Effects of Covid-19 Pandemic on Dysfunctional Eating Behaviors and Symptoms among the General Population: A Systematic Review and Meta-Analysis

ABSTRACT

Introduction: The coronavirus outbreak has been publicly and formally defined a global pandemic by the World Health Organization on March 11th 2020. Some extreme but effective safety measures have been applied in order to limit the spread of the infection among the population. The price of COVID-19 restrictive measures and lockdowns has been especially heavy for individual's mental health. There is previous evidence that the COVID-19-related lockdown has impacted on mental health worsening among individuals with Feeding and Eating Disorders (EDs) and clinical obesity. Potential affecting aspects might have been restriction to daily activities and movements, excessive exposure to harmful eating patterns on social media, emotional distress, fear of contagion, and low access to treatment and care. Nevertheless, especially on the basis of the proven-detrimental impact of the COVID-19 lockdown on in- dividuals with clinical eating disorders, home confinement might analogously have had a negative impact also on the eating behaviors of individuals from the general population. The aim of this systematic review and meta-analysis is to investigate the impact of the COVID-19 pandemic on the prevalence of EDs symptoms and dysfunctional eating behaviours (i.e. emotional overeating, night eating, snacking, binge eating, undereating, food avoidance) among the general population. Method(s) We searched eligible articles in Medline, Embase, PsycInfo, Scopus, and Web of Science. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. A total of 221 studies met the inclusion criteria. Result(s) The pooled prevalence of increased body weight was 33% (95% CI 30-35) among individuals in 84 studies. Forty-five percent (95% CI 31-59) of participants in 10 studies experienced body shape concern, body dissatisfaction and body misperception. Other EDs symptoms increased in the general population during the pandemic, such as overeating (41%;95% CI 33-48), food cravings (36%;95% CI 12- 59), binge eating (35%;95% CI 20-51), emotional eating (28%;95% CI 23-33) and snacking (27%;95% CI 23-32). Food restriction, excessive physical activity, weight loss and night eating were also common. Pooled data of longitudinal studies showed a significant difference in BMI and dysfunctional eating behaviours before and during the pandemic. Conclusion(s) This meta-analysis evidenced a negative impact of the pandemic on eating behaviors among the general population. Overall, these results highlight the need for further high-quality longitudinal studies that examine which specific populations experienced higher distress than others, and what are the long-term negative consequences of COVID-19.