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The Impact of COVID-19 Stay-At-Home Orders on Health Behaviors in Adults.
Flanagan, EW, Beyl, RA, Fearnbach, SN, Altazan, AD, Martin, CK, Redman, LM
Obesity (Silver Spring, Md.). 2021;29(2):438-445
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In response to the global outbreak of COVID-19, a wave of quarantine and stay-at-home mandates were issued to attenuate the rapid worldwide spread. The aim of this study was to quantify changes in habitual dietary behaviours, physical activity, sleep, sedentary behaviours, and mental health before and during the initial peak of the COVID-19 pandemic. This study is based on an anonymous survey via paid advertisements on the social media platform Facebook. A total of 7,753 completed the first COVID-19 question and were thus included in the analysis. Results indicate that: - declines in healthful eating behaviours were coincident with reductions in physical activity. These negative behaviours were characteristic of individuals reporting weight gain in response to the pandemic outbreak. - anxiety scores nearly doubled in response to the pandemic and 20% of the sample reported that symptoms were severe enough to interfere with daily routines. - home confinement led to shifts in daily work and household responsibilities which resulted in mental health declines alongside some positive and many negative changes to health behaviours. Authors conclude that with increased cases of weight gain and significant declines to mental health, COVID-19 may impact clinical practice for years to come.
Abstract
OBJECTIVE Stay-at-home orders in response to the coronavirus disease 2019 (COVID-19) pandemic have forced abrupt changes to daily routines. This study assessed lifestyle changes across different BMI classifications in response to the global pandemic. METHODS The online survey targeting adults was distributed in April 2020 and collected information on dietary behaviors, physical activity, and mental health. All questions were presented as "before" and "since" the COVID-19 pandemic. RESULTS In total, 7,753 participants were included; 32.2% of the sample were individuals with normal weight, 32.1% had overweight, and 34.0% had obesity. During the pandemic, overall scores for healthy eating increased (P < 0.001), owing to less eating out and increased cooking (P < 0.001). Sedentary leisure behaviors increased, while time spent in physical activity (absolute time and intensity adjusted) declined (P < 0.001). Anxiety scores increased 8.78 ± 0.21 during the pandemic, and the magnitude of increase was significantly greater in people with obesity (P ≤ 0.01). Weight gain was reported in 27.5% of the total sample compared with 33.4% in participants with obesity. CONCLUSIONS The COVID-19 pandemic has produced significant health effects, well beyond the virus itself. Government mandates together with fear of contracting the virus have significantly impacted lifestyle behaviors alongside declines in mental health. These deleterious impacts have disproportionally affected individuals with obesity.
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Increased emotional eating during COVID-19 associated with lockdown, psychological and social distress.
Cecchetto, C, Aiello, M, Gentili, C, Ionta, S, Osimo, SA
Appetite. 2021;160:105122
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After China, Italy was the first country in which the coronavirus disease 2019 (COVID-19) pandemic rapidly spread. As a consequence, a lockdown was imposed in the entire nation to reduce the spread of infections. The main aim of this study was to investigate how the negative emotions raised by the lockdown and the social features that characterised the quality of life during lockdown interacted with individual characteristics to affect the eating behaviour during the lockdown. This study is based on an anonymous online survey which was shared via social media targeting Italian residents or speakers who were 18 years of age or older. A total of 365 participants were considered for this study. Results indicate that: - increased emotional eating was significantly predicted by higher level of anxiety, depression, and partially, by Quality of Life and Quality of the Relationships. - increased binge eating was predicted by higher stress. - higher alexithymia [a broad term to describe problems with feeling emotions] scores were associated by increased emotional eating and higher body mass index scores were associated with both increased emotional eating and binge eating. - emotional eating and binge eating decreased significantly in Phase 2 compared to Phase 1 of the lockdown period. Authors conclude that future policies during lockdown should also take into consideration the emotional toll on individual well-being and should include measures of psychological support.
Abstract
Due to the spread of COVID 2019, the Italian government imposed a lockdown on the national territory. Initially, citizens were required to stay at home and not to mix with others outside of their household (Phase 1); eventually, some of these restrictions were lifted (Phase 2). To investigate the impact of lockdown on emotional and binge eating, an online survey was conducted to compare measures of self-reported physical (BMI), psychological (Alexithymia), affective (anxiety, stress, and depression) and social (income, workload) state during Phase 1 and Phase 2. Data from 365 Italian residents showed that increased emotional eating was predicted by higher depression, anxiety, quality of personal relationships, and quality of life, while the increase of bingeing was predicted by higher stress. Moreover, we showed that higher alexithymia scores were associated by increased emotional eating and higher BMI scores were associated with both increased emotional eating and binge eating. Finally, we found that from Phase 1 to Phase 2 binge and emotional eating decreased. These data provide evidence of the negative effects of isolation and lockdown on emotional wellbeing, and, relatedly, on eating behaviour.
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Psychological Aspects and Eating Habits during COVID-19 Home Confinement: Results of EHLC-COVID-19 Italian Online Survey.
Di Renzo, L, Gualtieri, P, Cinelli, G, Bigioni, G, Soldati, L, Attinà, A, Bianco, FF, Caparello, G, Camodeca, V, Carrano, E, et al
Nutrients. 2020;12(7)
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The new form of coronavirus (Sars-CoV-2) has triggered a worldwide state of emergency. The lockdown measures have had a great impact on everyday life, often associated with a negative influence on psychological well-being. The aim of this study was to analyse the psychological status during the COVID-19 pandemic and its correlation with the eating habits in the Italian population. This study is based on the “Eating Habits and Lifestyle Changes in COVID-19 lockdown” (EHLC-COVID19) project which conducted research, using an electronic survey in Italian, to collect data on the Italian population regarding eating habits, lifestyle and the behavioural and emotional impact related to the COVID-19 pandemic. Results showed that the lockdown has had effects on the mood of the participants (n = 61.3% lowering of their mood). Most of the participants referred to anxious feelings and depressed moods as well as exhaustion and tension with tachycardia and breathing difficulties. Furthermore, almost half of the participants felt anxious because of their eating habits which lead to comfort food and increased food intake in order to feel better. Authors conclude that since the COVID-19 pandemic is still on-going, further study on psychological status, eating habits and positivity in relation to COVID-19 should be conducted.
Abstract
The COVID-19 pandemic has had a huge impact on the population with consequences on lifestyles. The aim of the study was to analyse the relationship between eating habits, mental and emotional mood. A survey was conducted online during social isolation, from 24 April to 18 May 2020, among the Italian population. A total of 602 interviewees were included in the data analysis. A high percentage of respondents experienced a depressed mood, anxious feelings, hypochondria and insomnia (61.3%, 70.4%, 46.2% and 52.2%). Almost half of the respondents felt anxious due to the fact of their eating habits, consumed comfort food and were inclined to increase food intake to feel better. Age was inversely related to dietary control (OR = 0.971, p = 0.005). Females were more anxious and disposed to comfort food than males (p < 0.001; p < 0.001). A strength of our study was represented by the fact that the survey was conducted quickly during the most critical period of the Italian epidemic lockdown. As the COVID-19 pandemic is still ongoing, our data need to be confirmed and investigated in the future with larger population studies.
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Long-term effects of a three-component lifestyle intervention on emotional well-being in women with Polycystic Ovary Syndrome (PCOS): A secondary analysis of a randomized controlled trial.
Jiskoot, G, Dietz de Loos, A, Beerthuizen, A, Timman, R, Busschbach, J, Laven, J
PloS one. 2020;15(6):e0233876
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Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women in their reproductive years. The condition is often associated with higher rates of depression and anxiety, particularly with a Body Mass Index (BMI) of >30. As weight-loss has shown to improve a host of symptoms experienced in PCOS, the authors sought to investigate whether weight-loss would also lead to a reduction in depressive symptoms. This secondary analysis of a longitudinal, randomised trial of 155 women, compared a combined lifestyle intervention of diet advice, eating behaviour, exercise and standardised Cognitive Behaviour Therapy (CBT) to standard advice for weight reduction. Over a 12-months the chosen lifestyle interventions demonstrated a sustained improvement in self-assessed depression scores, though independent of weight-loss. However, weight-loss itself was closely linked with improved body image and self-esteem. Additional monitoring of hormones (androgens, insulin, cortisol) and calculations for insulin sensitivity (HOMA-IR ) did not show any direct link with depressive scores. This study affirms the benefit of integrative lifestyle approaches on emotional well-being in women with PCOS. Practitioners might find it of interest that improvements in emotional well-being can occur independent of weight loss in individuals experiencing depressive symptoms with PCOS.
Abstract
Many women with Polycystic Ovary Syndrome (PCOS) report high depression rates. The relationship between PCOS and these high depression rates is unclear. Two-component lifestyle interventions have revealed short-term effects on depression scores in this group of women. In general, 3-component interventions including diet, exercise, and cognitive behavioral therapy (CBT) are more effective in the long-term to improve emotional well-being. This has not yet been studied in women with PCOS. This study examined the effect of 20 CBT lifestyle (LS) sessions combined with a healthy diet and physical therapy with or without 9 months additional feedback through Short Message Service (SMS) via mobile phone, compared to care as usual (CAU, involving advice to lose weight). In this secondary analysis, 155 women with PCOS and a BMI above 25 kg/m2 were eligible. Depression scores decreased significantly in the LS programme compared to CAU (P = 0.045). In both the LS programme without SMS (P = 0.036) and the LS programme with SMS (P = 0.011) depression scores decreased while no change was observed in CAU (P = 0.875). Self-esteem scores improved significantly in the LS programme compared to CAU (P = 0.027). No differences in body image scores were observed in LS participants compared to CAU (P = 0.087), although body image improved significantly in both the LS without SMS (P = 0.001) and with SMS (P = 0.008) study arms. We found no significant mediating role by androgens in the relationship between LS participants and emotional well-being. Only weight-loss mediated the relationship between LS and self-esteem. To conclude, a three-component lifestyle intervention programme with or without additional SMS resulted in significant improvements in depression and self-esteem compared to CAU, in women with PCOS, obesity, and a wish to achieve a pregnancy. Testosterone, androstenedione, DHEA, insulin, HOMA-IR, and cortisol did not mediate this effect. Weight loss mediated the effects on self-esteem but not on depression and body-image. This suggests that lifestyle treatment independent of weight loss can reduce depression and body-image, but both lifestyle treatment and weight loss can improve self-esteem. Thus, a three-component lifestyle intervention based on CBT could prove successful in improving mood in women with PCOS who are overweight or obese and attempting to become pregnant.
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Type 2 Diabetes Mellitus in Class II and III Obesity: Prevalence, Associated Factors, and Correlation between Glycemic Parameters and Body Mass Index.
Silveira, EA, de Souza Rosa, LP, de Carvalho Santos, ASEA, de Souza Cardoso, CK, Noll, M
International journal of environmental research and public health. 2020;17(11)
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Type 2 diabetes mellitus (T2DM) and obesity are independently known to cause serious health complications, with risks of cardiovascular diseases, higher mortality, low quality of life, and increased public health spending. However, when these diseases occur concurrently, their negative effects on health, health systems, and mortality are even greater. The main aim this study was to investigate the prevalence of T2DM and its associated factors, with an emphasis on biochemical parameters and eating habits, in class II and III obese individuals. The study included 150 class II and III obese individuals from the primary healthcare system of the Brazilian Unified Health System. Results indicate a high prevalence of T2DM (40%) in the studied population, with the associated risks being lower educational level, non-consumption of whole grains, and high insulin resistance. Furthermore, there was no correlation between BMI and glycaemic parameters, that is, an increased BMI did not directly affect a decline in the metabolic condition of T2DM individuals. Authors conclude by emphasising the need to perform further research on T2DM in class II and III obese population.
Abstract
Despite the worldwide growth of class II and III obesity, the factors associated with type 2 diabetes mellitus (T2DM) in these obese individuals are not widely understood. Moreover, no study has investigated these associations in South America. Our study aimed to investigate the prevalence of T2DM and its associated factors, with an emphasis on biochemical parameters and eating habits, in class II and III obese individuals. We also aimed to analyze the correlation between glycemic parameters and body mass index (BMI). Baseline data from a randomized clinical trial (DieTBra Trial) of 150 class II and III obese individuals (BMI > 35 kg/m2) was used. An accelerometer, Food Frequency Questionnaire, and bioimpedance analysis were used to assess physical activity levels, eating habits, and body composition, respectively. Blood was collected after 12 h of fasting. Hierarchical multivariate Poisson regression was performed, and prevalence ratios (PRs) were calculated. Correlations between glycemic parameters (fasting blood glucose, glycosylated hemoglobin, homeostasis model assessment of insulin resistance (HOMA-IR), and insulin) and BMI were also analyzed. The prevalence of T2DM was 40.0% (95% CI, 32.1-48.3), high fasting blood glucose level was 19.33% (95% CI, 13.3-26.6), and high glycosylated hemoglobin was 32.67% (95% CI, 25.2-40.8). Age ≥ 50 years (PR = 3.17, 95% CI, 1.26-7.98) was significantly associated with T2DM; there was a positive linear trend between age and T2DM (p = 0.011). Multivariate analysis showed an association with educational level (PR = 1.49, 1.07-2.09, p = 0.018), nonconsumption of whole grains daily (PR = 1.67, 1.00-2.80, p = 0.049), and high HOMA-IR (PR = 1.54, 1.08-2.18, p = 0.016). We found a high prevalence of T2DM and no significant correlations between BMI and glycemic parameters.
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Food processing and cardiometabolic risk factors: a systematic review.
Santos, FSD, Dias, MDS, Mintem, GC, Oliveira, IO, Gigante, DP
Revista de saude publica. 2020;54:70
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Cardiovascular diseases (CVD) comprise the main cause of mortality in the world and approximately three quarters of deaths occur in low- and middle-income countries. The aim of this study was to assess the association between food consumption according to processing and cardiometabolic factors in adults and/or the elderly. This study is a systematic review of eleven studies. Five studies (46%) had a sample size greater than 10,000 participants and the smallest sample identified evaluated 302 individuals. Results indicate that the consumption of UPF can have an unfavourable impact on the health of individuals, especially contributing to increase the body mass index. The cardiometabolic risk factors identified were overweight or obesity, arterial hypertension and metabolic syndrome. Authors conclude that their findings may contribute to strengthening scientific evidence that underlies public policies related to the area of food and nutrition and the coping with cardiovascular diseases.
Abstract
OBJECTIVE To systematically review the evidence for the association between food consumption according to processing and cardiometabolic factors in adults and/or the elderly. METHOD Two independent evaluators analyzed the electronic databases PubMed, Web of Science and Lilacs until December 2018. We used the following terms: (convenience foods OR food processing OR highly-processed OR industrialized foods OR minimally-processed OR prepared foods OR processed foods OR ultra-processed OR ultraprocessed OR ultra processed OR unprocessed) AND (metabolic syndrome OR hypertension OR blood pressure OR diabetes mellitus OR glucose OR glycaemia OR insulin OR cholesterol OR triglycerides OR blood lipids OR overweight OR obesity) AND (adult OR adults OR adulthood OR aged OR elderly OR old). We assessed methodological and evidence qualities, and also extracted information for the qualitative synthesis from the selected studies. RESULTS Of the 6,423 studies identified after removing duplicates, eleven met the eligibility criteria. The main food classification we used was Nova. The consumption of ultra-processed foods was positively associated with overweight and obesity, high blood pressure and metabolic syndrome. All articles included met more than 50% of the methodological quality criteria. The quality of evidence was considered moderate for the outcome overweight and obesity and weak for hypertension and metabolic syndrome. CONCLUSIONS The Nova food classification stands out in the area of nutritional epidemiology when assessing the effects of food processing on health outcomes. Although caution is required in the interpretation, the results indicated that the consumption of ultra-processed foods can have an unfavorable impact in the health of individuals.
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A Biopsychosocial Model of Sex Differences in Children's Eating Behaviors.
Keller, KL, Kling, SMR, Fuchs, B, Pearce, AL, Reigh, NA, Masterson, T, Hickok, K
Nutrients. 2019;11(3)
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This paper discusses the role of sex on children’s appetite and responses to food cues. The review flips the question of whether the variations in obesity and eating disorders seen by biological sex are actually influenced by, and to what extent, by sex eg. is sex the determining factor for differing responses? It specifically reviews behaviours in children aged 11 years and younger, avoiding adolescence (the typical age when differences in eating patterns occur), to understand if these differences are correlated with sex, given the high incidence of female eating disorders. The researchers reviewed specific traits including food acceptance, food intake, picky eating, appetitive traits, eating compensation, eating in the absence of hunger, and meal-specific microstructural patterns (e.g., bite rate and eating speed). They found that girls typically like a wider variety of foods than boys and had a greater preference for plant foods whilst boys typically preferred meats and foods higher in fats and sugar. No sex differences were found for picky eating. Boys were found to have greater enjoyment for eating, with girls showing more food avoidance traits, however this may be from parental strategies reinforcing this behaviour in girls. Boys are more readily satiated and better able to regulate their food and drink intake than girls. Yet boys are also more likely to eat in the absence of hunger and have a faster eating rate and larger bite size. The paper concludes that the studies reviewed are suggestive of male–female differences in food liking and intake, appetitive traits, self-regulatory eating, and meal-related microstructure.
Abstract
The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to critically discuss the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in food acceptance, food intake, appetitive traits, eating-related compensation, and eating speed. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits. Further, results from neuroimaging suggest that obesity in female children is positively related to neural reactivity to higher-energy-dense food cues in regions involved with contextual processing and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.