How Indian obese population managed their lifestyle during first and second lockdown during COVID-19 pandemic? - A comparative study.

Background: People from all over the world have been affected by the COVID-19 (SARS-CoV-2) pandemic. The lockdown during the pandemic has impacted the lifestyle of most of the population. The aim of the present study is to compare the effect of COVID lockdown-1 and lockdown-2 on the lifestyle of the obese Indian population. Methods: This was a cross-sectional study conducted during the COVID-19 lockdown on obese adults. A well-structured questionnaire was developed and administered among the study population. The study was conducted in two phases (lockdown-1 and lockdown-2). A total of 390 subjects were included in the study (260 subjects in the lockdown-1 phase and 130 subjects in the lockdown-2 phase). Data on diet, sleep, stress, and physical activity were obtained and analyzed. Results: The mean age of the participants of phase-1 in the study was 41.7 ± 10.2 years and the participants of phase-2 were 44.5 ± 9.2 years. Statistically significant differences were observed between lockdown-1 and lockdown-2 in terms of monitoring of weight and other comorbid conditions, changes in the consumption of refined flour and processed foods, sugar and sugar-sweetened foods, oils and ghee, duration of physical activity, changes in the duration of sleep, and the stress levels related to COVID-19 (P < 0.001). Conclusion: The impact of the lockdowns on health was very significant and different areas of lifestyle were affected in both the lockdowns. Weight gain was reported in both phases of the lockdown. The monitoring of health parameters, eating frequency, diet, and stress levels were affected during lockdown-1, whereas during lockdown-2, sleep duration and physical activity were affected. A comprehensive lifestyle modification plan is required to be developed to avoid these effects in the future.

Effect of intensive weight-loss intervention on metabolic, ultrasound and anthropometric parameters among patients with obesity and non-alcoholic fatty liver disease: an RCT.

BACKGROUND: Lifestyle intervention is the mainstay therapy for Non-Alcoholic Fatty Liver Disease (NAFLD). We aimed to assess the efficacy of an intensive (9 contact points in 6 months) weight-loss intervention among patients with obesity (BMI 25-39.9 kg/m2) and NAFLD in north India. METHODS: A total of 140 patients (18-60 years) with obesity and NAFLD were randomized into intervention (n = 70) and control (n = 70) groups, at a tertiary-care hospital. Weight, anthropometric parameters, Controlled Attenuation Parameter (CAP), Liver Stiffness Measurement (LSM), liver enzymes, grade of fatty liver and HOMA-IR were measured at baseline (T0) and 6 months (T6). There was a high drop-out, exacerbated by the Covid-19 pandemic. Completers comprised of 59 participants (n = 30 intervention, n = 29 control). Intention to treat analysis was done. RESULTS: At T6, ALT normalized in significantly higher (p = 0.03) number of cases in the intervention arm (66.7%) versus control arm (18.2%). No significant improvement was seen in other metabolic, ultrasound or anthropometric outcomes. Weight (p < 0.001), AST (p = 0.01), ALT (p = 0.02), body fat% (p < 0.001), WC (p < 0.001) and CAP (p < 0.001) significantly improved within the intervention arm along with a trend of improvement in steatosis and HOMA-IR. Control group showed significant decrease in weight (p < 0.001), WC (p < 0.001) and CAP (p = 0.02). Twice the number of patients in intervention arm (46.7%) lost ≥5% weight, compared to control arm (24.1%) (p = 0.07). CONCLUSION: The intensive weight-loss intervention was not effective in improving the treatment outcomes among patients with obesity and NAFLD. However, given the potential of our intervention, we recommend larger trials with more intensive weight-loss interventions.

A cross sectional survey of 504 women regarding perceived risk factors and barriers to follow healthy lifestyle and association with sociodemographic factors and menopausal symptoms.

BACKGROUND AND AIMS: Midlife women undergoing menopausal transition are predisposed to weight gain. Weight gain in midlife is driven by two modifiable risk factors: menopausal symptom's severity and lifestyle practices. The independent and interactive nature of menopausal symptoms and lifestyle practices as risk factors of weight gain has not been investigated yet. This study was undertaken to study menopausal symptoms and lifestyle practices as risk factors for weight gain in midlife women and identify midlife -related barriers in managing corrective lifestyle practices. METHODS: In this cross-sectional study, menopausal symptom severity and lifestyle practices such as diet, exercise, and sleep were assessed using a pre-validated and reliable questionnaire on a convenience sample of midlife women (43-55 years) via an interview schedule. The association of lifestyle practices and its barriers with socio-demographics and menopausal symptoms were analysed. RESULT: A total of 504 women (mean age: 47.3 ± 4.1 years) were recruited. More than half of them followed corrective dietary practices, but only one-fourth engaged in moderate-intensity exercises. Total menopausal symptom severity was associated with increased food intake (P < 0.001), joint pain with limited physical activity and hot flashes and emotional volatility with sleep disturbances (P < 0.01). Demographic variables such as education, economic and employment status were associated with unhealthy lifestyle practices. CONCLUSION: Assessment of menopausal symptoms and lifestyle practices as risk factors and associated barriers must be the pivotal component to devise comprehensive women-centric weight management modules. Similar studies should be carried out in future when there is no clear effect of COVID19 on lifestyle factors.

Knowledge, barriers and facilitators regarding COVID-19 vaccine and vaccination programme among the general population: A cross-sectional survey from one thousand two hundred and forty-nine participants.

BACKGROUND AND AIMS: The success of the COVID-19 vaccination program is dependent on people's knowledge and attitude regarding the vaccination program. Higher vaccine acceptance can be ensured by strengthening the facilitators and limiting the barriers being observed among the general population. MATERIAL AND METHODS: Indexed study is a cross-sectional web-based survey using a pre-validated questionnaire to assess knowledge, barriers and facilitators of COVID-19 vaccine and vaccination programme administered on adults across India using a Google online survey platform. RESULTS: A total of 1294 responses (age: 38.02 ± 13.34 years) were collected. Most of the participants had limited knowledge regarding the eligibility of vaccines in vulnerable population groups such as people with allergies (57.89%) and immune-compromised patients (62.98%), pregnant and lactating women (41.89%) and patients with chronic illness (34.78%). Older participants (>45 years) were more willing to take the COVID-19 vaccine (p < 0.001) as they believed the vaccine is not harmful and considered it as societal responsibility. Younger participants (<45 years) and those residing in urban settings raised concerns on the availability of the vaccine and authenticity of the vaccine (p < 0.001). CONCLUSION: There is a scope for improvement in people's knowledge regarding COVID-19 vaccine and the vaccination programme by addressing the barriers and facilitators which can improve the participants' turnover at vaccination centres.

Development and validation of a questionnaire to assess knowledge, attitude, practices, and concerns regarding COVID-19 vaccination among the general population.

BACKGROUND AND AIMS: There seems to be hesitation in the general population in accepting COVID 19 vaccine because of associated myths and/or misinformation. This study is dedicated to develop and validate a tool to interpret vaccine acceptance and/or hesitancy by assessing the knowledge, attitude, practices, and concerns regarding the COVID vaccine. MATERIAL AND METHODS: Mixed methods study design was used. In phase 1, the questionnaire was developed through literature review, focus group discussion, expert evaluation, and pre-testing. In phase 2, the validity of the questionnaire was obtained by conducting a cross-sectional survey on 201 participants. The construct validity was established via principal component analysis. Cronbach's alpha value was used to assess the reliability of the questionnaire. RESULTS: The 39-item questionnaire to assess the knowledge, attitude, practices, and concerns regarding the COVID-19 vaccine was developed. The Cronbach's alpha value of the questionnaire was 0.86 suggesting a good internal consistency. CONCLUSION: The developed tool is valid to assess the knowledge, attitude, practices and concerns regarding the COVID-19 vaccine acceptance and/or hesitancy. It has the potential utility for healthcare workers and government authorities to further build vaccine literacy.

What Indians Think of the COVID-19 vaccine: A qualitative study comprising focus group discussions and thematic analysis.

BACKGROUND AND AIMS: The study aims to interpret current knowledge, attitude, perceptions and concerns regarding COVID-19 vaccine in the Indian population. METHODS: Eight focus group discussions were conducted. Participants were recruited via purposive sampling. Discussions were recorded and transcribed verbatim. Key themes were extracted using thematic analysis method. RESULTS: There were 19 males and 24 females, with a mean age of 36 ± 11 years. Sub-themes identified were knowledge, attitude, perception and concerns regarding COVID-19 vaccine, leading to the main theme, i.e., views about the COVID-19 vaccine. CONCLUSION: People have mixed perceptions regarding COVID-19 vaccine. Channelling correct messages may improve people's willingness to get vaccinated.

A short questionnaire to assess changes in lifestyle-related behaviour during COVID 19 pandemic.

BACKGROUND AND AIMS: The lasting impact of COVID 19 pandemic and associated restrictions are bound to be significant on lifestyle-related behaviour including diet, physical activity and sleep which is one of the important components in the management of diabetes mellitus and metabolic syndrome. This study was conducted to develop and validate a questionnaire to assess changes in individual's lifestyle-related behaviour during COVID 19 pandemic. MATERIALS AND METHODS: The questionnaire was developed through a standardised methodology including literature review, focus group discussion, expert evaluation, pre-testing and validation. The face validity and content validity of the questionnaire were analysed. A cross-sectional survey was carried out on 103 participants to validate the questionnaire that used a 5-point Likert scale for the response option. Exploratory factor analysis was performed to establish construct validity. Cronbach's alpha was calculated to test the internal consistency of the whole questionnaire. RESULTS: A questionnaire with 20 items to assess the lifestyle-related behaviour of people was developed. The questionnaire shows a satisfactory validity and a good internal consistency with the Cronbach's alpha value of 0.72. CONCLUSION: The developed tool is valid and reliable to assess the changes in lifestyle-related behaviour of individuals during COVID 19 pandemic.

Impact of COVID-19 on lifestyle-related behaviours- a cross-sectional audit of responses from nine hundred and ninety-five participants from India.

BACKGROUND AND AIMS: The impact of measures taken to contain COVID-19 on lifestyle-related behaviour is undefined in Indian population. The current study was undertaken to assess the impact of COVID-19 on lifestyle-related behaviours: eating, physical activity and sleep behaviour. METHODS: The study is a cross-sectional web-based survey. A validated questionnaire to assess the changes in lifestyle-related behaviour was administered on adults across India using a Google online survey platform. RESULTS: A total of 995 responses (58.5% male, mean age 33.3 years) were collected. An improvement in healthy meal consumption pattern and a restriction of unhealthy food items was observed, especially in the younger population (age <30 years). A reduction in physical activity coupled with an increase in daily screen time was found especially among men and in upper-socio-economic strata. Quarantine induced stress and anxiety showed an increase by a unit in nearly one-fourth of the participants. CONCLUSIONS: COVID-19 marginally improved the eating behaviour, yet one-third of participants gained weight as physical activity declined significantly coupled with an increase in screen and sitting time. Mental health was also adversely affected. A detailed understanding of these factors can help to develop interventions to mitigate the negative lifestyle behaviours that have manifested during COVID-19.

Is excess weight a risk factor for the development of COVID 19 infection? A preliminary report from India.

BACKGROUND AND AIM: This study explored the association between BMI and COVID-19 positive status in a tertiary care hospital from New Delhi. METHODS: Three hundred and seventy nine adult patients who presented to COVID-19 screening outpatient department of the hospital were interviewed over the phone regarding their body weight and height. The COVID-19 RT-PCR report of the patients was extracted from the hospital information system. RESULTS: The mean BMI and the prevalence of obesity was observed to be higher in individuals who were detected to be COVID-19 RT-PCR positive as compared to those who were negative. With every one-unit increment in BMI above 23 kg/m2, the odds of being COVID-19 positive increased by 1.8 times among these patients. CONCLUSION: The findings suggest a dose-response association between BMI and the odds of COVID-19 infection in individuals with excess weight.