Determinants of weight, psychological status, food contemplation and lifestyle changes in patients with obesity during the COVID-19 lockdown: a nationwide survey using multiple correspondence analysis.

INTRODUCTION: The corona virus disease 2019 (COVID-19) pandemic forced most of the Italian population into lockdown from 11 March to 18 May 2020. A nationwide survey of Italian Clinical Nutrition and Dietetic Services (Obesity Centers or OCs) was carried out to assess the impact of lockdown restrictions on the physical and mental wellbeing of patients with obesity (PWO) who had follow-up appointments postponed due to lockdown restrictions and to compare determinants of weight gain before and after the pandemic. METHODS: We designed a structured 77-item questionnaire covering employment status, diet, physical activity and psychological aspects, that was disseminated through follow-up calls and online between 2 May and 25 June 2020. Data were analyzed by multiple correspondence analysis (MCA) and multiple linear regression. RESULTS: A total of 1,232 PWO from 26 OCs completed the questionnaires (72% female, mean age 50.2 ± 14.2 years; mean BMI 34.7 ± 7.6 kg/m2; 41% obesity class II to III). During the lockdown, 48.8% gained, 27.1% lost, while the remainder (24.1%) maintained their weight. The mean weight change was +2.3 ± 4.8 kg (in weight gainers: +4.0 ± 2.4 kg; +4.2% ± 5.4%). Approximately 37% of participants experienced increased emotional difficulties, mostly fear and dissatisfaction. Sixty-one percent reduced their physical activity (PA) and 55% experienced a change in sleep quality/quantity. The lack of online contact (37.5%) with the OC during lockdown strongly correlated with weight gain (p < 0.001). Using MCA, two main clusters were identified: those with unchanged or even improved lifestyles during lockdown (Cluster 1) and those with worse lifestyles during the same time (Cluster 2). The latter includes unemployed people experiencing depression, boredom, dissatisfaction and increased food contemplation and weight gain. Within Cluster 2, homemakers reported gaining weight and experiencing anger due to home confinement. CONCLUSIONS: Among Italian PWO, work status, emotional dysregulation, and lack of online communication with OCs were determinants of weight gain during the lockdown period.

Factors predicting weight gain during Covid-19 lockdown in patients with obesity: A national survey

Rationale: We hypothesized that Covid-19 epidemics lockdown1,2 might have negatively impacted on weight control in Italian patients with obesity being followed-up at Specialistic Centres. Methods: A survey was carried out at Italian Clinical Nutrition & Dietetic Services by means of a structured questionnaire (77 items) - covering diet, physical activity and psychological aspects - to get information about how their patients with obesity coped with Covid-19 lockdown. Ethical clearance was obtained. The survey has been carried out between 2ndMay and 25th June 2020 during follow-up phone calls by direct questioning or by sending invitations to complete the questionnaire on the Web. Data were analyzed by Chi-square test, ANOVA and MANCOVA as appropriate. Results: 1046 patients from 23 Centers (41% Obesity Class 2 to 3) completed the questionnaires (71% females, mean age 50,5 ± 14,2 yrs, mean BMI 34.7 ± 7.6 kg/m2). During the lockdown period, 49,3% of patients increased and 27.4% reduced their weight, while this was unchanged in 19,6%. Mean weight change was +2.3 ± 4.8 kg (+ 4% in those who experienced weight gain). There was a significant association between reduced physical activity, emotional difficulties during lockdown and weight gain. Moreover, those working from home and those on layoffs experienced a significantly higher weight gain than those allowed to work outside home or retired. Sixty-six% declared to be on a weight control diet before the lockdown, and of these, 40% reported difficulty to follow their diet. More frequent snacking and increased intake of high calorie foods were the most frequent food habits change declared. Only 4% of patients were on obesity medications, but 14% of patients would have liked to be on obesity medications during the lockdown. Conclusion: During Covid-19 lockdown about half of patients with obesity in follow-up at Italian Dietetic Services did not increase their weight or experiences weight loss. However, the remaining half experienced a clinically relevant weight gain. Those who increased their weight likely did mostly so because of reduced physical activity and difficult emotional coping. Working from home was also associated with more difficult weight control. References: 1. Disclosure of Interest: None declared