Target Audience and Goal Statement: Endocrinologists, infectious disease specialists, primary care physicians
The goal of this study was to examine the impact of COVID-19 stay-at-home orders on weight-related behaviors among patients with obesity.
Question Addressed:
- Did the stay-at-home orders affect the physical, mental, and financial health of people with obesity?
Study Synopsis and Perspective:
The fast-spreading SARS-CoV-2 virus has upended lives and economies worldwide. Broad and quick societal upheavals have been the norm, due to the mounting COVID-19 death toll (more than 450,000 worldwide at last count).
Although the “patchwork pandemic” may be “fraying” in the U.S. and elsewhere, one thing has become clear: deaths have not been distributed evenly. For example, obesity-related conditions seem to worsen the effect of COVID-19. Indeed, as U.S. states continue to reopen, a Kaiser Family Foundation study reported that almost one in four American adult workers could be vulnerable to severe illness from COVID-19.
Action Points
- Patients with marked obesity reported more anxiety and depression, as well as less exercise and more stress eating, due to stay-at-home orders implemented to stop the spread of COVID-19, according to a University of Texas survey study.
- Note that these results show that the COVID-19 pandemic is having a significant impact on patients with obesity regardless of infection status, and can help inform clinicians and healthcare professionals about effective strategies to minimize negative outcomes for this vulnerable population now and in post-COVID-19 recovery efforts.
Various strategies have been devised for jump-starting economies by ending social distancing or quarantine — two of the ways to slow the spread of COVID-19 in the absence of effective treatments or a vaccine. However, implicit in this approach is the supposition that vulnerable individuals may have to self-isolate longer than others or take additional precautions.
According to research led by Sarah Messiah, PhD, of the University of Texas (UT) Health Science Center at Houston School of Public Health in Dallas, people with obesity have been struggling to maintain their weight and mental health during the stay-at-home orders.
Results from their study of weight management patients at the UT Southwestern Weight Wellness Program and a community bariatric surgery practice were recently published in Clinical Obesity.
“Everyone was told to stay home to protect themselves from infection and this was especially important for people with severe obesity, who are more likely to have serious complications and higher risk of death with the coronavirus,” said Messiah in a statement. “But these are also patients who often have comorbidities such as heart disease and diabetes that need consistent care. This was the first assessment of this patient population to see the effects of the upheaval of their daily lives on their health behavior and well-being.”
The final analytic sample consisted of 123 patients (87% women, mean age 51.2 years, mean body mass index [BMI] 40.2 kg/m2, 49.2% non-Hispanic white); 33.1% had completed bariatric surgery. More than half of the patients (56.1%) had graduated college and an additional third had some education beyond high school. Most of the sample (53.6%) had an annual household income >$75,000. Frequent self-reported medical conditions were high blood pressure (67%), sleep apnea (51%), and diabetes (30%).
Patients responded to an online survey (non-anonymous) designed to obtain information about the pandemic’s impact on their lives. This was started on April 15 — about 2 weeks after the state’s governor issued a stay-at-home order. They also filled out a demographic questionnaire (Behavioral Risk Factor Surveillance System [BRFSS]). Depressive symptoms were assessed using the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR).
Most patients reported only leaving their homes for necessities. While only two patients (1.7%) had tested positive for SARS-CoV-2, more patients (14.6%) reported COVID-19 symptoms.
Since the start of the stay-at-home orders, 72.8% reported increased anxiety and 83.6% reported increased depression.
A significantly higher proportion of non-Hispanic white patients reported increased anxiety compared with other racial and ethnic groups, though there were no significant differences in those reporting depression. After adjustment, Hispanic patients were less likely to report anxiety than non-Hispanic whites.
Those with obesity already have a 25% higher risk of developing mood and anxiety disorders.
Almost 70% of the participants reported having more difficulty in achieving their weight loss goals since the order, while 48% had less exercise time, and 56% had less intensity in exercise.
Half of the sample reported an increase in stockpiling food, while slightly more than a third (39.6%) of the sample reported grocery shopping once a week. Well over half reported cooking more often (63.8%), and 61.2% reported stress eating. Although most respondents were not food insecure (78.3%), some of them did skip meals (12.1%). Almost 10% lost their jobs during the pandemic, and 20% said they could not afford a balanced meal.
This was a convenience sample, and thus prone to selection bias. Furthermore, participants had established weight management goals and secured health insurance, which is not representative of the average American challenged with obesity, in which <2% receive anti-obesity medications. This limits the generalizability of the findings and may not accurately reflect the burden of COVID-19 on obesity-related health and behaviors in those of lower socioeconomic status and/or ethnic minority populations who are disproportionately more affected by obesity and COVID-19. Other study limitations included the self-reported perception of patient behavioral changes at the time of the survey, rather than quantified behaviors.
Source Reference: Clinical Obesity 2020; DOI: 10.1111/cob.12386
Study Highlights and Explanation of Findings:
Stay-at-home orders mandated in many states plus efforts to isolate vulnerable populations and people with diagnosed or suspected COVID-19 have had serious effects on health behaviors and well-being for patients with obesity.
“Public health strategies to control the outbreak that focused on social distancing have led to an increase in loneliness and social isolation, which play a significant role in behaviors that influence body weight,” Messiah and team wrote.
Most of the patients followed the stay-at-home orders, and as a result 87% left their homes only for necessities. Overall, nearly 70% of patients reported that their weight loss goals were harder to achieve.
There were substantial decreases in physical activity duration and intensity. Patients also reported negative impacts on food access and consumption behaviors. Even more troubling, according to the researchers, were the increased anxiety, depression, and job loss.
“You don’t have to contract the virus to be adversely affected by it. The major strength of this study is that it is one of the first data-driven snapshots into how the COVID-19 pandemic has influenced health behaviors for patients with obesity,” said first author Jaime Almandoz, MD, MBA, an assistant professor of internal medicine at UT Southwestern, in a press release.
Almandoz highlighted the point that some patients may reside in food deserts lacking grocery stores, where their choices may be limited to fast food and processed foods from convenience stores.
“Unchecked diabetes, hypertension, and other obesity-related comorbidities will create a huge backlog of needs that will come back to haunt us. When you throw in disruptions like social isolation, coupled with losing your job and insurance coverage, a potential disaster is waiting to unfold,” he added.
Lost health insurance due to lost jobs and missed non-COVID-19 medical appointments because of the pandemic might add to lives lost.
The researchers emphasized that due to the “increase in obesogenic behavior” found in this study, healthcare access should not be interrupted for patients with obesity.
“In addition to asking about diet and exercise patterns, screening for indicators of mental health, loneliness, financial stressors and behaviors that may influence body weight should be implemented by healthcare teams” to prevent “exacerbating the negative health and economic consequences of excess body weight,” the team wrote.
Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College
Primary Source
Clinical Obesity
Secondary Source
MedPage Today
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