key: cord-0427153-ec63ouo3 authors: Khan, M. A.; Menon, P.; Govender, R.; Samra, A.; Nauman, J.; Ostlundh, L.; Muistafa, H.; Allaham, K. K.; Smith, J. E. M.; Al Kaabi, J. title: Systematic review of the effects of pandemic confinements on body weight and their determinants date: 2021-03-05 journal: nan DOI: 10.1101/2021.03.03.21252806 sha: e264ce630f303ed8657fd59276d861161853ba51 doc_id: 427153 cord_uid: ec63ouo3 Pandemics and subsequent lifestyle restrictions such as lockdowns may have unintended consequences including alterations in body weight. Understanding the impact and the mechanisms affecting body weight is paramount for planning effective public health measures for both now and future lockdown-type situations. This systematic review assesses and the impact of pandemic confinement on body weight and to identifies contributory factors. A comprehensive literature search was performed in seven electronic databases and in gray sources from their inception until 1st July 2020 with an update in PubMed and Scopus on 1st February 2021. In total, 2,361 unique records were retrieved, of which 41 studies were identified eligible: 1 case-control study, 14 cohort and 26 cross-sectional studies (469362 total participants). Weight gain occurred predominantly in participants who were already overweight or obese. Associated factors included increased consumption of unhealthy food with decreased intake of healthy fresh fruits and vegetables, changes in physical activity, and altered sleep patterns. Weight loss during the pandemic was observed in individuals with previous low weight, and those who ate less and were more physically active before lock down. Associated factors included increased intake of fruits and vegetables, drinking more water and consuming no alcohol. Maintaining a stable weight was more difficult in populations with reduced income particularly in individuals with lower educational attainment. The findings of this systematic review highlight the short-term effects of pandemic confinements. Learning from the lockdown experience is fundamental if we are to prepare for the next wave; a holistic, reactive, tailored response is needed involving multiple providers. are to prepare for the next wave; a holistic, reactive, tailored response is needed involving multiple providers. Devastating physical morbidity and mortality outcomes due to coronavirus disease 2019 (COVID-19) have been mitigated by (1, 2) social distancing and quarantine measures (3) , with significant direct and indirect health implications. Although lockdown has reduced the "R number", physical wellbeing may have suffered from increased levels of stress, anxiety, and mental health issues (4) (5) (6) . Moderate weight gain in people with a normal body mass index (BMI) has an adverse effect on metabolism, which increases the risk of diabetes, cardiovascular disease (7) , or long-term ill-health (8) . Lockdown may precipitate weight gain similar to that seen during the six-week summer holidays because of increased inactive time spent at home and snacking on energy dense foods (9) (10) (11) . Rundle and colleagues argued that the extent and haste of the restrictions have exaggerated these observations (13) leading to rapid weight gain. This presents particular issues with the gained weight being more difficult to shed (14) . Moreover, physical and social isolation is a recognized risk factor for obesity (15) ; with weight due to overconsumption, particularly when large "emergency" food stores are present (16) . Reduced physical activity has further exacerbated the weight gain. The COVID-19 outbreak adversely affected food supply and demand on a global scale (17) . For some, lockdown gave more time to cook and overconsume, while those who were financially disadvantaged suffered from malnutrition and weight loss because of inflated food prices and food insecurity (18, 19) . Table 2 describes the characteristics of each of the 41 included studies. All of the studies were published in 2020 and 2021. Two studies were from preprints and were included after assessing their qualities individually (22, 52) . The included studies had the following countries of origin: Brazil (59) , China (40, 57) , Croatia (51, 64) , France (47, 52, 56) , Jordan (58) , India (48, 55) , Iraq (61) , Italy (21, 23, 24, 35, 36, 45, 45, 53) , Korea (50) , Lithuania (39) , Netherlands (60) , Poland (25, 42, 51) , Spain (44, 46, 63) , Turkey (43, 49, 65, 66) , United Arab Emirates (33) , United Kingdom (54) and the United States of America (26, 38, 41, 67) . Furthermore, multi-regional studies conducted intercontinentally (22) , among eighteen countries in the Middle East and North Africa (MENA) region (34) , and Paraguay and Italian based multinational research (62) are included in our analysis. Altogether, the studies enrolled 469,362 participants. The participants ranged in age from 6 to 86 years, and the mean ages for the individuals studied ranged from 9.9 to 74.3 years. The proportion of female participants ranged from 37% to 100%. The number of participants in the included studies ranged from 41 to 381,564. All studies included both male and female participants except one study (37) . The duration of confinement for the selected studies for this systematic review ranged between 1 and 24 weeks. In our study, 7.2%-72.4% of all participants including both adults and children , experienced an increase in body weight during the confinement periods ( There was a higher weight gain among participants who self-reported stress (26, 45, 55, 56, 58, 61, 62) , anxiety and depression (23, 52, 58, 61, 62) . Weight loss was observed in 11.1%-32.0% of participants (21, 25, 33, 35, 37, 40, 51, 52, 55, 60, 65, 68) . The mean experienced weight loss ranged from 2.0 (±1.4) to 2.9 (±1.5) kg. There was increased alcohol consumption (25, 47, 56, 62, 68) during the lockdown, while a decrease in alcohol consumption was also noted compared with pre-COVID-19 in another study (21, 47) . There was an increase in cigarette smoking generally (47, 51, 56, 64) while in contrast, 3.3% of the smokers surveyed reported reduced smoking during quarantine (20) . Although, the participants reported spending more time in bed before lockdown (24, 26, 55, 57) ,the overall sleep quality was worse (46, 55, 63) . In contrast, secondary school students felt refreshed on awakening and increased sleeping hours (51) . Weight gain was reported by others to be related to decreased night time sleep and reduced physical activity time (26, 41, 60) Sedentary lifestyle and screen time increased during the lockdown (24, 26, 38, 47, (55) (56) (57) . Those participants who were not currently working or those who started working from home felt that they gained more weight compared with participants who did not have a change in job routine (21, 21, 52, 58) . Physical activity altered by varying amounts, reduced in some studies to between 18% and 84% (23, 24, 34, 35, 40, 47, 52, 54, 55, 59) . People who were already overweight or obese engaged in less physical activity and had decreased energy expenditure during lockdown (37, 39, 44, (52) (53) (54) 56, 59) . Obese children spent less time participating in sports activities (24) . By contrast, studies reporting an increase in physical activity (21, 52) found greater engagement in yoga/pilates, functional training, home training, and treadmill use and overall increased training frequency (21) . Weight gain was more common in those already overweight or obese prior to lockdown and in individuals with pre-existing difficulty in weight management (21, (23) (24) (25) 37, 39, 44, 46, 49, 64) . Increased snacking and food consumption were observed in participants with a higher BMI (24, 25, 33, 34, 68) . Many of the participants agreed that they consumed less fruits and vegetables on a daily basis (22, 25, 34, 52, 69, 70) but more high energy processed foods (23) (24) (25) 41, 44) . This intake was associated with an enhanced appetite and after-dinner hunger (21, 37, 39, 45) . Obese children reported an increase in the number of meals eaten along with an increased consumption of sweetened drinks, potato chips, and red meat (24) . A decrease in intensive physical activity was associated with obesity (54) . An inverse relationship was found between changes occurring in sporting activities and the number of meals consumed per day (24, 41, 53, 68) . The participants self-reporting anxiety and depression displayed an estimated weight gain (23, 45, 55, 56, 58, 62) . Table 4 describes the determinants of body weight changes during the pandemic. Many determinants that can influence increased weight gain during confinement were identified via this current systematic review. This includes past behaviors, dietary behaviors, physical activity patterns, work environment, psychosocial and socioeconomic factors, and preexisting comorbidities. Female sex (21, 35, 39, 43, 52, 64) , age under 25 years and over 45 years (25, 39, 52, 54) are in particular at higher risk of gaining weight. Initial weight status , diet quality and physical exercise pattern before lockdown are important factors (21, (23) (24) (25) 37, 45, 49, 52, 64) . In Chinese (40) and Korean (50) populations, BMI <24 kg/m 2 was associated with weight gain. However, some observed that those who were underweight before confinement lost more weight during confinement (25, 37) . Poor diet quality before the lockdown was associated with weight gain (52) . Decreased consumptions of legumes, fruits, and vegetables (25, 39) was related to an increased consumption of sweets (23) (24) (25) . Moreover, more home cooking with consumption of unhealthy foods are associated with increased weight gain (20, 22, 23, (34) (35) (36) 38, 40, 42, 43, 48, 65) as is increased alcohol intake (35, 37, 39, 47, 68) . This was due to the limitations of outdoor activities and in-gym activities (21, 43, 53) . In addition, there has been more sedentary behavior with increased screen time (23, 37, 38, 47) which has been associated with weight gain. Changed working habits; whether furloughed or working from home during the lockdown or those who had their job suspended (21, 52, 58) , having children aged <18 years at home (52) , urban residence and attaining a lower educational level (23) were associated with weight gain. Patients with pre-existing psychiatric comorbidities had weight gain during COVID-19 lockdown (35, 38, 44, 45, 52, 62) , and stress (22, 26, 45, 55, 56, 56, 58, 61, 62) , anxiety and/or depression (23, 58, 61, 62) , eating in response to stress (22, 26) , boredom (23) , living alone (23) emotional eating (EE) (22, 43, 45) or weight or body shape concerns (38) were associated with an increase in body weight during confinement. Decreased sleeping time (26) or poor quality sleep (46, 51, 63) were further associated with weight gain. Socio economic factors such as urban residence (52, 61) , lack of access to garden (54) , lower socio economic level (48) or lower education levels (23) and residence in a macroeconomic region (37) were associated with significant gain in the weight. Patients with chronic illness such as diabetes, hypertension, lung disease, chronic coronary heart disease, congestive heart failure, depression or disability affecting one or more activities of daily living or lower levels of physically activity had an increase in weight (35, 41, 45, 47, 52, 54, 56, 62, 65) . Those who were previously underweight before the lockdown tended to lose more weight (25, 25, 37) . Those whose diet included more fruits and vegetables, pulses and drank more water lost weight (37) . This systematic review highlights contrasting effects of pandemic confinements on body weight, and we identified specific factors associated with change in body weight during the lockdown periods. A BMI of >25 kg/m 2 was identified as an independent risk factor for increased food intake during lockdown (71) . Other influences were inadequate sleep, decreased physical activity, EE in response to stress, lack of control in dietary habits (21, 25, 54) , and increased alcohol consumption and smoking (35, 37, 39, 51, 56, 64, 68) .The impact of these influences is more significant in the obese population. Eating habits as well as diet composition are linked to weight gain (72) . Increased snacking after meals, particularly post dinner, was associated with weight gain (72) . Jakubowicz et al. also concluded that increased calories at dinner increased the subjects' weight (73) . Thus, decreasing food consumption during and post dinner should be recommended. Social networks, neighborhood social activities, and physical activity can influence an individual's opportunity to make better choices contributing to protection from obesity (74) . The absence of these influences during extended lockdown periods may facilitates a more obesogenic environment, thus encouraging weight gain (75) . By contrast, not all effects of pandemic confinement resulted in weight gain. In an Italian study, 38% of participants adhered to a Mediterranean diet. This may have been assisted by the Italian Ministry of Health publishing online materials regarding favorable lifestyle choices during the lockdown in April 2020 and providing practical guidelines on healthy behaviors (76, 77) . reporting weight management issues, stock-piling food, and stress eating (23, 41, 78) . Weight loss was reported in three studies by 13% to 19% of participants (21, 25, 52) . Two studies showed stress related weight among working professionals and university students (79, 80) . The mechanism is twofold and results from decreased, unchanged or increased energy intake coupled with adaptive adrenergic stimulated thermogenesis involving brown adipose tissues (81) . The weight loss observed in this systematic review may also be attributed to the negative effect of stress (21, 25, 26, 52, 82) . The link between weight changes and stress has been studied extensively (83, 84) . Behavioral and physiological explanations suggest that the sensation of eating is associated with a psychological escape from emotional distress (85) and that the consumption of high calorie foods alleviates stress (83) . During a pandemic, where cities and even entire nations were locked down, fear and anxiety related to COVID-19 induced an over eating behavior. However, management of this associated condition is difficult (86) . The adverse effects of lockdown on the psychological and social wellbeing of society emphasize the need for strong public health interventions to support particularly at-risk people. The associations between health outcomes, exercise, and physical activity are wellestablished. The results from studies that we included in this review were mixed; some participants engaged in increased physical activity, while others had lower levels of physical activity. Confinement did not induce many sedentary participants to increase their physical activity. Other unhealthy behaviors such as increased screen time were noted which are similar to previous studies (87) . Stress may impair efforts to become physically active; conversely, those who already participate may do so to reduce stress (88) , which may explain the variation in physical activity observed. Siegel et al. (2002) describes this as stress-related behavioral activation or inhibition (89) . Other unhealthy behaviors were noted during the confinement. There was a 14.6% increase in the consumption of alcohol in participants who had issues with alcohol (25) . In the acute postdisaster period of the September 11 attacks in Manhattan, New York City, the prevalence of alcohol consumption and marijuana use among New York City residents increased over a five-to eight-week period (90) . These results mirror our findings, suggesting shared responses to intense community stresses. Although these activities may not directly affect weight, alcohol consumption and obesity are common risk factors for chronic illnesses leading to increased morbidity and mortality (91) . Furthermore, in a study conducted in the Netherlands, it was reported that overweight and obese individuals found it more difficult to make healthy food choices. More savory snacks and non-alcoholic beverages were purchased and consumed at home (35.6%) because of more leisure time (31.5%) and boredom (21.9%) during the lockdown (92) . Positive outcomes from confinement have also been reported (93) . These behaviors may result from the increased availability of time to cook, health risk perceptions, lack of negative social distractions (94) , and socio-cognitive ideation toward a healthier lifestyle (95) . Long-term studies are necessary to determine whether these constructive and preventive behaviors can be sustained after confinement is over. Food security, which involves food availability, accessibility, and affordability, is another important factor in the relationship between pandemic confinement and body weight changes (96) . Global non-pharmaceutical interventions, such as lockdowns and quarantines, food trade policies, and financial pressures in the food supply chain. As dependence on food banks grew with an exponential increase in demand, basic survival needs presided over healthy dietary choices (18) . Prior to 2020, 690 million people were already food-insecure and hungry (99) . By the end of 2020, the COVID-19 pandemic had created an additional 270 million food-insecure people (100, 101) . Unfortunately, vulnerable populations are not restricted to under-resourced countries; developed nations are suffering as well. In the United States alone, food insecurity more than doubled as a result of the economic crisis brought on by the outbreak, impacting as many as 23% of households (102) . Serious ethical and health-related issues hinder healthcare providers working with vulnerable populations. In general, differences in weight status and dietary intake reveal that a trend in obesity increases as the degree of food insecurity increases (103) . The COVID-19 crisis has highlighted food insecurity as a significant factor in nutritional poverty (97) . This awareness of food insecurity may provide nations with the impetus to robustly tackle food-related epidemics, such as obesity and diabetes. COVID-19 has challenged us to consider the role and balance of healthcare, personal health, and holistic wellbeing. Redefining these dynamics in preparation for future pandemics is imperative to minimize severe impacts to health and resources (104) . It was previously observed that consumerism is affected by internal factors, such as personal character, and external factors, such as economic crises. The pandemic served as an external factor that altered consumer behavior (105) . Relief efforts by governmental and non-governmental agencies achieved temporary solutions without significant public pressure (106) , but the demand for aid from all sectors of society is mounting. National governments should take the lead in providing strategic directions that will ensure the continuity of food accessibility to all, particularly the most vulnerable. Focus must be on coordinated and integrated public health programs through legislative action to end sub-standard dietary conditions endured by those most in need. By collaborating with key stakeholders, health professionals must provide aggressive nutritional counseling to improve dietary habits, and concerted efforts across the board are paramount. Recent research has shown obesity to be an independent risk factor for severe complications and increased mortality from COVID-19 (107,108) . The evidence suggests a linear relationship with obesity increasing the risk of severe disease and death among COVID-19 patients (109) . The co-existence of both pandemics, COVID-19 and obesity, along with the emergence of obesity evolving from lockdown have caused a 'syndemic' or a symbiotic pandemic (110) . Researchers must address the significant knowledge gaps that have become apparent during this pandemic regarding preparedness and response to such a crisis. Moreover, COVID-19 has disproportionately affected certain populations, and future research should focus on such vulnerable populations to ensure better outcomes. To our knowledge, this is the first systematic review evaluating the effects of pandemic confinement on body weight. Our study highlights major determinants that can have an impact on body weight during confinement and those that can be targeted in future pandemics to effectively manage body weight during pandemics via public health initiatives. Moreover, confinements are not solely related to pandemics and can also occur during natural disasters or calamities and in prisons. Determinants identified could be modified via appropriate public health measures to reduce negative impacts. This study has limitations. First, there was limited evidence from past pandemics related to obesity and morbidity or mortality. This may reflect the recent evolution of worldwide obesity (111) . Second, within the common research theme of body weight changes during pandemic confinements, our systematic review found marked heterogeneity in the determinants and measured outcomes. This variation could be explained by differences in the study population and types of outcome measurements (112) . Nevertheless, in our systematic review, we followed a rigorous protocol with clear objectives and inclusion and exclusion criteria. This allowed for the identification and pooling of the determinants of body weight changes during pandemic confinements (Table 4) . A thorough and complete identification of the different determinants related to pandemic confinements could guide decision makers. Furthermore, our study calls for further research into the level of impact of each determinant. Third, given the contemporary nature of the pandemic, the literature was primarily related to countries where COVID-19 had an early "first wave" impact. Findings from other continents, particularly from Africa and South America, are yet to emerge. Fourth, online surveys using social media platforms were the predominant data collection method, which has recognized strengths and biases. Although the researchers used this form of data collection to reach a wider population, the likelihood of a bias toward a younger population should be noted. Fifth, although this analysis provides evidence for the effects of confinement on body weight, we are unable to comment on the potential for interventions such as lifestyle changes to attenuate the phenomenon. Sixth, because of the limited number of studies included, we were unable to correct for influences, such as preexisting diets, and could not quantify the impact of possible factors in isolation. Although we know that weight gain is likely during confinement, further research using more sophisticated data collection techniques is necessary to determine the holistic impact of confinement to provide evidence-based practical solutions for future eventualities. This systematic review highlights the significant effects that pandemic confinements can have in the short term on body mass. Poor sleep, snacking post dinner, lack of dietary restraint, pre-existing overweight status, EE due to stress, and decreased physical activity are risk factors for weight gain. Preparing for the next "wave" is challenging given the multitude of factors that must be tailored to the local situations and available resources. Planning for future episodes requires a strong, evidence-based national policy in conjunction with clear guidelines to ensure that the negative sequelae of lockdowns are minimized. We declare that there are no conflicts of financial and commercial interest that could be perceived as prejudicing the impartiality of this study. This article was not plagiarized and had not previously been published in other journals. The authors received no specific funding for this work. Springer. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. ; (2007) All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. ; (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. ; Studies showing measures taken to manage weight changes during confinement. Designs: All study designs. Language: All languages. Year: Publication year inception -1 st February All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. ; https://doi.org/10.1101/2021.03.03.21252806 doi: medRxiv preprint All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. . C h a g u é F , B o u l i n M , E i c h e r J -C , e t a l . ( 2 0 2 0 ) I m p a c t o f l o c k d o w n o n p a t i e n t s w i t h c o n g e s t i v e h e a r t f a i l u r e d u r i n g t h e c o r o n a v i r u s d i s e a s e 2 0 1 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. e n t i l e A , T o r a l e s J , O ' H i g g i n s M , e t a l . ( 2 0 2 0 ) P h o n e -b a s e d o u t p a t i e n t s ' f o l l o w -u p i n m e n t a l h e a l t h c e n t e r s d u r i n g t h e C O V I D -1 9 q u a r a n t i n e . I n t e r n a t i o n a l J o u r n a l o f S o c i a l P s y c h i a t r y , 0 0 2 0 7 6 4 0 2 0 9 7 9 7 3 2 . M a l k a w i S H , A l m h d a w i K , J a b e r A F , e t a l . ( 2 0 2 0 ) C O V I D -1 9 Q u a r a n t i n e -R e l a t e d M e n t a l H e a l t h S y m p t o m s a n d t h e i r C o r r e l a t e s a m o n g M o t h e r s : A C r o s s S e c t s e n M M , R e g e e r H , L a n d s t r a C P , e t a l . ( 2 0 2 1 ) I n c r e a s e d s t r e s s , w e i g h t g a i n a n d l e s s e x e r c i s e i n r e l a t i o n t o g l y c e m i c c o n t r o l i n p e o p l e w i t h t y p e 1 Baseline obese and overweight (2, 3, (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) BMI <24 (16, 17) Age group > 45 years (3, 9, 18) Age group < 25 years (1, 9) Having children under the age of 18 at home (1) Changed work environment to working from home (1, 2, 19) Loss of job (2) Interruption of work routine (2) Changed work habits: Furloughed or working from home (2) Suspension of schools (17) Increased food consumption (3, 4, 7, 12, 14, (20) (21) (22) Decreased consumption of fresh food products (particularly fruits, vegetables, and fish) (2, 3, 12, 16, 23) Increased consumption of homemade recipes, sweets, and pizza (7, 8) Increased home cooking (3) Increased cereal consumption (2, 7) Consumption of unhealthy foods (2) (3) (4) (5) 7, 7, 8, 10, 12, 24, 25) Poor attention to diet balance (7) Snacking after dinner (2, 26) Binge eating (24, 27) Loss of control to eating (24) Eating in response to stress as a coping mechanism (23, 26) Eating secondary to appearance and smell of food (26) Emotional eating (5, 11, 23) Increase in alcohol intake (3, 4, 12) R e f e r e n c e s Stress (11, 19, 19, 23, 26, (30) (31) (32) (33) Boredom (7) Being alone (4, 7) Anxiety/Depression (6, 7, 19, 24, 32) Depressive symptoms (1, 4, 11, 24) Mood disturbances (10) Weight/ shape concerns (21) Lack of garden (18) Urban residence (1, 32) Lower education level (7, 19) Residence in a macroeconomic region >50% of EU-28 GDP (12) Lower socioeconomic level (19,34) Physical activity before lockdown (35) Decreased physical activity (3) (4) (5) 7, 8, 12, 15, 16, (19) (20) (21) (22) 24, 26, (29) (30) (31) 33, (35) (36) (37) (38) (39) Limitations of outdoor and in-gym activities (2, 4, 5, 7) Increased screen/tv time (7, 12, 21, 31, 33, 36, 39) Comorbidities Associated chronic illness (1, 33, (39) (40) (41) Determinants that can be associated with weight loss Underweight before confinement (9, 12) Younger age (12) Remote work (12) Urban residence (12, 33) Ate less (12) Ate more fruits/vegetable (12) Drank more water (12) Ate more pulses/seafood/fish (12) Did not consume alcohol (12) Regular exercise before lockdown (6) All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. ; 1 . D e s c h a s a u x -T a n g u y M , D r u e s n e -P e c o l l o N , E s s e d d i k Y , e t a l . ( 2 0 2 0 ) D i e t a n d p h y s i c a l a c t i v i t y d u r i n g t h e C O V I D -1 9 l o c k d o w n p e r i o d ( M a r c h -M a y 2 0 2 0 ) : All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. ; 1 5 . A d ı b e l l i D & S ü m e n A ( 2 0 2 0 ) T h e e f f e c t o f t h e c o r o n a v i r u s ( C O V I D -1 9 ) p a n d e m i c o n h e a l t h r e l a t e d q u a l i t y o f l i f e i n c h i l d r e n . C h i l d r e n a n d Y o u t h S e r v i c e s R e v i e w 1 1 9 , 1 0 5 5 9 5 . 1 6 . H e M , X i a n Y , L v X , e t a l . ( 2 0 2 0 ) C h a n g e s i n B o d y W e i g h t , P h y s i c a l A c t i v i t y , a n d L i f e s t y l e D u r i n g t h e S e m i -l o c k d o w n P e r i o d A f t e r t h e O u t b r e a k o f C O V I D -1 9 i n C h i n a : A n O n l i n e S u r v e All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 5, 2021. ; https://doi.org/10.1101/2021.03.03.21252806 doi: medRxiv preprint 9 . M a r t í n e z -d e -Q u e l Ó , S u á r e z -I g l e s i a s D , L ó p e z -F l o r e s M , e t a l . ( 2 0 2 1 ) P h y s i c a l a c t i v i t y , d i e t a r y h a b i t s a n d s l e e p q u a l i t y b e f o r e a n d d u r i n g C O V I D -1 9 l o c k d o w n : A l o n g i t u d i n a l s t u d y . A p p e t i t e 1 5 8 , 1 0 5 0 1 9 . E l s e v i e r . 3 0 . d e M a t o s D G , A i d a r F J , A l m e i d a -N e t o P F d e , e t a l . ( 2 0 2 0 ) T h e i m p a c t o f m e a s u r e All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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