Lockdowns Making Things Worse for Obese Americans: Study
As COVID-19 closed gyms and forced people to hunker down at home, "Quarantine-15" jokes flooded the internet, referring to the weight gain that many anticipated.
For people who are already obese, though, breaking healthy habits poses special risks, according to Sarah Messiah, of the University of Texas School of Public Health in Dallas. She works with many people who have had or plan to have weight-loss surgery.
After the operation, which limits how much a person can eat, patients are supposed to follow strict diets, and doctors regularly check in on them to help them stick with it and continue to shed pounds.
After Texas ordered people to shelter in place in late March, Messiah and her colleagues feared that their obese patients -- now stuck at home without access to in-person medical care -- would fall back into unhealthy habits. In addition to other health consequences, their weight puts them at higher risk of death from COVID-19.
To find out how they were adapting and whether they had been infected, Messiah and her team surveyed 123 patients between April 15 and May 31. Their findings were published June 9 in the journal Clinical Obesity.
The results were not encouraging. While two patients tested positive for COVID-19 and 15% reported symptoms, their reported changes in eating and exercise were also alarming.
"Things were actually worse than we had expected," Messiah said.
Almost 70% reported more difficulty in achieving weight-loss goals, and 6 out of 10 reported they were doing more stress-eating.
"This is a population that's already sick from doing this. So doing more of it is absolutely not a good thing," Messiah said.
Half said they were frequently stockpiling food, in fear of possible rationing and to limit potential exposure to the coronavirus during grocery shopping trips.
A surplus of food in the house can trigger overeating, especially for morbidly obese patients, who sometimes struggle with impulse control, according to Messiah.
While some experts hoped that the closure of restaurants would force healthier eating habits, the study's responses found otherwise.
"Even though more patients are cooking at home, the type of foods that are being stockpiled are likely to be processed foods due to their longer shelf life," the authors wrote. "It is possible Americans may be trading one pattern of low-quality consumption for another by choosing cheaper processed foods instead of eating out."
Almost half of patients said they were exercising less, and nearly 56% said the intensity of their workouts had decreased since quarantine began. The study noted that loneliness and social isolation are predictors of physical inactivity.
The survey also revealed that many patients were struggling with mental health symptoms. More than 72% reported an increase in anxiety, and more than 83% said they were more depressed than usual.
Since obesity is partly behavior-driven, mental health issues can make the situation worse, triggering harmful habits like stress-eating, the authors noted.
Connie Diekman, a St. Louis-based food and nutrition consultant who reviewed the findings, said that health care providers in the weight-loss field need to be mindful of the pandemic's psychological impacts.
"One of the things that we dietitians have seen through all of this is a lot of guilt on the part of patients, because they aren't exercising, because they're overeating, or because they're bingeing," Diekman said. "Guilt, of course, only makes those behaviors worse."
That's why, she said, it's necessary to give people a break.
"It's OK if you fell off the wagon, but now the key is when you're going to get back on the wagon," Diekman said.
She said those who are struggling to lose weight should start by identifying one simple change they can make in their diet and exercise. For example, that could mean getting on a meal schedule, lowering the number of snacks consumed per day, or committing to a daily walk around the block.
"It's about identifying the easiest first step towards regaining control," Diekman said. "Take it one step at a time, because small steps lead to big change, and they also are maintainable."
The study authors hope their findings underscore the importance of making mental health services a routine part of weight-loss treatment.
Messiah said high obesity rates in the United States and worldwide mean that many, many people are being negatively affected by the shelter-in-place orders.
"It's like a shadow epidemic that may be happening as a result of these COVID-19 stay-at-home orders, in that people with chronic diseases are now not getting treatment and potentially getting sicker as a result," she said.
For more about life after weight-loss surgery, visit the U.S. National Library of Medicine.
SOURCES: Sarah Messiah, Ph.D., M.P.H., professor, epidemiology, human genetics and environmental sciences, University of Texas, School of Public Health, Dallas; Connie Diekman, M.Ed., R.D., St. Louis-based food and nutrition consultant and former president, Academy of Nutrition and Dietetics; Clinical Obesity, online, June 9, 2020
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