Weight trends amongst adults with diabetes or hypertension during the COVID-19 pandemic: an observational study using OpenSAFELY (preprint)

AimsTo describe patterns of weight change amongst adults living in England with Type 2 Diabetes (T2D) and/or hypertension during the COVID-19 pandemic. Design and SettingWith the approval of NHS England, we conducted an observational cohort study using the routinely collected health data of approximately 40% of adults living in England, accessed through the OpenSAFELY service inside TPP. MethodWe estimated individual rates of weight gain during the pandemic ({delta}). We then estimated associations between clinical and sociodemographic characteristics and rapid weight gain (>0.5kg/m2/year) using multivariable logistic regression. ResultsWe extracted data on adults with T2D (n=1,231,455, 44% female, 76% white British) or hypertension (n=3,558,405, 50% female, 84% white British). Adults with T2D lost weight overall (median {delta} = -0.1kg/m2/year [IQR: -0.7, 0.4]), however, rapid weight gain was common (20.7%) and associated with sex (male vs female: aOR 0.78[95%CI 0.77, 0.79]); age, older age reduced odds (e.g. 60-69-year-olds vs 18-29-year-olds: aOR 0.66[0.61, 0.71]); deprivation, (least-deprived-IMD vs most-deprived-IMD: aOR 0.87[0.85, 0.89]); white ethnicity (Black vs White: aOR 0.70[0.69, 0.71]); mental health conditions (e.g. depression: aOR 1.13 [1.12, 1.15]); and diabetes treatment (non-insulin treatment vs no pharmacological treatment: aOR 0.68[0.67, 0.69]). Adults with hypertension maintained stable weight overall (median {delta} = 0.0kg/m2/year [-0.6, 0.5]), however, rapid weight gain was common (24.7%) and associated with similar characteristics as in T2D. ConclusionAmongst adults living in England with T2D and/or hypertension, rapid pandemic weight gain was more common amongst females, younger adults, those living in more deprived areas, and those with mental health conditions. How this fits inPrevious studies, in the general population, have reported female sex, deprivation and comorbid mental health conditions increased risk of unhealthy weight gain during the pandemic, but it is not clear whether people living with hypertensions and/or type 2 diabetes experienced the same trends. We found that, during the pandemic, adults with hypertension maintained a stable weight whilst those with type 2 diabetes lost weight overall. However, underlying these overall trends, rapid weight gain was common amongst people with type 2 diabetes (20.7%) or hypertension (24.7%)), with female sex, younger age, deprivation, and comorbid mental health conditions associated with an increased odds of rapid weight gain in both populations. We have identified clinical and sociodemographic characteristics of individuals with hypertension and/or type 2 diabetes who could benefit from primary care interventions on weight and health behaviours to combat health inequalities in patterns of weight gain that were exacerbated by the pandemic.

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

Background We investigated which clinical and sociodemographic characteristics were associated with unhealthy patterns of weight gain amongst adults living in England during the pandemic. Methods With the approval of NHS England we conducted an observational cohort study of Body Mass Index (BMI) changes between March 2015 and March 2022 using the OpenSAFELY-TPP platform. We estimated individual rates of weight gain before and during the pandemic, and identified individuals with rapid weight gain (>0.5kg/m2/year) in each period. We also estimated the change in rate of weight gain between the prepandemic and pandemic period and defined extreme-accelerators as the ten percent of individuals with the greatest increase (>1.84kg/m2/year). We estimated associations with these outcomes using multivariate logistic regression. Findings We extracted data on 17,742,365 adults (50.1% female, 76.1% White British). Median BMI increased from 27.8kg/m2[IQR:24.3 to 32.1] in 2019 (March 2019 to February 2020) to 28.0kg/m2 [24.4 to 32.6] in 2021. Rapid pandemic weight gain (n=3,214,155) was associated with female sex (male vs female: aOR 0.76 [95%CI:0.76 to 0.76]); younger age (50 to 59 years vs 18 to 29 years: aOR 0.60 [0.60 to 0.61]); White British ethnicity (Black Caribbean vs White British: aOR 0.91 [0.89 to 0.94]); deprivation (least-deprived-IMD-quintile vs most-deprived:aOR 0.77 [0.77 to 0.78]); and long-term conditions, of which mental health conditions had the greatest effect (e.g. depression (aOR 1.18[1.17 to 1.18])). Similar characteristics increased risk of extreme acceleration (n=2,768,695). Interpretation We found female sex, younger age, deprivation and mental health conditions increased risk of unhealthy patterns of pandemic weight gain. This highlights the need to incorporate sociodemographic, physical, and mental health characteristics when formulating post-pandemic research, policies, and interventions targeting BMI. Funding NIHR