key: cord-1010997-3mubkox5 authors: Mulugeta, Wudeneh; Desalegn, Hailemicheal; Solomon, Samrawit title: Impact of the COVID‐19 pandemic lockdown on weight status and factors associated with weight gain among adults in Massachusetts date: 2021-04-14 journal: Clin Obes DOI: 10.1111/cob.12453 sha: 487fcd2b5f09d9ab61e1dbdad72668cd8c0e94f5 doc_id: 1010997 cord_uid: 3mubkox5 The study aims to examine the impact of the coronavirus disease‐2019 (COVID‐19) pandemic lockdown on weight, overweight and obesity, and identify factors associated with weight gain. At a safety net health system in Massachusetts, 11 534 adults were retrospectively followed within 3 months of the COVID‐19 lockdown. Chi‐square and 95% confidence intervals (CI) were reported for categorical and continues variables, respectively. Multivariate analyses were performed to identify factors associated with weight gain (≥0.01 kg and 5%). During the lockdown period, greater proportion of women gained weight compared to men (46.1% vs 40.6%, P < .01). The obesity rate after the lockdown increased among women (40.7%‐41.7, P < .01) but decreased among men (39.6%‐38.6, P < .01) compared to before the lockdown. Post‐lockdown obesity rates increased among Haitian (51.2%‐55.0%, P < .01) and Hispanic women (50.7%‐51.8%, P < .01). More than 5% weight gain was associated with 18 to 39 vs ≥60 years of age (OR = 1.45, 95% CI = 1.07, 1.97), food and housing insecurity (OR = 1.44, 95% CI = 1.05, 1.97) and tobacco use (OR = 1.38, 95% CI = 1.07, 1.78) among men; and 18 to 39 vs ≥60 years of age (OR = 1.55, 95% CI = 1.25, 1.91), Hispanics (OR = 1.25, 95% CI = 1.01, 1.54), Brazilians (OR = 1.22, 95% CI = 1.03, 1.45), and tobacco use (OR = 1.36, 95% CI = 1.10, 1.69) among women. During the COVID‐19 lockdown, significant proportion of participants gained weight, but subgroup variations existed. Our study can inform healthcare professionals about the impact of the lockdown on unhealthy weight gain and identify vulnerable populations. Strategies are needed to combat unhealthy weight gain during and beyond the pandemic. ethnic and racial minorities have been disproportionately affected by COVID-19. 2 Obesity, which is also more prevalent among minorities, has been identified as one of the strongest risk factors for severe complications of COVID-19. [3] [4] [5] [6] To combat the spread of the pandemic, local and national governments have been imposing lockdowns. The state of emergency was declared in Massachusetts, USA on 10 March 2020, and most businesses, parks, recreational facilities were not allowed to reopen until 25 May 2020, in a gradual phase-based approach. 7 The pandemic and the subsequent restrictions have had significant impact on the lives, livelihoods, lifestyle and activities of individuals. A large study of 2766 participants found considerable psychological impact during the national COVD-19 quarantine period in Italy. 8, 9 Since the pandemic and the stay-at-home orders, studies have reported individuals suffering from increased anxiety and depression along with more stress eating patterns. 10 Unhealthy behaviour such as binge eating and increased night eating episodes during the lockdown has been linked to weight gain. 11 Less physical activities and more unhealthy dietary choices have also been reported during the lockdowns, which have negative impact on maintaining healthy weight. [12] [13] [14] A recent large study among Chinese youth found increased weight and body mass index during the lockdown period. 14 However, to our knowledge, the impact of the pandemic lockdown on weight status and obesity among adults in the United States has not been reported. To fill this gap the study examines the impact of the COVID-19 lockdown on weight, overweight and obesity, and identify factors associated with any and at least 5% weight gain. A retrospective study of patients was conducted using electronic medical records (EMR) at Cambridge Health Alliance (CHA) in Massachusetts. CHA is a large safety net health system serving >140 000 patients in Cambridge and Boston's metro-north region, mostly immigrants, ethnic minorities, and underserved communities. Data were analysed within 3 months before and after the COVID-19 pandemic lockdown period in Massachusetts. The state of emergency was declared in the state of Massachusetts on 10 March 2020 and most business, parks, recreational facilities were not allowed to reopen, until 25 May 2020 in a phase-based approach. 7 For ease of data collection, the first lockdown period was approximated to be between 01 March 2020 and 31 May 2020. All CHA patients who had weight and body mass index (BMI) before 01 March 2020 and after 31 May 2020 were included. Initially, 32 425 participants were identified. A total of 1467 were excluded because of pregnancy. Children (n = 3312) were excluded from this study. Additional 16 112 patients were excluded as their initial or follow-up measures were longer than 3 months of the lockdown period in Massachusetts, leaving 11 534 adults in the final analyses. The study was exempted by the Institutional Review Board of the CHA. Anthropometric data obtained during medical visits at CHA were used. BMI was determined by dividing weight in kilograms (kg) over the square of height in meters (m). Obesity was defined as BMI ≥30 kg/m 2 and overweight was defined as BMI ≥25 kg/m 2 . Any weight gain was defined as ≥0.01 kg. Clinically meaningful weight gain of ≥5% was determined as at least 5% weight increase in pounds from their corresponding baseline weight. Weight gain cut-off of ≥5% is used as it has been reported to be a clinically meaningful weight change. 15 Demographic information of age and sex were obtained from the electronic medical record. Primary languages patients chose for communications were used as more accurate approximation of ethnic/ racial categories based on information collected routinely during regis- • To our knowledge, this is one of the first studies to report the impact of the COVID-19 lockdown on weight, overweight and obesity among adults in the United States. • During the COVID-19 lockdown in Massachusetts, significant proportion of adults had increase in weight, overweight and obesity. • The study found subgroup variations in the burden and increase of overweight and obesity during the COVID-19 lockdown. Diseases and Related Health Problems (ICD) code 10 diagnoses in the EMR. The prevalence of obesity and overweight were compared for all and subgroups of participants who gained weight stratified by sex. Chisquare tests was used for categorical variables. The mean weight and BMI changes were calculated within 3 months before and after the lockdown among those who gained weight. The mean changes in weight and BMI were significant if their 95% CI did not include 0. Multivariate logistic regression analyses were computed with any and ≥ 5% weight gain as outcome variables after adjusting for confounding factors and other covariates. Potential confounders were identified based on priori and our conceptual framework. Confounders included in the final models were age, initial weight, and duration of follow-up stratified by sex. Two-tailed statistical significance was assessed at α < 0.05. Data analyses were conducted using SAS, version 9.4. Data were collected and analysed in November 2020 to December 2020. Basic characteristics of the study population are shown in Table 1 . Women accounted for 66.6% of participants. Overall, 30.2%, 39.6%, and 30.2% of the study population were 18 to 39, 40 to 59, and > 60 years of age, respectively. Majority (54.4%) were English speakers, followed by Brazilian Portuguese speakers at 19.5%, Spanish speakers at 11.2% and 6.2% of Haitian Creole speakers (Table 1) . Housing or food insecurity were reported by 9.1% of participants, and 14.5% had COVID-19. comparison to older women, greater proportion (34.1%) of younger women gained at least 5% of their baseline weight (P < .01) (Figure 1 ). (Table 3) . women more than men. Of these, nearly a third gained more than 5% of their baseline weight. Overall obesity and overweight rates also significantly increased post-lockdown among women but not men. Overweight rates were highest among Hispanic men and Haitian women. Among men, ≥5% weight gain was associated with younger age, food and housing insecurity and tobacco use. Similarly, younger age and tobacco use were associated with ≥5% weight gain among women, along with Spanish and Brazilian Portuguese speaker women. During the first COVID-19 lockdown in the state of Massachusetts, 40.6% of men and 46.1% of women gained weight. Of these, 26 .8% of men and 29.5% of women gained clinically meaningful weight of more than 5% of their baseline weight. Although weight gain during the COVID-19 pandemic among adults have not yet been reported, a large study among Chinese youth found significant increase in body mass index as well as in overweight and obesity rates. 14, 16 The increase in unhealthy weight during the pandemic correlates with reported increase in sedentary lifestyle as well as decreased physical activity and exercise. 14,17 Increased anxiety, stress and related problematic eating behaviours, such as stress eating and night time eating could also be contributing for such findings of unhealthy weight gain. 10, 11, 13 Our study found significant subgroup differences in weight gain, obesity and overweight during the lockdown period. During the lockdown period, greater proportion of women gained weight, and the obesity rates among women also increased compared to men. This is likely due to the disproportionate impact of the COVID-19 shutdowns on women. The US Department of Labor report indicates femaledominated job sectors, such as hospitality, retail and restaurants have been hit hardest by the pandemic lockdown. 18 Furthermore, school and daycare closures impact mothers more as primary childcare givers. 18 consume high-carbohydrate, non-perishable meals, rather than healthy fresh foods. 23 Interestingly, younger adults in our study had greater odds of gaining clinically meaningful weight than older individuals. This finding likely reflects the consequences of decreased physical activities among younger individuals as gyms and fitness centers were closed and sporting activities were restricted during the pandemic. 24 Prior longitudinal studies conducted before the COVID-19 pandemic have found most of the weight gains tend to occur during early adulthood. 25, 26 In addition to changes in obesogenic environments, basal metabolic factors as well as differences in lean muscle mass and distribution of body fat could be contributing for the more weight gain observed in younger age groups. 15 The pandemic lockdown might have exacerbated and accelerated these findings. The study has several limitations. First, the study's generalizability can be limited since it was conducted in a patient population in the state of Massachusetts, USA. Second, as the study is based on medical records, demographic and anthropometric information obtained during routine clinical encounters may not have been complete and consistent. Furthermore, the inclusion and analysis of additional confounders and independent variables can be limited by data available through the medical record. Finally, BMI could underestimate body fat and risk of disease outcomes among particular subgroups. 27 Therefore, caution needs to be taken when interpreting the study findings. Notwithstanding these limitations, the study has several strengths. One of the strengths of this study is the large and diverse World Health Organization (WHO) Weekly epidemiological update-19 Centers for Disease Control and Prevention (CDC) Coronavirus (Covid-19 Prevalence of Obesity and Severe Obesity among Adults: United States Obesity and its implications for COVID-19 mortality Obesity and mortality of COVID-19. 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Impact of the COVID-19 pandemic lockdown on weight status and factors associated with weight gain among adults in Massachusetts No conflict of interest was declared. https://orcid.org/0000-0001-7794-4323