and beyond.

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Key Words

• COVID-19
• age
• education
• health policy
• obesity
• sociodemographic characteristic
• stay-at-home order

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MESH Headings

• Humans
• COVID-19/epidemiology
• Obesity/epidemiology
• Male
• United States/epidemiology
• Female
• Prevalence
• Adult
• Middle Aged
• Cross-Sectional Studies
• Behavioral Risk Factor Surveillance System
• Sociodemographic Factors
• Aged
• SARS-CoV-2
• Socioeconomic Factors
• Pandemics
• Young Adult

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Affiliation(s)

Beomyoung Cho Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
Yining Pan Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
McKinley Chapman Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
Aaron Spaulding Division of Health Care Delivery Research, College of Medicine, Mayo Clinic, Jacksonville, FL, USA
Sericea Stallings-Smith Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA

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Unveiling the lockdown effects: exploring behavior, dietary habits and weight changes in rural Egypt during COVID-19 lockdown: a cross-sectional retrospective study

BACKGROUND

The COVID-19 lockdown significantly impacted dietary habits and body weights globally, particularly in Egypt, where 57.03% of the population resides in rural areas, despite lack of information. The study examines the impact of COVID-19 lockdown on the weight changes of the rural Egyptian population through behavioral, physical, and dietary changes.

METHODS

A cross-sectional online survey using Microsoft Forms was distributed in Delta regions in Egypt. The questionnaire used a modified version of the validated 14- items PREDIMED MedDiet Adherence Screener (MEDAS). The first part of the questionnaire addressed sociodemographic variables whereas the second one included questions related to dietary, behavioral and weight changes of participants. These changes were statistically tested for significance in relation to BMI, gender, home living, current job and family history of obesity.

RESULTS

A total of 306 participated in the study (70% females, 13% obese, 95% living with family, 56% university students, and 36% with family history of obesity). Obese showed a significant increase in sweet intake whereas underweight and normal weight people displayed a significant decrease in eating desire. Both females and males showed significant increase in consumption of fruits and vegetables with significant decrease in soft drink. However, women showed a significant decrease in sport activity relative to men. Participants living with family showed an increase in sweet intake while those living alone explored an increase in meal frequency. Employers revealed a significant decrease in sport activities and people with family history of obesity reported more sleeping times than those without family history of obesity.

CONCLUSION

During Covid-19 quarantine, Egyptians' eating habits improved, but daily routines were disrupted. Raising awareness about obesity and providing guidance on maintaining activity, energy, and mood is crucial for future quarantine situations.

LIFANA - toward developing a meal recommender system as a dietary support app for the elderly

Background: Though a variety of eHealth/mHealth dietary solutions exist, many are ill-adapted to the target population and local eating habits. A specific need exists for the elderly, a growing vulnerable population with limited digital literacy. The LIFANA project aimed at developing a mobile nutrition solution, i.e. a dietary meal-recommender app for personalized meal planning useful for the elderly. Methods: In addition to considering age, gender, and physical activity, the app assured sufficient intake of calories and proteins. The solution was optimized to consider local eating culture in Portugal (PT)/The Netherlands (NL) where it was tested. Recipes (>300) were included and aligned with national food composition dietary databases (FCDBs) to analyse their nutritional values for meal planning. Individual dietary preferences, food restrictions (i.e., allergies), and budget considerations were included in the user profile. The development process involved user integration, including focus groups and usability evaluations, followed by longer field trials in Portugal (n=53 participants, age 60-81 y, 14 months) and the Netherlands (n=107, age 52-86 y, 3 months). Endpoints regarding acceptance/usage frequency, anthropometric measures and (in PT) blood pressure and body fat were collected. Results: 23/34 elderly finalized the trials in PT/NL. No significant changes in anthropometry or other assessed markers, including blood pressure, were observed. 9% (NL) and 47% (PT) of users reported that they would consider using the solution if it were on the market. Conclusions: Via an iterative adaptive process, a dietary app was developed and improved that demonstrated acceptance/user-friendliness comparable to other tools available on the market and allowed - despite the COVID crisis - for stable anthropometric markers and blood pressure. However, it was also observed that additional features, such as a link to an online shopping app, and closer personal follow-up was associated with increased usability and acceptance of the solution and thus further personalization and nudges are warranted to increase employment of such dietary apps.

Understanding family dynamics of obesity: Do parents and children lose and gain weight together?

BACKGROUND

Obesity is prevalent among children and adults. Yet, understanding the relationship between parent and child weight trajectories is limited.

OBJECTIVE

(1) Examine the association between parent/child undesirable body mass index (BMI) category change. (2) Assess whether parental BMI category predicts child modified BMI z-score (mBMIz) annual change.

METHODS

We conducted a cross-sectional study of weight trajectories of 3821 parent-child dyads between March 2020 and December 2021 within the NYC Health + Hospitals system. Undesirability of child and parental BMI category change and the magnitude of mBMIz change by parental BMI are analysed.

RESULTS

Of 3821 children (mean [SD] baseline age, 9.84 [3.51]), 1889 were female. Of the 3220 parents (mean [SD] baseline age, 39.9 [8.51]), 2988 were female. Most children (53.52%) and parents (81.94%) presented with overweight and obesity. Undesirable BMI change in children was associated with concordant change in parents (adjusted OR: 1.7, 95% CI [1.45, 2.01], adjusted p < 0.001). Children of parents with obesity (adjusted coef: 0.076, 95% CI [0.004, 0.147], p < 0.038) and severe obesity (adjusted coef: 0.1317, 95% CI [0.024, 0.239], adjusted p < 0.016) demonstrated greater change in mBMIz than those of parents with normal weight or underweight.

CONCLUSION

Parents and children have concordant weight trajectories, and public health interventions targeting both populations are essential.

Age-related differences in the association between financial hardship and weight change during the COVID-19 pandemic

Objective

To examine the association of financial hardship with weight changes in the US during the COVID-19 pandemic.

Methods

We used data from the COVID-19's Unequal Racial Burden survey, a nationally representative, cross-sectional, online survey of diverse adults living in the US, 12/2020-2/2021. This study included 1000 Asian, Black, Latino (half Spanish-speaking), and White adults and 500 American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and multiracial adults (5500 total). Age-specific (18-39, 40-59, ≥60) associations between financial hardship domains and weight change were estimated using multinomial logistic regression, adjusted for demographic and health characteristics.

Results

Financial hardship during the COVID-19 pandemic was prevalent across all age groups (18-39: 76.2 %; 40-59: 75.6 %; ≥60: 50.6 %). Among adults aged 18-39 and ≥ 60 years old, food insecurity was significantly associated with weight loss (18-39: aOR = 1.42, 95 % CI = 1.04, 1.95; ≥60: aOR = 3.67, 95 % CI = 1.50, 8.98). Among all age groups, unmet healthcare expenses was also associated with weight loss (18-39: aOR = 1.31, 95 % CI = 1.01, 1.70; 40-59: aOR = 1.49, 95 % CI = 1.06, 2.08; ≥60: aOR = 1.73, 95 % CI = 1.03, 2.91). Among adults aged 18-39 and ≥ 60 years old, lost income was significantly associated with weight gain (18-39: aOR = 1.36, 95 % CI = 1.09-1.69; ≥60: aOR = 1.46, 95 % CI = 1.04, 2.06), and among adults 40-59 years old, experiencing increased debt was significantly associated with weight gain (aOR = 1.50, 95 % CI = 1.13, 1.99).

Conclusions

For those aged 18-39 and ≥ 60 years old experiencing financial hardship during the COVID-19 pandemic was associated with both weight loss and weight gain. Less correlation was observed among adults aged 40-59.

Effect of Lockdown Period of COVID-19 Pandemic on Maternal Weight Gain, Gestational Diabetes, and Newborn Birth Weight

OBJECTIVE

This study aimed to determine whether the lockdown period of the initial novel coronavirus disease 2019 (COVID-19) surge in New York affected gestational weight gain (GWG), newborn birth weight (BW), and the frequency of gestational diabetes mellitus (GDM). Maternal and newborn outcomes during the first wave of the pandemic were compared with those during the same timeframe in the previous 2 years.

STUDY DESIGN

Retrospective cross-sectional study of all live singleton term deliveries from April 1 to July 31 between 2018 and 2020 at seven hospitals within a large academic health system in New York. Patients were excluded for missing data on: BW, GWG, prepregnancy body mass index, and gestational age at delivery. We compared GWG, GDM, and BW during the pandemic period (April-July 2020) with the same months in 2018 and 2019 (prepandemic) to account for seasonality. Linear regression was used to model the continuous outcomes of GWG and BW. Logistic regression was used to model the binary outcome of GDM.

RESULTS

A total of 20,548 patients were included in the study: 6,672 delivered during the pandemic period and 13,876 delivered during the prepandemic period. On regression analysis, after adjustment for study epoch and patient characteristics, the pandemic period was associated with lower GWG (β = -0.46, 95% confidence interval [CI]: -0.87 to -0.05), more GDM (adjusted odds ratio [aOR] = 1.24, 95% CI: 1.10-1.39), and no change in newborn BW (β = 0.03, 95% CI: -11.7 to 11.8) compared with the referent period. The largest increases in GDM between the two study epochs were noted in patients who identified as Hispanic (8.6 vs. 6.0%; p < 0.005) and multiracial/other (11.8 vs. 7.0%; p < 0.001).

CONCLUSION

The lockdown period of the pandemic was associated with a decrease in GWG and increase in GDM. Not all groups were affected equally. Hispanic and multiracial patients experienced a larger percentage change in GDM compared with non-Hispanic white patients.

KEY POINTS

· The COVID-19 lockdown was associated with decreased GWG and increased GDM.. · No change in newborn BW was seen during the lockdown.. · Overall, the lockdown did not have a large clinical effect on these pregnancy outcomes..

Cognitive reappraisal moderates the protective effect of body satisfaction on mental health and wellbeing in adults: A prospective study during COVID-19 lockdown

BACKGROUND

Body satisfaction is associated with mental health and well-being in adults. However, prospective studies are needed to better understand its protective effects, and in whom these are most beneficial. This study investigated body satisfaction as a predictor of depressive symptoms, generalised anxiety, and well-being in a representative Australian sample collected during the initial COVID-19 lockdown. Two emotion regulation strategies - cognitive reappraisal and expressive suppression - were also tested as moderating variables.

METHODS

The sample comprised 684 adults aged 19 to 87 years who completed three primary waves of data spanning two months [Wave 3 (W3), W4 and W7] from the Australian National COVID-19 Mental Health, Behaviour and Risk Communication Survey.

RESULTS

Hierarchical multiple regression models controlling for demographic and COVID-19 risk factors, as well as W3 for each outcome variable, indicated that W3 body satisfaction predicted greater W7 well-being, and fewer W7 depressive symptoms and greater W7 well-being in participants reporting low levels of W4 cognitive reappraisal. No moderation for W4 expressive suppression was observed, nor predictive relationships between W3 body satisfaction and W7 anxiety.

LIMITATIONS

The two-month follow-up period precludes conclusions relating to the longer-term protective effects of body satisfaction within and beyond the pandemic context. Examination of focal relationships in clinical samples, and inclusion of broader indices of body image, emotion regulation and mental health, is needed in future studies.

CONCLUSIONS

Findings suggest body satisfaction warrants attention in community well-being promotion in adults, and may be particularly beneficial for those lack adaptive emotion regulation strategies.

Telephone Virtual Versus In-Person Pharmacotherapy-Based Obesity Care: A COVID-19-Related Experience at a Veterans Administration Facility

Background: Most of the Veterans Administration (VA) population is either overweight or obese, which is a serious health concern. Medical weight management visits have traditionally occurred through in-person clinics. However, the COVID-19 pandemic forced care delivery to virtual platforms. Methods: We compared weight loss with in-person versus telephone-based medical weight management (lifestyle counseling coupled with pharmacotherapy) delivered by physician and nurse practitioner visits during the pandemic. We designed a program evaluation utilizing a naturalistic (pragmatic) observational study structure, including both newly enrolled and previously established participants in the Minneapolis VA MOVE! program between 2017 and 2021. A "transition" cohort (n = 74) received in-person care from March 2019 to March 2020, and then transitioned to virtual care. A "new start" virtual care cohort (n = 149) enrolled after March 2020 was compared to a separate historical group (n = 180) that received in-person care between January 2017 and December 2019. Weight loss was accessed over a 9-month period in both cohorts. Results: Mean weight loss over 9 months was -6.5 ± 18.2 and -2.5 ± 13.3 lbs in the in-person and virtual phases of the transition cohort, respectively, without significant difference between the two phases (p = 0.22). Mean weight loss over 9 months in the new start (virtual) cohort was -14.4 ± 17.0 lbs compared to -16.7 ± 21.0 lbs in the historical cohort, without significant difference between groups (p = 0.44). Conclusions: In our naturalistic study in a single-site VA clinic setting, weight loss with telephone-based medical weight management during the pandemic was comparable to in-person care. These findings are important for veterans living in rural and/or underserved areas.

Impact of a Public Health Emergency on Behavior, Stress, Anxiety and Glycemic Control in Patients With Pancreas or Islet Transplantation for Type 1 Diabetes

A public health emergency such as the COVID-19 pandemic has behavioral, mental and physical implications in patients with type 1 diabetes (T1D). To what extent the presence of a transplant further increases this burden is not known. Therefore, we compared T1D patients with an islet or pancreas transplant (β-cell Tx; n = 51) to control T1D patients (n = 272). Fear of coronavirus infection was higher in those with β-cell Tx than without (Visual Analogue Scale 5.0 (3.0-7.0) vs. 3.0 (2.0-5.0), p = 0.004) and social isolation behavior was more stringent (45.8% vs. 14.0% reported not leaving the house, p < 0.001). A previous β-cell Tx was the most important predictor of at-home isolation. Glycemic control worsened in patients with β-cell Tx, but improved in control patients (ΔHbA1c +1.67 ± 8.74 vs. -1.72 ± 6.15 mmol/mol, p = 0.006; ΔTime-In-Range during continuous glucose monitoring -4.5% (-6.0%-1.5%) vs. +3.0% (-2.0%-6.0%), p = 0.038). Fewer patients with β-cell Tx reported easier glycemic control during lockdown (10.4% vs. 22.6%, p = 0.015). All T1D patients, regardless of transplantation status, experienced stress (33.4%), anxiety (27.9%), decreased physical activity (42.0%), weight gain (40.5%), and increased insulin requirements (29.7%). In conclusion, T1D patients with β-cell Tx are increasingly affected by a viral pandemic lockdown with higher fear of infection, more stringent social isolation behavior and deterioration of glycemic control. This trial has been registered in the clinicaltrials.gov registry under identifying number NCT05977205 (URL: https://clinicaltrials.gov/study/NCT05977205).

Multilevel perceptions of the virtual delivery of the University of California Diabetes Prevention Program on RE-AIM domains due to COVID-19 mandates

Background

The University of California's Diabetes Prevention Program (UC DPP) Initiative was implemented across all 10 UC campuses in 2018. The COVID-19 pandemic and accompanying mandates required swift changes to program delivery, including pivoting from in-person to virtual delivery (i.e., Zoom). Our goal was to assess multilevel constituent perceptions of the use of a virtual platform to deliver UC DPP due to COVID-19 mandates.

Methods

We conducted qualitative interviews with 68 UC DPP participants, coordinators, and leaders to examine the use of virtual platform delivery on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of UC DPP. Transcripts were analyzed using rapid qualitative analysis and emergent themes were categorized using domains corresponding to RE-AIM framework.

Results

Among UC DPP participants (n = 42), virtual delivery primarily impacted perceptions of UC DPP effectiveness and implementation. Some participants perceived program effectiveness to be negatively impacted, given their preference for in-person sessions, which they felt provided more engagement, peer support, and accountability. Implementation challenges included problems with virtual format (e.g., "Zoom fatigue"); however, several benefits were also noted (e.g., increased flexibility, maintenance of DPP connections during campus closures). UC DPP coordinators (n = 18) perceived virtual delivery as positively impacting UC DPP reach, since virtual platforms provided access for some who could not participate in-person, and negatively impacting effectiveness due to reduced engagement and lower peer support. UC leaders (n = 8) perceived that use of the virtual format had a positive impact on reach (e.g., increased availability, accessibility) and negatively impacted effectiveness (e.g., less intensive interactions on a virtual platform). Across constituent levels, the use of a virtual platform had little to no impact on perceptions of adoption and maintenance of UC DPP.

Conclusion

Perceptions of the reach, effectiveness, and implementation of UC DPP using a virtual platform varied across constituents, although all groups noted a potential negative impact on overall program effectiveness. Unanticipated program adaptations, including virtual delivery, present potential benefits as well as perceived drawbacks, primarily across the effectiveness domain. Understanding differential constituent perceptions of the impact of virtual delivery can help maximize RE-AIM and inform future UC DPP delivery strategies.

Baseline Characteristics in the Remote Diet Intervention to REduce long-COVID Symptoms Trial (ReDIRECT)

Background

The persistence of symptoms for ≥12 weeks after a COVID-19 infection is known as Long COVID (LC), a condition with unclear pathophysiology and no proven treatments to date. Living with obesity is a risk factor for LC and has symptoms which may overlap with and aggravate LC.

Methods

ReDIRECT is a remotely delivered trial assessing whether weight management can reduce LC symptoms. We recruited people with LC and BMI >27kg/m 2. The intervention was delivered remotely by dietitians, with online data collection (medical and dietary history, COVID-19 infection and vaccination, body composition, LC history/symptoms, blood pressure, quality of life, sociodemographic data). Participants self-selected the dominant LC symptoms they most wanted to improve from the intervention.

Results

Participants (n=234) in England (64%) and Scotland (30%) were mainly women (85%) of white ethnicity (90%), with 13% living in the 20% most deprived areas, a mean age of 46 (SD10) years, and median BMI of 35kg/m 2 (IQR 32-40). Before starting the study, 30% reported more than one COVID-19 infection (82% confirmed with one or more positive tests). LC Diagnosis was mainly by GPs (71%), other healthcare professionals (9%), or self-diagnosed (21%). The median total number of symptoms was 6 (IQR 4-8). Self-selected dominant LC symptoms included fatigue (54%), breathlessness (16%), pain (12%), anxiety/depression (1%) and "other" (17%). At baseline, 82% were taking medication, 57% reported 1+ other medical conditions. Quality of life was poor; 20% were on long-term sick leave or reduced working hours. Most (92%) reported having gained weight since contracting COVID-19 (median weight change +11.5 kg, range -11.5 to +45.3 kg).

Conclusions

Symptoms linked to LC and overweight are diverse and complex. Remote trial delivery enabled rapid recruitment across the UK yet certain groups (e.g. men and those from ethnic minority groups) were under-represented.

Trial registration

ISRCTN registry ( ISRCTN12595520, 25/11/2021).

Changes in weight status during the COVID-19 pandemic: impact of educational level and mental health

BACKGROUND

The COVID-19 pandemic has resulted in a disruption of daily routines and changes in health behaviors leading to widespread concerns about unfavorable changes in weight status and a potential increase in the prevalence of obesity. This study examined the long-term impact of the COVID-19 pandemic on changes in weight status and its possible dependency on educational level and mental health.

METHODS

The study utilizes the Danish Health and Well-being Survey with repeated self-reported information on weight status collected before the COVID-19 pandemic (autumn of 2019) and twice during the pandemic (autumns of 2020 and 2021). Information on educational level was derived from registers, whereas mental health was measured using validated scales. Generalized estimating equations were performed to investigate changes in mean weight and body mass index (BMI) category (BMI < 30 to BMI ≥ 30) between 2019 and 2021 and to investigate potential differences in changes in weight status by pre-pandemic educational level and mental health.

RESULTS

Mean weight significantly increased by 0.34 kg [95% confidence interval (CI): 0.16-0.51] in 2020 and by 0.46 kg (95% CI: 0.26-0.66) in 2021 compared with pre-pandemic weight status. The increase was greater among individuals with lower educational levels and poorer mental health. There were no significant changes in BMI category during the pandemic.

CONCLUSION

The results showed a significant increase in mean weight among the Danish population, particularly among individuals with lower educational levels and poorer mental health, but without detectable differences in obesity, supporting a long-term but minor impact of the COVID-19 pandemic on weight status.

Effects on Cancer Prevention from the COVID-19 Pandemic

The COVID-19 pandemic led to disruption of health services around the world, including cancer services. We carried out a narrative review of the effect of the pandemic on cancer prevention services, including screening. Services were severely affected in the early months of the pandemic, and in some areas are still recovering. Large numbers of additional cancers or additional late-stage cancers have been predicted to arise over the coming years as a result of this disruption. To minimize the effects on cancer outcomes, it is necessary to return as quickly as possible to prepandemic levels of screening and prevention activity or indeed to exceed these levels. The recovery of services should address health inequalities.

Conventional weight loss therapy in morbid obesity during COVID-19 pandemic: degree of burdens at baseline and treatment efficacy

Introduction

COVID-19 affected global physical and psychological health. The purpose of this study was to explore the pandemics impact on health-related quality of life (HRQoL), mental health (anxiety, depression, and perceived stress) and eating behavior in people with severe obesity participating in a multimodal conservative behavioral weight loss (BWL) program conducted via videoconferencing. Additionally, the efficacy of the six-month BWL program in a virtual video-based setting during the pandemic was examined.

Methods

297 participants of a face-to-face multimodal behavioral weight loss program prior to the pandemic (PrePAN, May 2014-September 2019) and 146 participants of the in terms of content same intervention in a videoconference-based setting during the pandemic (PAN, July 2020-April 2022) were questioned and compared using standardized questionnaires for HRQoL, symptoms of depressive and anxiety disorders, perceived stress, and eating behavior at baseline and at the end of treatment.

Results

Symptoms for anxiety, depression and perceived stress were similar between PrePAN and PAN at baseline. In addition, PAN tended to show lower disinhibition of eating behavior and feelings of hunger than PrePAN. During the pandemic, the BWL intervention resulted in body weight loss (67%) or stabilization (16%) in most of the participants. It also contributed by improving physical HRQoL, lower worries, and improved eating behaviors compared to baseline.

Conclusion

During the COVID-19 pandemic, baseline mental health of people with morbid obesity was not worse than before the pandemic. Additionally, the BWL intervention in the virtual video-based setting stabilized and improved physical and mental health during the COVID-19 pandemic.

Liver biopsy for assessment of suspected drug-induced liver injury in metabolic dysfunction-associated steatohepatitis clinical trials: Expert consensus from the Liver Forum

BACKGROUND

Causality assessment of suspected drug-induced liver injury (DILI) during metabolic dysfunction-associated steatohepatitis (MASH) clinical trials can be challenging, and liver biopsies are not routinely performed as part of this evaluation. While the field is moving away from liver biopsy as a diagnostic and prognostic tool, information not identified by non-invasive testing may be provided on histology.

AIM

To address the appropriate utilisation of liver biopsy as part of DILI causality assessment in this setting.

METHODS

From 2020 to 2022, the Liver Forum convened a series of webinars on issues pertaining to liver biopsy during MASH trials. The Histology Working Group was formed to generate a series of consensus documents addressing these challenges. This manuscript focuses on liver biopsy as part of DILI causality assessment.

RESULTS

Expert opinion, guidance and recommendations on the role of liver biopsy as part of causality assessment of suspected DILI occurring during clinical trials for a drug(s) being developed for MASH are provided. Lessons learned from prior MASH programs are reviewed and gaps identified.

CONCLUSIONS

Although there are no pathognomonic features, histologic evaluation of suspected DILI during MASH clinical trials may alter patient management, define the pattern and severity of injury, detect findings that favour a diagnosis of DILI versus MASH progression, identify prognostic features, characterise the clinicopathological phenotype of DILI, and/or define lesions that influence decisions about trial discontinuation and further development of the drug.

The politics of COVID-19: Differences between U.S. red and blue states in COVID-19 regulations and deaths

The study investigated infection variables and control strategies in 2020 and 2021 and their influence on COVID-19 deaths in the United States, with a particular focus on comparing red (Republican) and blue (Democratic) states. The analysis reviewed cumulative COVID-19 deaths per 100,000 by year, state political affiliation, and a priori latent factor groupings of mitigation strategies (lockdown days in 2020, mask mandate days, vaccination rates), social demographic variables (ethnicity, poverty rate), and biological variables (median age, obesity). Analyses first identified possible relationships between all assessed variables using K-means clustering for red, blue, and purple states. Then, a series of regression models were fit to assess the effects of mitigation strategies, social, and biological factors specifically on COVID-19 deaths in red and blue states. Results showed distinct differences in responding to COVID infections between red states to blue states, particularly the red states lessor adoption of mitigation factors leaving more sway on biological factors in predicting deaths. Whereas in blue states, where mitigation factors were more readily implemented, vaccinations had a more significant influence in reducing the probability of infections ending in death. Overall, study findings suggest politicalization of COVID-19 mitigation strategies played a role in death rates across the United States.

"It's Gonna Be Okay"-A Qualitative Exploration of the COVID-19 Pandemic's Effects on African American Participants During a Dietary Intervention Study

BACKGROUND

African American adults are at increased risk for chronic diseases. Limited research exists regarding how the COVID-19 pandemic affected African American adults in behavioral interventions.

OBJECTIVE

This study assessed how the early months of the COVID-19 pandemic, before vaccine availability and widespread testing, affected stress, nutrition, and exercise behaviors of African American adults participating in a dietary intervention study.

DESIGN

This was a qualitative interview study conducted with participants from both diet groups as part of the ongoing Nutritious Eating with Soul (NEW Soul) study. NEW Soul is a 2-year, randomized dietary intervention study with participants randomized to follow a vegan (intervention) or low-fat omnivorous diet (control), with both diets focused on soul food.

PARTICIPANTS/SETTING

Participants (n = 20) came from 2 cohorts of the larger intervention study in South Carolina and were purposefully recruited based on high and low attendance at intervention sessions. Participants in the first cohort were near the end of the intervention, and participants in the second cohort were near the mid-point. The interviews were conducted from June to July 2020.

MAIN OUTCOME MEASURES

Outcomes included participants' experiences related to stress, nutrition, and exercise behaviors during the early months of the COVID-19 pandemic.

ANALYSIS

Interviews were recorded and transcribed verbatim. Interview transcripts were coded by two coders using NVivo software. Interviews were coded through content analysis using a constant comparative method.

RESULTS

Participants discussed the following 3 themes in relation to health behaviors: increased stress, change in routines, and advice to follow health goals.

CONCLUSIONS

Findings provide perspectives for designing interventions for African American adults establishing new routines to overcome setbacks and changes in routines created by the COVID-19 pandemic.

Impact of a randomized controlled trial of discounts on fruits, vegetables, and noncaloric beverages in NYC supermarkets on food intake and health risk factors

The objective of this study was to observe the effects of a multi-level (30%, 15%, and 0%) randomized discount on fruits, vegetables, and non-caloric beverages on changes in dietary intake. This randomized controlled trial (RCT) comprised an 8-week baseline, a 32-week intervention, and a 16-week follow-up. 24-hour dietary recalls were conducted during the baseline period and before the intervention midpoint. In-person clinical measures were analyzed from Week 8 (end of baseline) and 24 (midpoint). This report is from an interim analysis up to the intervention period midpoint at Week 24, as the study is still ongoing. Participants with BMIs of 24.5-50 kg/m2 and ages 18-70 years old who were the primary household shoppers were recruited from several New York City supermarkets, starting in September 2018. Of these, we analyzed 20 in the 30% discount group, 25 in the 15% discount group, and 19 in the 0% discount group. The 30% discount group reported greater intake of vegetables (+98.4 g ± 48.9 SD, P = 0.049) and diet soda (+63.3 g ± 29.3, P = 0.035) relative to the baseline period, compared to the 0% discount group. The clinical measures including body weight remained unchanged. The participants who experienced the COVID-19 pandemic had a marginal increase in body weight of 1.5 kg, P = 0.053. In conclusion, we observed a significant increase in intake of vegetables and diet soda in the 30% discount group relative to the 0% discount group.

BMI Increases in Individuals with COVID-19-Associated Olfactory Dysfunction

(1) Background: Reports suggest COVID-19-associated olfactory dysfunction (OD) may result in alterations in dietary behaviors and perceived weight change, but few studies using psychophysical evaluation of post-COVID-19-associated chemosensory dysfunction and body mass index (BMI) exist. The purpose of this study is to assess the impact of both quantitative and qualitative features of COVID-19-associated OD on BMI; (2) Methods: Recruitment of thirty-one participants with self-reported OD in the form of quantitative loss with and without qualitative features. Surveys with questions specific to qualitative olfactory function, Sniffin' Sticks tests, and BMI measures were completed at two visits, one year apart. Group differences were assessed with Wilcoxon signed-rank tests and the Holm-Bonferroni method; (3) Results: Individuals with persistent quantitative OD (n = 15) and self-reported parosmia (n = 19) showed statistically significant increases in BMI after 1 year (p = 0.004, adjusted α = 0.0125; p = 0.011, adjusted α = 0.0167). Controls with transient quantitative OD (n = 16) and participants without self-reported parosmia (n = 12) showed no statistically significant changes in BMI over the same time period (p = 0.079, adjusted α = 0.05; p = 0.028, adjusted α = 0.025); (4) Conclusions: This study shows an association between COVID-19-associated OD and BMI, suggesting olfaction may play a role in altering dietary habits and nutrition in this population. Larger study cohorts are needed to further evaluate this relationship.

New-Onset Diabetes After COVID-19

There is evidence suggesting that infection with SARS-CoV-2 can lead to several long-term sequelae including diabetes. This mini-review examines the rapidly evolving and conflicting literature on new-onset diabetes after COVID-19, which we term NODAC. We searched PubMed, MEDLINE, and medRxiv from inception until December 1, 2022, using Medical Subject Headings (MeSH) terms and free text words including "COVID-19," "SARS-CoV-2," "diabetes," "hyperglycemia," "insulin resistance," and "pancreatic β-cell." We also supplemented searches by examining reference lists from retrieved articles. Current evidence suggests that COVID-19 increases the risk of developing diabetes, but the attributable risk is uncertain because of limitations of study designs and the evolving nature of the pandemic, including new variants, widespread population exposure to the virus, diagnostic options for COVID-19, and vaccination status. The etiology of diabetes after COVID-19 is likely multifactorial and includes factors associated with host characteristics (eg, age), social determinants of health (eg, deprivation index), and pandemic-related effects both at the personal (eg, psychosocial stress) and the societal-community level (eg, containment measures). COVID-19 may have direct and indirect effects on pancreatic β-cell function and insulin sensitivity related to the acute infection and its treatment (eg, glucocorticoids); autoimmunity; persistent viral residency in multiple organs including adipose tissue; endothelial dysfunction; and hyperinflammatory state. While our understanding of NODAC continues to evolve, consideration should be given for diabetes to be classified as a post-COVID syndrome, in addition to traditional classifications of diabetes (eg, type 1 or type 2), so that the pathophysiology, natural history, and optimal management can be studied.

Social Disparities in Lifestyle and Body Weight Changes during COVID-19 Quarantine and Post-Quarantine Persistence of Changes among Lithuanian Adult Population

The role of social factors on changes in lifestyle habits during the COVID-19 quarantine and their maintenance post-quarantine is underexamined. This study aimed to assess sociodemographic differences in nutrition, physical activity and body weight changes during the quarantine and their persistence post quarantine. The study included a random sample of Lithuanian residents aged 20 to 64. The questionnaires were filled in during the face-to-face interview within households countrywide in 2023. In total, 1500 individuals (742 men and 758 women) participated in the survey. Up to 34.9% of the respondents reported changes in eating habits, mostly increased consumption, 29.5% indicated reduced physical activity, and 22.7% gained weight. Multivariate logistic regression analysis revealed that highly educated individuals were more likely than poorly educated individuals to increase healthy and decrease unhealthy food consumption and increase physical activity during the quarantine. The city inhabitants reported unfavourable changes in nutrition habits more often than those living in villages did. The proportion of respondents who reported the maintenance of the quarantine changes in lifestyle depending on the habit varied from 23.2% to 71.4% in the post-quarantine period. Highly educated individuals were less likely to maintain the decreased consumption of fresh fruits and increased body weight than less-educated individuals were. Our study provides evidence that the targeted interventions are needed to help less-educated individuals and city residents develop and maintain healthy lifestyle habits, even in times of crisis.

Body Mass Index Increased at a Large Midwestern Children's Hospital During the COVID-19 Pandemic

Background: The COVID-19 pandemic has presented a great challenge to children and their families with stay-at-home orders, school closures, decreased exercise opportunities, stress, and potential overeating with home confinement. Our study describes the body mass index (BMI) changes over an entire decade, including a year of the COVID-19 pandemic at a large children's hospital. Methods: With our retrospective observational study, data were extracted from Cincinnati Children's Hospital's Epic electronic medical record, a free-standing children's hospital with 670 inpatient beds and >1.2 million patient encounters per year. Children aged 19 years and under with at least one height and weight were included in the analysis. Results: In all, 2,344,391 encounters were analyzed with 712,945 visits in years 2018-2021. The prevalence of overweight/obesity was relatively stable with a gradual rise from 35% to 36.4% from 2011 to 2020. However, the year of the COVID-19 stay at home and restrictions (2020-2021) showed an increase in overweight/obesity to 39.7% (8.3% increase), with the greatest increase in those with Class 3 obesity from 3.0% to 3.8%. When viewing the change in BMI percentile during the pandemic year compared with the 2 years prior, there was a significantly increasing trend (p < 0.0001). Conclusions: Children attending a large children's hospital showed an increase in overweight/obesity during the COVID-19 pandemic. These data suggest greater efforts are needed to reverse the increase in weight status from the COVID-19 pandemic as obesity is a risk factor for poor outcomes with COVID-19.

Associations between comfort eating and weight change during the COVID-19 pandemic among U.S. adults

Objective

To examine associations between comfort eating in response to loneliness or stress and weight change during the COVID-19 pandemic among U.S. adults.

Design

Quantitative, cross-sectional study.

Setting

The 2021 SummerStyles survey data.

Subjects

U.S. adults (≥18 years; N = 4068).

Measures

The outcome was reported weight changes since the start of the COVID-19 pandemic with four responses: lost weight, weight remained the same, gained weight, and don't know. The exposure variable was frequency of comfort eating in response to loneliness or stress during the past year with three responses: never/ rarely, sometimes, or often/always.

Analysis

We used chi-square analysis to examine the independence of survey variables related to weight changes, and comfort eating in response to loneliness or stress during the COVID-19 pandemic. Next, we used a multinomial logistic regression to estimate adjusted odds ratios for weight changes by comfort eating in response to loneliness or stress frequency.

Results

Overall, 20.1% of adults reported losing weight, 39.9% remained about the same weight, 30.4% gained weight, and 9.4% did not know about their weight change during the COVID-19 pandemic. Taking comfort by eating in response to loneliness or stress was reported by over 33% of participants (often/always = 8.3%; sometimes = 25.3%). Weight change and comfort eating during the COVID-19 pandemic significantly varied by sociodemographic factors. Respondents that sometimes or often/always reported taking comfort by eating in response to loneliness or stress were more likely to report losing weight (Adjusted Odds Ratio ranges: 1.62-2.99) or gaining weight (Adjusted Odds Ratio ranges: 3.10-4.61) than those who never/rarely took comfort by eating in response to loneliness or stress.

Conclusions

Taking comfort by eating when stressed/lonely was significantly associated with reported weight changes during the COVID-19 pandemic. Weight changes may lead to additional health complications. Implementing evidence-based strategies to reduce loneliness or stress and support healthy eating during the COVID-19 pandemic may benefit weight management and future well-being.

Body mass index and prevalence of metabolic syndrome among Korean adults before and after the COVID-19 outbreak: a retrospective longitudinal study

OBJECTIVES

Studies evaluating weight changes during the coronavirus disease 2019 (COVID-19) pandemic have yielded inconsistent results, and most of those studies were based on self-reported anthropometric measures. We investigated changes in body mass index (BMI), professionally measured waist circumference (WC), and metabolic syndrome components from before to during the pandemic in a sample of the adult population in Korea.

METHODS

This retrospective study included 1,118 male and female (age≥18 years) who underwent health checkups at a university medical center between January 1, 2016 and March 31, 2022. Changes in BMI, lifestyles, and metabolic syndrome components during the pandemic were analyzed using the paired t-test, McNemar test, generalized estimating equations, and repeated-measures analysis of variance.

RESULTS

Changes in body weight, BMI, and body fat percentage during the pandemic were not clinically significant. However, statistically significant results were found for decreased physical activity (p<0.001) and WC (p<0.001), and exacerbation of all metabolic syndrome components (except serum triglyceride levels). Moreover, the metabolic syndrome prevalence increased significantly from 20.2% to 31.2% during the pandemic (p<0.001). The prevalence of abdominal obesity and high fasting blood glucose levels also significantly increased from 2019 to 2021.

CONCLUSIONS

Metabolic syndrome, its components, and fat distribution worsened significantly after the implementation of social distancing and lockdowns, despite no clinically significant changes in body weight and BMI. Further studies on the post- pandemic period should investigate the long-term impact of social lockdowns on BMI and the prevalence of metabolic syndrome.

A cohort study of BMI changes among U.S. Army soldiers during the COVID-19 Pandemic

BACKGROUND

The increasing number of individuals with obesity is a healthcare concern in the United States (U.S.) population; the men and women who serve in the Army are no exception, with 17.3% of soldiers categorized with a body mass index (BMI) of Obesity in 2017. The COVID-19 pandemic profoundly disrupted life around the globe. During the pandemic, restrictions to soldier movement and activity were put in place to limit COVID-19 transmission. We strive to assess what effects these changes may have had on the BMIs of soldiers.

METHODS

We conducted a retrospective cohort study of active duty U.S. Army soldiers using data from the Military Health System Data Repository. BMI was calculated and categorized before (February 2019 - January 2020) and during the pandemic (September 2020 - June 2021). Women who were pregnant or delivered during and one year prior to the study periods were excluded. Statistical analyses included paired t-tests evaluating mean BMI, percent change, and the Stuart-Maxwell test for marginal homogeneity.

RESULTS

191,894 soldiers were included in the cohort. During the pandemic, 50.5% of soldiers in the cohort were classified as Overweight and 23.2% were classified as Obesity. T-test and Stuart-Maxwell test indicated significant differences and changes in BMI categories between the pre-pandemic and pandemic periods, particularly the Obesity category, which experienced a 5% growth and 27% change. Significant absolute changes were observed during the pandemic; 26.7% of soldiers classified as Healthy weight in the pre-pandemic period shifted to Overweight in the pandemic period and 15.6% shifted from Overweight in the pre-pandemic period to Obesity in the pandemic period. Absolute increases were observed across every demographic category in soldiers with obesity; the categories that saw the highest increases were female, ages 20-24, White, and Junior Enlisted soldiers.

CONCLUSIONS

Higher rates of obesity may result in decreased health of the force. The specific needs of younger and Junior Enlisted soldiers need to be further addressed, with focus on special intervention programs by the U.S. Army.

Improved awareness of physical activities is associated with a gain of fitness and a stable body weight in breast cancer patients during the first year of antineoplastic therapy: the BEGYN-1 study

Background

Breast cancer is the most frequent cancer in women. Reduced physical activity and overweight are associated with poor prognosis. Breast cancer patients have a high risk to gain weight, lose muscle mass and reduce physical activity during therapy. Concepts are urgently needed to motivate patients to engage in physical activity.

Methods

110 non-metastatic breast cancer patients were included in the prospective observational BEGYN-1 study. Physiological parameters and body composition were measured before the start of therapy and then quarterly for one year. Patients used a fitness tracker and documented their physical activity in a diary throughout the study.

Results

Although the patients were not offered any guided exercise, and despite the restrictions during the COVID-19 pandemic, they increased their physical activity (metabolic equivalent of task (MET) -minutes): p<0.001), physical fitness (decreasing resting heart rate: p=0.001) and did not gain weight (median - 0.4kg) over the course of the study.

Conclusion

Improved awareness of physical activity is associated with an increase in physical activity, fitness, and a stable weight during the first year of therapy in breast cancer patients. Counselling at diagnosis should motivate patients to engage in physical activity, wear a fitness tracker and document activities.

Does COVID-19 Infection Increase the Risk of Diabetes? Current Evidence

PURPOSE OF REVIEW

Multiple studies report an increased incidence of diabetes following SARS-CoV-2 infection. Given the potential increased global burden of diabetes, understanding the effect of SARS-CoV-2 in the epidemiology of diabetes is important. Our aim was to review the evidence pertaining to the risk of incident diabetes after COVID-19 infection.

RECENT FINDINGS

Incident diabetes risk increased by approximately 60% compared to patients without SARS-CoV-2 infection. Risk also increased compared to non-COVID-19 respiratory infections, suggesting SARS-CoV-2-mediated mechanisms rather than general morbidity after respiratory illness. Evidence is mixed regarding the association between SARS-CoV-2 infection and T1D. SARS-CoV-2 infection is associated with an elevated risk of T2D, but it is unclear whether the incident diabetes is persistent over time or differs in severity over time. SARS-CoV-2 infection is associated with an increased risk of incident diabetes. Future studies should evaluate vaccination, viral variant, and patient- and treatment-related factors that influence risk.

Healthy Eating in the Australian Coal Mining Industry: Assessing the Efficacy of the 'Out of the Box' Workplace Health Promotion Program

Noncommunicable diseases are the world's leading cause of death. To curb the global rise in these diseases, using the workplace as a front to disseminate health communication messages and resources has been suggested. This study aimed to assess the efficacy of a workplace health promotion program, 'Out of the Box', that targeted nutrition outcomes and nutrition guideline knowledge. A 6-month workplace health promotion program was implemented within a coal mine site. Over the 6 months, there were four wellness focus areas, lasting 1 month each, including fruits, vegetables and portion controlling, label reading, alcohol awareness, and hydration promotion. The study utilized a quasi-experimental pre-test-post-test design, with measurements via self-reported paper-based surveys. At baseline there were 163 responses, and 106 at follow-up. At the 6-month follow-up, respondents had increased odds of recalling the current fruit (OR 1.29, p = 0.032) and vegetable (OR 1.76, p < 0.001) guidelines. Being male was associated with lower vegetable intake (B: -0.28), although this did not reach statistical significance. A nutrition-focused workplace health promotion program can be an efficacious strategy in improving knowledge of fruit and vegetable guidelines. Further research is needed to evaluate the effectiveness of these programs over time.

A quasi-experimental study on adult weight loss using a multidimensional approach among a rural population

Objectives

The study aimed to investigate the effectiveness of a yearlong digital multidimensional weight-loss intervention among residents in a southern rural community. The intervention utilized a quasi-experimental design to assess weight loss and lifestyle habit changes in volunteer individuals living in a rural community in western North Carolina.

Methods

The quasi-experimental design featured pre- and post-in-person health assessments, including anthropometric measures such as body composition, blood pressure, and lifestyle habits, through a health risk questionnaire. Upon completion of the in-person pre-assessment, participants received digital health education and challenges via email and challenge runner for 1 year. Following 12 months, participants were asked to complete the post-assessment to review their results. The multidimensional weight-loss intervention was communicated via newspaper and social media to promote participation among community members, utilizing a volunteer sample. Univariate analyses were conducted to determine age, weight, BMI, and body fat percentage. A paired sample t-test was conducted on pre- and post-weight as well as pre- and post-health scores. The health score was derived from the health risk questionnaire. A bivariate Pearson correlation was conducted for post-weight and post-health score analyses.

Results

The average participant was female in their mid-40s (N = 67). Results showed insignificant statistical mean differences between pre- and post-weight and pre- and post-health scores. A Pearson correlation indicated a moderate correlation r = -0.36, p = 0.003) between post-weight and post-health score. The negative correlation indicates changes in health behavior reflected in the health score improving as weight decreased.

Conclusion

The weight-loss intervention proved unsuccessful in clinical weight loss but demonstrated an association between healthy behavior changes and weight loss. However, further research is needed to solidify the current findings, as there were limitations identified in COVID-19.

Medical management of obesity

Obesity is a global epidemic that has worsened over the past few decades. It is strongly associated with multiple health conditions, including type 2 diabetes mellitus, cardiovascular diseases, obstructive sleep apnoea, certain malignancies and has an increased mortality risk. The annual cost of obesity to the NHS is around £6 billion, projected to increase to just under £10 billion by 2050. In 2020-2021, obesity was cited as a factor in over 1 million hospital admissions. An early and pragmatic approach to the management of obesity would reduce obesity-associated multiple health conditions and result in cost savings for the NHS. Here, we discuss current management strategies for obesity, including dietary intervention, pharmacological therapies and optimisation, and bariatric surgery.

Lifestyle and Dietary Patterns during the COVID-19 Lockdown in Bahrain: A Web-Based Cross-Sectional Study

Lifestyle factors such as dietary habits, perceived weight, sleep, and physical activity worsened during the COVID-19 pandemic. Through this study, we aimed to understand the impact of COVID-19 on these lifestyle factors in Bahrain. A cross-sectional study was conducted among 1005 adult Bahrainis. Data were collected online using a structured and validated questionnaire for the assessment of eating habits, physical activity, and lifestyle during the COVID-19 pandemic. Participants were snowballed through those who agreed to answer the online questionnaire. There was a higher consumption of fast food, and a higher dependence on takeaways during the COVID-19 pandemic. About 63.5% of the participants consumed >4 meals per day, compared to 36.5% before the COVID-19. About 30% reported consumption of sugar sweetened beverages from two to three times a day. Weight loss was predominantly observed in persons exercising 1-3 times a week. The consumption of sugar-sweetened beverages was also high, with about 19% reporting drinking sweet beverages once every day, 10.6% from two to three times a day, and 40.4% from one to four times a week. A higher proportion of the participants reported poor sleep quality during the pandemic (31.2%) compared to before (12.2%), and 39.7% of the participants reported feeling lazy. Screen time use also doubled during the pandemic, with participants spending more than five hours per day on screens for entertainment, which went from 22.4% before to 51.9% during the pandemic. The lifestyle and dietary habits changed drastically for our study participants during the pandemic. The increased reliance on processed fast food instead of healthier options is a challenge to be tackled in any future pandemic situation. Future research needs to focus on strategies to promote healthier lifestyle modifications during situations such as the COVID-19 pandemic.

"If I start panicking over having enough, then I start eating too much": Understanding the eating behaviors of SNAP recipients in larger bodies during COVID-19

BACKGROUND/OBJECTIVE

Living in a food-insecure household may increase the risk for disordered eating. Though the Supplemental Nutrition Assistance Program (SNAP) was designed to reduce food insecurity, it may increase risk for disordered eating with the frequency in which benefits are distributed. Limited research has explored the lived experiences of managing eating behaviors while on SNAP, particularly among SNAP participants in larger bodies, and during COVID-19. Thus, the purpose of this study is to examine the experiences with eating behaviors among adults with a BMI ≥ 25 kg/m², and who received SNAP benefits during the COVID-19 pandemic.

METHODS

Eligible adults were recruited to participate in a semi-structured interview. Interviews were transcribed verbatim and analyzed using thematic analysis and content analysis.

RESULTS

Participants (N = 16), had a mean (±SD) age of 43.4 ± 10.9 years, and overwhelmingly identified as female (86 %). One-third of the participants were Black. We identified 4 main themes: (1) not having enough money/benefits to cover needs; (2) navigating loss of control and emotional eating; (3) making sure the kids are alright; and (4) still feeling the pressure to manage weight.

CONCLUSION

Managing eating behaviors while also navigating SNAP benefits is complex and may exacerbate risk of disordered eating.

Impact of COVID-19 Pandemic on Weight Change Among Adults in the UAE

Background

The COVID-19 pandemic which started in November 2019 and since then has led to multiple lockdowns aimed towards controlling the pandemic, these lockdowns contributed to major changes in individuals' lifestyles including eating patterns and restriction of physical activity due to continues house confinement. Such changes have significantly contributed to weight change, with increasing rates of obesity in the UAE, COVID-19 have posed a major concern to the country's obesity levels.

Aim

To measure the prevalence and investigate the views related to weight change among adults in the UAE during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted through a self-administered online questionnaire distributed using social media platforms between February 15th and March 14th, 2021. The sample size was 439 adults in the UAE (18-59 years), collected by volunteer sampling. Analysis was done using SPSS with a significance of 5.0%. Exclusion criteria included pregnancy and bariatric surgeries history.

Results

51.1% of participants gained weight, 36.2% lost weight and 12.7% maintained their weight. Meal consumption frequency and weight gain were correlated. Consuming fast food resulted in 65.7% of participants gaining weight. 66.2% of people who lost weight during the COVID-19 pandemic did exercise. Stress management and sleeping patterns were not contributing factors to the weight change. 64.4% of the participants who were not satisfied with their weight and believed that they need to make changes in their lifestyle received no guidance from professional personnel to reach their desired weight.

Conclusion

In this study, the majority of participants have witnessed an increase in weight. UAE health authorities must provide guidance and support to the population via structured nutritional programs and lifestyle awareness campaigns.

Obesity partially potentiates dimethylbenz[a]anthracene-exposed ovotoxicity by altering the DNA damage repair response in mice†

Obesity adversely affects reproduction, impairing oocyte quality, fecundity, conception, and implantation. The ovotoxicant, dimethylbenz[a]anthracene, is biotransformed into a genotoxic metabolite to which the ovary responds by activating the ataxia telangiectasia mutated DNA repair pathway. Basal ovarian DNA damage coupled with a blunted response to genotoxicant exposure occurs in obese females, leading to the hypothesis that obesity potentiates ovotoxicity through ineffective DNA damage repair. Female KK.Cg-a/a (lean) and KK.Cg-Ay/J (obese) mice received corn oil or dimethylbenz[a]anthracene (1 mg/kg) at 9 weeks of age for 7 days via intraperitoneal injection (n = 10/treatment). Obesity increased liver weight (P < 0.001) and reduced (P < 0.05) primary, preantral, and corpora lutea number. In lean mice, dimethylbenz[a]anthracene exposure tended (P < 0.1) to increase proestrus duration and reduced (P = 0.07) primordial follicle number. Dimethylbenz[a]anthracene exposure decreased (P < 0.05) uterine weight and increased (P < 0.05) primary follicle number in obese mice. Total ovarian abundance of BRCA1, γH2AX, H3K4me, H4K5ac, H4K12ac, and H4K16ac (P > 0.05) was unchanged by obesity or dimethylbenz[a]anthracene exposure. Immunofluorescence staining demonstrated decreased (P < 0.05) abundance of γH2AX foci in antral follicles of obese mice. In primary follicle oocytes, BRCA1 protein was reduced (P < 0.05) by dimethylbenz[a]anthracene exposure in lean mice. Obesity also decreased (P < 0.05) BRCA1 protein in primary follicle oocytes. These findings support both a follicle stage-specific ovarian response to dimethylbenz[a]anthracene exposure and an impact of obesity on this ovarian response.

Supplementation use and diet changes during COVID-19 pandemic according to anxiety level and Mediterranean diet adherence

Aim; This study was planned and conducted to examine the change in food consumption and nutritional supplement use during the COVID-19 pandemic according to individuals' status of anxiety and Mediterranean diet adherence. Methods; This prospective, cross-sectional research was completed online with the participation of 949 people (66.4% women). The Mediterranean Diet Adherence Screener Scale (MEDAS) and Coronavirus Anxiety Scale (CAS) were applied. After this section of the questionnaire was completed, the participants were tasked with answering questions regarding changes in food consumption and use of nutritional supplements during the pandemic. Results; While 50.8% of the participants had low adherence to the Mediterranean diet, 18.2% were considered to have a high adherence. It was observed that legume (p = 0.001), milk and dairy (p = 0.01), and fruit (p < 0.001) consumption of participants with high adherence to the Mediterranean diet increased during the pandemic, and packaged food (p < 0.001) consumption decreased. The increase in the consumption of fruit (p < 0.001) and vegetables (p = 0.018) were significantly higher in the group with anxiety. Age, sex, educational status, positive COVID-19 test, place of residence, CAS score and MEDAS score affect the use of dietary supplements according to binary logistic regression (R² = 0.106 p < 0.001). The three most commonly used supplements were identified as vitamins C, D and B₁₂. Conclusions: These results can shed light on how to prepare for possible future pandemics when it comes to dealing with anxiety through diet.

Are fewer cases of diabetes mellitus diagnosed in the months after SARS-CoV-2 infection? A population-level view in the EHR-based RECOVER program

Long-term sequelae of severe acute respiratory coronavirus-2 (SARS-CoV-2) infection may include increased incidence of diabetes. Here we describe the temporal relationship between new type 2 diabetes and SARS-CoV-2 infection in a nationwide database. We found that while the proportion of newly diagnosed type 2 diabetes increased during the acute period of SARS-CoV-2 infection, the mean proportion of new diabetes cases in the 6 months post-infection was about 83% lower than the 6 months preinfection. These results underscore the need for further investigation to understand the timing of new diabetes after COVID-19, etiology, screening, and treatment strategies.

Prevalence and factors associated with self-reported anxiety in adults during the COVID-19 pandemic in Argentina, Brazil, Peru, Mexico, and Spain: A cross-sectional Ibero-American study

The present study evaluated the factors associated with the perception of anxiety during the first wave of covid-19 in Ibero-American countries. This cross-sectional study was carried out with 5.845 participants of both sexes, over 18 years of age, and residents of four Latin American countries-Argentina (16.7%), Brazil (34.5%), Mexico (11.1%), and Peru (17.5%), and one European country-Spain (20.1%). Data were collected in 2020, between April 1st and June 30th in Spain and between July 13th and September 26th in the Latin American countries. We used an online questionnaire with sociodemographic, lifestyle, self-reported anxiety, and covid-19 related questions. The chi-square statistical test and Multivariate logistic regressions were performed to analyze the factors associated with self-reported anxiety. The presence of self-reported anxiety was found in 63.8% of the participants during the isolation period. The association occurred mainly in women (OR:1.52; CI: 1.3-1.7), those aged 18 to 29 years (OR: 1.51; CI: 1.2-1.9) and 30 to 49 years (OR: 1.56; CI: 1.3-1.9), residents of Argentina (OR: 1.55 CI: 1.2-1.9), Brazil (OR: 2.38; CI: 2.0-2.8) and Mexico (OR: 1.52; CI: 1.2-1.9), those who gained weight (OR:1.71 CI: 1.5-1.9) or lost weight (OR: 1.40; CI: 1.2-1.6), and those who reported having slept more (OR: 1.56; CI: 1.3-1.8) or less (OR: 2.89; CI: 2.5-3.4). We conclude that the prevalence of self-reported anxiety in Ibero-American countries was high during the period studied, highlighting a higher likelihood of its occurrence in Brazil, in those who began to sleep less and gained weight.

Gender-dependent impact of COVID-19 lockdown on metabolic and psychological aspects

The first COVID-19 lockdown resulted in enforced quarantine of heavily affected areas with social isolation and related measures by several governments to slow the spread of the disease. The general population experienced several mental and lifestyle changes. Herein, we aimed to evaluate the metabolic and psychological effects induced by lifestyle changes during COVID-19 self-isolation among an Apulian overweight/obese cohort with metabolic disturbances. The study assessed anthropometric data (weight, abdominal circumferences), dietary habits (adherence to the Mediterranean diet, junk food score), lifestyle habits (i.e., smoking, and physical activity), levels of stress and anxiety, and depression. Subjects underwent bioumoral exams before and after self-isolation to monitor glycemic and lipid profiles. A total of 245 subjects (M:F = 118:127) have been included in the study. After lockdown, the number of obese subjects significantly increased in both sexes, and was higher in females than in males (P < 0.0001). Glycemic and lipid profiles worsened, with higher levels of insulinemia, lower levels of HDL cholesterol, and higher levels of triglycerides in females than in males. Adherence to the Mediterranean diet and consumption of junk foods were altered in both groups, especially in females. Psychological aspects were significantly higher in females than in males. Finally, work activities and familial status strongly affected the metabolic and psychological profile. In conclusion, COVID-19 self-isolation induced changes in lifestyle and dietary habits with psychological distress and detrimental effects on metabolic patterns, which were more pronounced in female gender.

Evaluation of Health-Related Quality of Life and Mental Health in 729 Medical Students in Indonesia During the COVID-19 Pandemic

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has impacted the health-related quality of life (HRQoL) and mental health worldwide. However, its impact on medical students in Indonesia has not been well documented. This study aimed to evaluate HRQoL and mental health in 729 Indonesian medical students during the COVID-19 pandemic. MATERIAL AND METHODS We conducted a cross-sectional study from 31 August to 30 September 2021. The study instrument was an online questionnaire that was distributed via social media platforms. The 12-item short form version 2 (SF12v2) was used to measure HRQoL, and the 21-item Depression, Anxiety, and Stress Scale (DASS-21) was used to measure mental health. RESULTS From 729 Indonesian medical students included in the analyses, 37.3% had impaired physical component and 66.9% had impaired mental component of HRQoL. The determinants were medical students' island of residence, history of hospitalization, and family member's hospitalization and death due to COVID-19. Concerning mental health, the prevalence of reported symptoms of depression, anxiety, and stress were 45.4%, 65.2%, and 60.9%, respectively. Sex, study method, grade, previous COVID-19 disease severity, comorbidities, previous learning experience, and history of family isolation were identified as the determinants of mental health. CONCLUSIONS This study highlights the adverse effects of COVID-19 on HRQoL and mental health in Indonesian medical students. The results identified key associations, including SARS-CoV-2 infection and comorbidities experienced by the students, the health of their families, including grief following bereavement, and the effects of social isolation during the pandemic.

Analysis on the physiological changes of residents before and during the COVID-19 pandemic: A cross-sectional study

People's lifestyles have changed dramatically during the coronavirus disease 2019 (COVID-19) pandemic, yet data on physical examinations in the Chinese population before and during the pandemic are rarely reported. The study was based on the data from the physical examination center of Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine. We collected the data of physical examinations information between January 2017 and March 2022. The data of participants before December 31, 2019 were classified as "before COVID-19 pandemic group," while data after December 31, 2019 were classified as "during COVID-19 pandemic group." We used t-test and χ²  test to compare the differences before and during COVID-19 pandemic. A total of 72 257 individuals participated in the physical examinations, and finally retained 65 629 individuals for analysis. During the COVID-19 pandemic, body mass index (BMI), high-density lipoprotein, total cholesterol levels, as well as pulmonary nodule and thyroid nodule proportion of participants were higher than those before the pandemic, and the levels of systolic blood pressure and diastolic blood pressure of participants were lower than those before the pandemic. Ongoing assessment and surveillance are necessary to assess whether lifestyle changes caused by the COVID-19 pandemic are likely to increase chronic disease risk in the future.

Validation of the SmartPlate for detecting food weight and type

This study determined accuracy (comparing to criterion), inter-plate reliability (comparing measures between two plates), and intra-plate reliability (comparing successive measures on one plate) of the SmartPlate for food weight and type. Food weight validation included comparing SmartPlate weights to criterion [reference] scale weights (1,980 measures) and weights of 188 foods (2,256 measures). Food type validation included assessing SmartPlate accuracy for 188 foods. For weight, mean absolute percent errors for accuracy, inter-plate reliability, and intra-plate reliability were 6.2, 7.4, and 4.9%, respectively. For food type, foods were correctly identified/listed or searchable 67.0 or 98.9% of the time, respectively, with 76.0% inter-plate reliability and 86.3% intra-plate reliability. The SmartPlate had acceptable accuracy and reliability for assessing food weight and type and may be appealing for monitoring dietary surveillance or intervention. Due to high intra-plate reliability, the SmartPlate may be especially useful for one-on-one interventions and assessing change over time.

Changes in dietary habits and weight status during the COVID-19 pandemic and its association with socioeconomic status among Iranians adults

Background

COVID-19 pandemic has impacted human health through sudden lifestyle changes, including isolation at home, and social distancing. Therefore, the current study aimed to investigate the effect of the COVID-19 pandemic on eating habits, weight status, and their associations with socioeconomic status.

Methods

This cross-sectional study was conducted using an online structured questionnaire that inquired demographic, anthropometric (reported weight and height); dietary habits (weekly intake of certain foods); and dietary supplement intake information.

Results

A total of 1,187 participants completed the questionnaire, and after validation of the data, 1,106 respondents were included in the study, with a mean age of 34.5 ± 9.4 years. Our findings showed that the body mass index (BMI) of the participants significantly increased during COVID-19 (P < 0.001). Also, there were significant changes in the intake of a variety of food and beverage during the COVID-19, including less consumption of milk, yogurt, red meat, fish, canned fish, homemade fast foods, take out fast foods, carbonated drinks, and more consumption of whole bread, legumes (chickpeas, lentil, peas, kidney beans, black beans, pinto beans, and navy beans), soy bean, nuts, seeds, high vitamin C vegetables, high vitamin C fruits, green-yellow fruits and vegetables, onion/garlic, dried fruits, natural fruit juices, and water (P < 0.001; for all). It is informed that individuals consumed more vitamin and mineral supplements (P < 0.001). Also, before and during COVID-19 pandemic weekly intakes of dairy, red meat, poultry, high vitamin C fruits, and whole bread were positively associated with socioeconomic status (P < 0.001).

Conclusion

Overall, this study indicates changes in body weight, dietary habits and supplement intake during the pandemic. Therefore, the findings of this study are valuable for, health professionals and politicians to better public health practice and policy making.

Exploring the Implications of New-Onset Diabetes in COVID-19: A Narrative Review

Post-viral new-onset diabetes has been an important feature of the COVID-19 pandemic. It is not always clear if new-onset diabetes is the unmasking of a previously undiagnosed condition, the acceleration of prediabetes, or new-onset diabetes that would not have otherwise occurred. Even asymptomatic cases of COVID-19 have been associated with new-onset diabetes. Diabetes that emerges during acute COVID-19 infection tends to have an atypical presentation, characterized by hyperglycemia and potentially life-threatening diabetic ketoacidosis. It is not always clear if new-onset diabetes is type 1 or type 2 diabetes mellitus. Many cases of COVID-associated diabetes appear to be type 1 diabetes, which is actually an autoimmune disorder. The clinical course varies temporally and with respect to outcomes; in some cases, diabetes resolves completely or improves incrementally after recovery from COVID-19. Disruptions in macrophagy caused by COVID-19 infection along with an exaggerated inflammatory response that can occur in COVID-19 also play a role. Those who survive COVID-19 remain at a 40% elevated risk for diabetes in the first year, even if their case of COVID-19 was not particularly severe. A subsequent post-pandemic wave of new diabetes patients may be expected.

Chronic liver disease-related mortality in diabetes before and during the COVID-19 in the United States

BACKGROUND

Global pandemic of COVID-19 represents an unprecedented challenge. COVID-19 has predominantly targeted vulnerable populations with pre-existing chronic medical diseases, such as diabetes and chronic liver disease.

AIMS

We estimated chronic liver disease-related mortality trends among individuals with diabetes before and during the COVID-19 pandemic.

METHODS

Utilizing the US national mortality database and Census, we determined the quarterly age-standardized chronic liver disease-related mortality and quarterly percentage change (QPC) among individuals with diabetes.

RESULTS

The quarterly age-standardized mortality for chronic liver disease and/or cirrhosis among individuals with diabetes remained stable before the COVID-19 pandemic and sharply increased during the COIVD-19 pandemic at a QPC of 8.5%. The quarterly mortality from nonalcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD) increased markedly during the COVID-19 pandemic. Mortality for hepatitis C virus (HCV) infection declined with a quarterly rate of -3.3% before the COVID-19 pandemic and remained stable during the COVID-19 pandemic. While ALD- and HCV-related mortality was higher in men than in women, NAFLD-related mortality in women was higher than in men.

CONCLUSIONS

The sharp increase in mortality for chronic liver disease and/or cirrhosis among individuals with diabetes during the COVID-19 pandemic was associated with increased mortality from NAFLD and ALD.