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

The gendered impact of Covid-19 on health behaviours and mental health: Evidence from the UK

The purpose of this paper is to assess whether the COVID-19 pandemic affected the health behaviours of men and women differently, and to estimate whether the associations between health behaviours and mental health differed by gender. By employing nationally representative panel data (UKHLS) and a difference-in-differences strategy, we provide evidence that the pandemic adversely affected health behaviours among women more than men in the UK. Compared to men, women were 3.2 percentage points less likely to adopt a healthy lifestyle and reported 0.09 fewer healthy behaviours (corresponding to 7.0 per cent of a standard deviation) during the pandemic. These changes are primarily driven by smaller improvements rather than absolute declines in health behaviours for women compared to men. The changes in health behaviours among women appear to persist over time when lockdown policies were relaxed. Importantly, we find that the pandemic considerably weakened the protective effect of health behaviours on mental health for women but not for men. For women, adopting a healthy lifestyle was strongly correlated with mental health before the pandemic, but this relationship was no longer significant during the pandemic. This loss in significance corresponds to a 0.61-points decline in the GHQ-12 Likert score, equivalent to 10.5 per cent of a standard deviation. However, we observe a partial return of the protective effect of health behaviours on mental health once lockdown measures had eased.

Food Security and Cardio-Metabolic Risk in Individuals with Metabolic Syndrome

This study assessed the association of food security with potential cardio-metabolic risk factors among persons with metabolic syndrome (MetS). Data were derived from the baseline data of a randomized controlled lifestyle intervention trial for individuals with MetS. Household food security, fruit and vegetable intake, perceived food environment, and perceived stress were collected using validated questionnaires. Cardio-metabolic measures assessed with standardized procedures included body mass index, waist circumference, blood pressure, glucose, HbA1c, and lipids. Regression models adjusted for demographics, medication use, and perceived stress were performed. Of a total of 664 participants (median age 56), the majority were female, non-Hispanic White, college-educated, and employed. Food insecurity affected 23% (n = 152), with 5% (n = 31) experiencing very low food security. Food-insecure individuals had significantly higher stress (p < 0.001), lacked healthy food access (p < 0.001), were and less likely to consume ≥2 servings of vegetables/day (p = 0.003). HbA1c was the only cardio-metabolic measure significantly associated with food security (p = 0.007). The link between food insecurity and elevated HbA1c levels highlights the importance of addressing food insecurity and stress to improve metabolic health outcomes in the MetS population.

Changes in food and drink purchasing behaviour in England during the first 3 months of the COVID-19 pandemic: an interrupted time series analysis

OBJECTIVE

This study examined changes food and drink purchasing during the first 3 months of the COVID-19 pandemic in England, and if changes varied by population subgroups.

DESIGN

We investigated changes in take-home food and drink purchasing and frequency of out-of-home (OOH) purchasing using an interrupted time series analysis design. The start of pandemic restrictions (the intervention) was defined as 16 March 2020, when first announced in the UK.

SETTING

London and the North of England.

PARTICIPANTS

1245 households reporting take-home and 226 individuals reporting OOH purchases between January 2019 and mid-June 2020 from the GB Kantar Fast Moving Consumer Goods Panel.

RESULTS

The marginal mean estimate of total take-home energy purchased was 17·4 % (95 % CI 14·9, 19·9) higher during the pandemic restriction period compared with the counterfactual. Increases of 35·2 % (95 % CI 23·4, 47·0) in take-home volume of alcoholic beverages and 1·2 % (95 % CI 0·1, 2·4) in foods and drinks high in fat, salt and sugar were observed. Reductions in purchased energy from fruit and vegetables (-7·3 %, 95 % CI -10·9, -3·6), ultra-processed foods (-4·0 %, 95 % CI -5·2, -2·8) and in OOH purchasing frequency (-44·0 %, 95 % CI -58·3, -29·6) were observed. Changes in chocolate and confectionery, soft drink and savoury snack purchases levelled off over time. Changes in all studied outcomes varied by sociodemographic characteristics and usual purchasing.

CONCLUSIONS

Pandemic restrictions were associated with positive and negative changes in food and drink purchasing, which differed by individual characteristics. Future research should ascertain if changes persist and translate into changes in health.

Misaligned or misheard? Physical activity and healthy eating messaging to ethnic minority communities during the COVID-19 pandemic: A qualitative study and scoping review

This mixed-methods study identified physical activity (PA) and healthy eating messages produced during the COVID-19 pandemic and explored how they were received by UK ethnic minority communities. A scoping review of research and grey literature identified categories of PA and healthy eating messaging targeted at ethnic minorities. Individual and group interviews were conducted, audio-recorded, transcribed and analysed using inductive thematic analysis. There was active community engagement in all study phases to ensure relevance and co-production of findings. Interviews were held with 41 study participants aged 18-86 years (20 men) residing in England and Wales using digital conferencing and in person. The scoping review identified 24 records containing messages grouped into three categories: 1) PA messages; 2) healthy eating messages; 3) risk messages. Five themes described participants' views of these messages: 1) lack of awareness of messaging; 2) responses to PA messaging; 3) responses to healthy eating messaging; 4) perceptions of risk messaging and 5) perceptions of conflict in messages. The review revealed that physical activity and healthy eating messaging specifically targeting ethnic minority communities is limited. This limited messaging was almost entirely missed by these communities. When received, the messaging was not interpreted as intended, perceived to be conflicting and risk messaging was perceived as blaming. More work with ethnic minority communities needs to be done to co-produce meaningful and appropriate PA and healthy eating messaging in a timely manner.

Trends in weight gain recorded in English primary care before and during the Coronavirus-19 pandemic: An observational cohort study using the OpenSAFELY platform

BACKGROUND

Obesity and rapid weight gain are established risk factors for noncommunicable diseases and have emerged as independent risk factors for severe disease following Coronavirus Disease 2019 (COVID-19) infection. Restrictions imposed to reduce COVID-19 transmission resulted in profound societal changes that impacted many health behaviours, including physical activity and nutrition, associated with rate of weight gain. We investigated which clinical and sociodemographic characteristics were associated with rapid weight gain and the greatest acceleration in rate of weight gain during the pandemic among adults registered with an English National Health Service (NHS) general practitioner (GP) during the COVID-19 pandemic.

METHODS AND FINDINGS

With the approval of NHS England, we used the OpenSAFELY platform inside TPP to conduct an observational cohort study of routinely collected electronic healthcare records. We investigated changes in body mass index (BMI) values recorded in English primary care between March 2015 and March 2022. We extracted data on 17,742,365 adults aged 18 to 90 years old (50.1% female, 76.1% white British) registered with an English primary care practice. We estimated individual rates of weight gain before (δ-prepandemic) and during (δ-pandemic) the pandemic and identified individuals with rapid weight gain (>0.5 kg/m2/year) in each period. We also estimated the change in rate of weight gain between the prepandemic and pandemic period (δ-change = δ-pandemic-δ-prepandemic) and defined extreme accelerators as the 10% of individuals with the greatest increase in their rate of weight gain (δ-change ≥1.84 kg/m2/year) between these periods. We estimated associations with these outcomes using multivariable logistic regression adjusted for age, sex, index of multiple deprivation (IMD), and ethnicity. P-values were generated in regression models. The median BMI of our study population was 27.8 kg/m2, interquartile range (IQR) [24.3, 32.1] in 2019 (March 2019 to February 2020) and 28.0 kg/m2, IQR [24.4, 32.6] in 2021. Rapid pandemic weight gain was associated with sex, age, and IMD. Male sex (male versus female: adjusted odds ratio (aOR) 0.76, 95% confidence interval (95% CI) [0.76, 0.76], p < 0.001), older age (e.g., 50 to 59 years versus 18 to 29 years: aOR 0.60, 95% CI [0.60, 0.61], p < 0.001]); and living in less deprived areas (least-deprived-IMD-quintile versus most-deprived: aOR 0.77, 95% CI [0.77, 0.78] p < 0.001) reduced the odds of rapid weight gain. Compared to white British individuals, all other ethnicities had lower odds of rapid pandemic weight gain (e.g., Indian versus white British: aOR 0.69, 95% CI [0.68, 0.70], p < 0.001). Long-term conditions (LTCs) increased the odds, with mental health conditions having the greatest effect (e.g., depression (aOR 1.18, 95% CI [1.17, 1.18], p < 0.001)). Similar characteristics increased odds of extreme acceleration in the rate of weight gain between the prepandemic and pandemic periods. However, changes in healthcare activity during the pandemic may have introduced new bias to the data.

CONCLUSIONS

We found female sex, younger age, deprivation, white British ethnicity, and mental health conditions were associated with rapid pandemic weight gain and extreme acceleration in rate of weight gain between the prepandemic and pandemic periods. Our findings highlight the need to incorporate sociodemographic, physical, and mental health characteristics when formulating research, policies, and interventions targeting BMI in the period of post pandemic service restoration and in future pandemic planning.

Long-lasting effects of the COVID-19 pandemic on lifestyle and body weight: results of representative cross-sectional surveys in adults in Germany

BACKGROUND

The COVID-19 pandemic severely affected people's daily lives and health. Few studies have looked into the persistence of these changes. In the current study, we investigated to what extent changes in lifestyle and body weight were sustained after two years of restrictions.

METHODS

We performed two representative online surveys among adults living in Germany. The first survey (S1) was performed in April 2021; the second survey (S2) in June 2022. The questionnaire focused on changes in physical activity, dietary habits, body weight, and mental stress levels. The data were weighted to optimally represent the general population of Germany. Using Chi-square tests, results were compared between the two surveys, and - per survey - between subgroups based on sociodemographic factors and mental stress levels. Furthermore, binomial logistic regression was performed to identify factors associated with weight gain.

RESULTS

A total of 1,001 (S1) and 1,005 (S2) adults completed the survey, of which 50.4% were men and 49.6% were women in both surveys. Mean body mass index (BMI) at the time of the survey was 27.4 ± 6.0 kg/m2 (S1) and 27.1 ± 5.5 kg/m2 (S2). Reduced physical activity was reported by 52% of the participants in S1 and by 40% in S2 (p < .001). Moderate to severe stress was reported by 71% of the participants in S1 and by 62% in S2 (p < .001). Less healthy eating compared to before the pandemic was reported by 16% of the participants in S1 and by 12% in S2 (p = 0.033). Weight gain was reported by 40% of the participants in S1 and by 35% in S2 (p = 0.059). Weight gain was associated with higher BMI, reduced physical activity levels, less healthy nutrition and increased consumption of energy-dense food.

CONCLUSIONS

Our results indicate that two years and three months after the start of the COVID-19 pandemic, the adverse effects on health-related lifestyle factors and body weight still existed, albeit to a lesser degree than directly after the first year of the pandemic. Targeted strategies are needed to better support the population subgroups most likely to change their lifestyle in unfavorable ways when faced with disruptions of their everyday lives.

The impact of the first COVID-19 lockdown on weight management practices in UK adults: A self-regulation perspective

This study aimed to identify the impact of the first UK COVID-19 lockdown on individuals' weight management attempts (WMA). A self-regulation theoretical framework was used to identify predictors of continuing with a WMA, and weight change during the lockdown. An online retrospective cross-sectional study was conducted after the first UK COVID-19 lockdown. The sample consisted of 166 UK adults (M:31.08, SD:12.15) that were trying to manage their weight before the lockdown started. The survey assessed changes in WMA and practices, and measured perceived stress, flexible/rigid restraint, uncontrolled eating, craving control, and self-compassion. Results showed that 56% of participants reported disruption to their WMA during the lockdown. Participants with lower levels of perceived stress and higher flexible restraint were more likely to continue their WMA. Flexible restraint was a significant predictor of weight change. Interventions that promote flexibility in weight management may be beneficial for at-risk individuals under lockdown conditions.

Digital communication and virtual reality for extending the behavioural treatment of obesity - the patients' perspective: results of an online survey in Germany

BACKGROUND

CBT has been found effective for the treatment of EDs and obesity. However not all patients achieve clinically significant weight loss and weight regain is common. In this context, technology-based interventions can be used to enhance traditional CBT but are not yet widespread. This survey therefore explores the status quo of pathways of communication between patients and therapists, the use of digital applications for therapy as well as attitudes towards VR from the perspective of patients with obesity in Germany.

METHODS

This cross-sectional online survey was conducted in October 2020. Participants were recruited digitally through social media, obesity associations and self-help groups. The standardized questionnaire included items concerning current treatment, paths of communication with their therapists, and attitudes toward VR. The descriptive analyses were performed with Stata.

RESULTS

The 152 participants were mostly female (90%), had a mean age of 46.5 years (SD = 9.2) and an average BMI of 43.0 kg/m² (SD = 8.4). Face-to-face communication with their therapist was considered of high importance in current treatment (M = 4.30; SD = 0.86) and messenger apps were the most frequently used digital application for communication. Participants were mostly neutral regarding the inclusion of VR methods in obesity treatment (M = 3.27; SD = 1.19). Only one participant had already used VR glasses as part of treatment. Participants considered VR suitable for exercises promoting body image change (M = 3.40; SD = 1.02).

DISCUSSION

Technological approaches in obesity therapy are not widespread. Face-to-face communication remains the most important setting for treatment. Participants had low familiarity with VR but a neutral to positive attitude toward the technology. Further studies are needed to provide a clearer picture of potential treatment barriers or educational needs and to facilitate the transfer of developed VR systems into clinical practice.

Low Dietary Variety Is Associated with Incident Frailty in Older Adults during the Coronavirus Disease 2019 Pandemic: A Prospective Cohort Study in Japan

BACKGROUND

Stagnation of social activity due to the COVID-19 pandemic probably reduces motivation to maintain a healthy diet. It is important to report on the dietary changes observed in older adults during a period of restriction on outings and to clarify the relationship between dietary variety and frailty. This one-year follow-up study examined the association between frailty and dietary variety during the COVID-19 pandemic.

METHODS

Baseline and follow-up surveys were conducted in August 2020 and August 2021, respectively. The follow-up survey was distributed by mail to 1635 community-dwelling older adults aged ≥65 years. Of the 1235 respondents, 1008 respondents who were non-frail at baseline are included in this study. Dietary variety was examined using a dietary variety score developed for older adults. Frailty was assessed using a five-item frailty screening tool. The outcome was frailty incidence.

RESULTS

In our sample, 108 subjects developed frailty. A linear regression analysis revealed a significant association between dietary variety score and frailty score (β, -0.032; 95% CI, -0.064 to -0.001; p = 0.046). This association was also significant in Model 1, adjusted for sex and age, (β, -0.051; 95% CI, -0.083 to -0.019; p = 0.002) and in a multivariate analysis that added adjustments for living alone, smoking, alcohol use, BMI, and existing conditions to Model 1 (β, -0.045; 95% CI, -0.078 to -0.012; p = 0.015).

CONCLUSIONS

A low dietary variety score was associated with an increased frailty score during the COVID-19 pandemic. The restricted daily routine caused by the COVID-19 pandemic will probably continue to have a long-term effect in terms of reduced dietary variety. Thus, vulnerable populations, such as older adults, might require dietary support.

Impact of COVID-19 Confinement on the Health-Related Habits of People at High Risk of Type 2 Diabetes

The general lockdown decreed in Spain due to the COVID-19 pandemic interrupted the ALAS health promotion intervention aimed at the population at high risk of suffering from type 2 diabetes. We conducted a descriptive study in 2020 through a telephone survey and a comparison with baseline data to determine the impact of confinement on the lifestyles of the participants. We collected sociodemographic variables and conducted assessments before/after confinement on general health status and lifestyle (sleep, physical activity and diet). Additionally, weight, BMI and adherence to a Mediterranean diet were assessed. Descriptive statistical analyses, comparisons of pre-post confinement data and logistic regression were carried out. A total of 387 individuals responded. Among them, 31.8% reported a worse perception of health after confinement, and 63,1% reported no change. Regarding exercise, 61.1% reduced their weekly physical activity time. Regarding diet, 34,4% perceived worse quality, and 53.4% reported no change, despite the fact that 89.4% declared changes in their eating practices. Weight and BMI decreased by 3,1%, and adherence to the Mediterranean diet improved from baseline. Confinement had a negative impact on the general health, diet, sleep and physical activity of this population (at risk of diabetes); however, weight and BMI decreased, and adherence to a Mediterranean diet improved.

Susceptibility to COVID-19 Nutrition Misinformation and Eating Behavior Change during Lockdowns: An International Web-Based Survey

To understand the susceptibility to nutrition-health misinformation related to preventing, treating, or mitigating the risk of COVID-19 during the initial lockdowns around the world, the present international web-based survey study (15 April-15 May 2020) gauged participants' (n = 3707) level of nutrition-health misinformation discernment by presenting them with 25 statements (including unfounded or unproven claims circulated at the time), alongside the influence of information sources of varying quality on the frequency of changes in their eating behavior and the extent of misinformation held, depending on the source used for such changes. Results revealed widespread misinformation about food, eating, and health practices related to COVID-19, with the 25 statements put to participants receiving up to 43% misinformed answers (e.g., 'It is safe to eat fruits and vegetables that have been washed with soap or diluted bleach'). Whereas higher quality information sources (nutrition scientists, nutrition professionals) had the biggest influence on eating behavior change, we found greater misinformation susceptibility when relying on poor quality sources for changing diet. Appropriate discernment of misinformation was weakest amongst participants who more frequently changed their eating behavior because of information from poor quality sources, suggesting disparities in the health risks/safety of the changes performed.

Changes in Diet, Physical Activity, Alcohol Consumption, and Tobacco Use in Adults During the COVID-19 Pandemic: A Systematic Review

The COVID-19 pandemic changed various lifestyle habits worldwide due to the prevention measures implemented in each country, these changes may affect or benefit people's health. We aimed to systematically review changes in diet, physical activity (PA), alcohol consumption, and tobacco use habits during the COVID-19 pandemic in adults. Two databases: PubMed and ScienceDirect, were used for this systematic review. The research was limited to open-access, peer-reviewed original articles published in English, French, or Spanish from January 2020 to December 2022 and investigated diet, PA, alcohol consumption, and tobacco use habits before and during the COVID-19 pandemic in adults. Excluded studies were review studies, intervention studies with a sample size of fewer than 30 participants, and poor-quality articles. This review followed PRISMA 2020 guidelines (PROSPERO: CRD42023406524), whereas to assess the quality of the studies, we used the quality assessment tools developed by the BSA Medical Sociology Group for cross-sectional studies and the QATSO for the longitudinal studies. Thirty-two studies were included. Some studies reported changes to promote healthy lifestyles; 13 out of 15 articles reported an increase in healthy diet consumption habits, 5 out of 7 studies reported a decrease in alcohol consumption, and 2 out of 3 studies reported a decrease in tobacco use. On the other hand, the other studies reported changes to promote unhealthy lifestyles: 9 out of 15, and 2 out of 7 studies reported an increase in unhealthy diet and alcohol consumption habits respectively, 25 out of 25 reported a decrease in physical activity, and 13 out of 13 reported an increase in sedentary behavior. During the COVID-19 pandemic, there have been changes to promote a healthy and unhealthy lifestyle; the latter can affect people's health. Therefore, effective responses are needed to mitigate the consequences.

Impact of COVID-19 Vaccination Status and Confidence on Dietary Practices among Chinese Residents

Healthy diets promote immune functions and have been shown to reduce COVID-19 severity. In 2021, COVID-19 vaccines have become available to the general public. However, whether vaccination status could affect individual and populational health behaviors is unknown. This study aimed to investigate the impacts of vaccination status and confidence on dietary practices. An online survey was conducted in August 2021. We collected data on dietary intake, diversity and behaviors, vaccination status and confidence and socio-demographic characteristics. Among the 5107 responses received, a total of 4873 study participants were included in the final analysis. Most of our participants aged between 18 and 45 years and 82% of them were fully vaccinated against COVID-19. Household level dietary diversity was found to be higher among people who were fully vaccinated (β = 0.321, 95%CI: 0.024 to 0.618) or who were more confident in the protectiveness of the vaccine (β for tertile 3 comparing with lowest tertile = 0.544, 95%CI: 0.407, 0.682). Vaccination promoted the intake of seafood, but it was also positively associated with the consumption of sugar, preserved, fried and barbequed foods and reduced vegetable intake. Higher vaccination confidence was associated with increased consumption of seafood, bean, fruits and vegetables and reduced fat intake. Changes in dietary behaviors compared with early 2021 (when vaccination was not common) were observed and differed by vaccination status and confidence level. Conclusion: COVID-19 vaccination status and confidence had varied, and possibly negative, impacts on dietary intake and behaviors. Our results suggest that vaccination status and confidence might be significant influencing factors affecting people’s health behaviors and highlight that healthy eating should be consistently promoted to prevent poor dietary practices during global health crisis.

Assessment of Dietary and Lifestyle Responses After COVID-19 Vaccine Availability in Selected Arab Countries

Background

The COVID-19 pandemic has been consistently associated with unhealthy lifestyle behaviors and dietary practices. This study aimed to assess the dietary and lifestyle behaviors of adults after COVID-19 vaccine availability and their attitude toward the vaccine in selected Arab countries.

Methods

A cross-sectional survey-based study was conducted between October 2021 and December 2021 using Google Forms (n = 2259). A multi-component questionnaire was used to collect socio-demographic characteristics, attitudes toward the COVID-19 vaccine, and behavioral, dietary, and lifestyle responses after easing the restriction. Participants were given a score based on the sum of positive dietary and lifestyle changes. The generalized linear models were used to identify the association between positive dietary and lifestyle changes score and sociodemographic characteristics.

Results

Weight gain during the pandemic was reported by 39.5% of the participants, 36.1% reported ever getting infected with the COVID-19 virus, and 85% received at least one dose of the vaccine. The key adverse reactions of the COVID-19 vaccine were fatigue, headache, and joint pain, and the main reason for vaccination was protection against infection. Most participants were concerned about the vaccine side effects (45.8%) and inadequate testing (50.7%). After easing of restriction, 54.3% of the participants reduced the frequency of disinfecting objects, and 58.3% joined social events. Most dietary and lifestyle behaviors remained unchanged after vaccine availability but there was an increase in the time spent behind the screen for work (50.1%) and entertainment (42.9%). The results of the multivariate regression analyses revealed that older participants (p = 0.001), those with higher education (p = 0.010), and those working from home (p = 0.040) were more likely to have higher positive dietary and lifestyle changes scores.

Conclusion

Although most participants were concerned about vaccine safety, low vaccine hesitancy rates were observed among the study sample. The availability of the COVID-19 vaccines resulted in loosening some of the safety social measures among Arab adults but the negative impact of the pandemic on dietary and lifestyle behaviors remained unaltered.