COVID ‐19 stay‐at‐home orders influence health behaviors of patients with obesity

Reviewed by Emily Henderson, B.Sc.Jun 11 2020

Shelter-in-place orders to reduce the spread of COVID-19 put unusual strains on people with obesity, making it more difficult for them to eat properly and manage their weight, according to a UT Southwestern study.

The study, published in the journal Clinical Obesity, surveyed 123 weight management patients at the UT Southwestern Weight Wellness Program and a community bariatric surgery practice. In addition to less exercise and more stress eating, most patients also reported increased anxiety and depression.

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."

Jaime Almandoz, M.D., MBA, endocrinologist and assistant professor of internal medicine at UT Southwestern who authored the study

Almandoz is also medical director for the UT Southwestern Weight Wellness Program, a multidisciplinary weight management and post-bariatric care clinic.

Beyond challenges with diet and exercise, the researchers are also concerned that patients may be missing medical appointments, surgeries, and medications due to the pandemic. People with obesity are at higher risk for complications and death from the virus due to many factors, including comorbidities such as diabetes and hypertension.

According to the Centers for Disease Control and Prevention, more than 42 percent of American adults are obese. Obesity-related health conditions include heart disease, stroke, Type 2 diabetes,

Almandoz points out that many patients with obesity struggle with access to appropriate fresh, healthy foods. Some reside in food deserts lacking grocery stores, where the only options are 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," Almandoz notes.

Although just 1.7 percent of the study group who were tested for COVID-19 were positive, the pandemic is having a significant impact on the group's physical and mental health.

Nearly 70 percent said their weight loss goals were more difficult to achieve during the shelter-in-place period. More than 47 percent exercised less, 49 percent stockpiled food, and 61 percent confessed to stress eating. Mental health issues also rose significantly, with 72 percent reporting anxiety and 83 percent noting depression.

"Those with obesity and severe obesity are already at the highest risk of death from COVID-19. We're concerned that they can be severely affected if a second wave hits in the fall," says senior author Sarah Messiah, Ph.D., M.P.H., an adjunct professor in the UTSW department of population and data sciences and also a professor in the department of epidemiology, human genetics and environmental sciences at the UTHealth School of Public Health.

Chronic stress, coupled with working from home and in some cases home schooling children, makes it difficult to follow recommendations for a healthy diet and exercise regimen. Job losses due to the pandemic present additional difficulties. In this study, 10 percent reported losing their jobs and health insurance coverage, which put them at further risk of health complications due to lack of access to care.

"We don't yet know how many additional lives will be lost to heart disease and diabetes simply because people did not receive care during COVID-19," says Messiah. "Unfortunately, many of these are ethnic minorities who are already hit hard with disease burdens."

The researchers believe their work can inform clinicians and other health professionals on effective strategies to minimize the physical and psychosocial health impacts from COVID-19 among adults with obesity both during and after the pandemic.

The study data came from an online questionnaire conducted April 15 through May 31. The study population was racially and ethnically diverse, had a mean age of 51, and 87 percent were women. The mean body mass index (BMI) for these patients was 40.