The health of millions of Americans may have been affected by weight gain and lack of exercise during the pandemic, even if they have avoided acute dangers of Covid-19 infection, emerging evidence collected by obesity researchers – and the anecdotal experiences of family physicians – suggests.
“Ninety-eight per cent of my day is, ‘You haven’t been exercising, you’ve gained weight, and your diabetes is no longer controlled. We need to help you with that,’” said Dr Andrew Carroll, who is part of a multidisciplinary family medicine practice in Chandler, Arizona. “It’s very rare I’m reducing medications over the last year.”
In several cases, doctors said major factors in worsening health were “lifestyle” factors, such as lack of exercise, poor diet and stress. More than 60% of American family doctors saw an increase in obesity among their patients, according to a survey of 910 doctors by American Academy of Family Physicians.
Weight gain is not necessarily unhealthy in and of itself. However, excess weight is associated with a number of chronic health problems, such as increased risk of heart disease, stroke, diabetes and certain types of cancer. Obesity is also associated with increased risks from Covid-19.
“The overwhelming stress of living in a pandemic time is really impacting [patients’] medical health significantly,” said Carroll. Typical patients are “gaining weight on the order of 10 to 30lb,” he said.
The immediate impact of Covid-19 in the US has been dire. More than 543,000 Americans have died of Covid-19 and 29 million have been infected. For every person who dies, and estimated nine more grieve. Further, millions of people may experience the potentially disabling effects of “long-haul Covid” or depression from the isolation the pandemic has caused.
But those who have survived the pandemic so far may also face long-term health consequences. Patients are “eating a lot more high-carbohydrate foods, they’re putting on weight, and other medical conditions are suffering from it”, said Dr Sterling Ransone Jr, president-elect of the American Academy of Family Physicians (AAFP), whose practice is in rural Deltaville, Virginia. “Mainly, it’s because of lifestyle concerns.”
Because such a large number of people across such a wide swath of the public are affected, the implications of weight gain across the population could be sweeping. More than 42% of American adults already live with obesity, a proportion which has increased 12% over the last 18 years, according to the US Centers for Disease Control and Prevention (CDC).
“Because of the stressors, I’m seeing a lot of people going to their comfort foods, be it macaroni and cheese or a bag of Chex Mix,” said Rascone.
On surveys conducted by obesity researchers, people have self-reported more snacking, junk food and delivery meals amid the pandemic. Counterintuitively, intake of some healthy foods, such as fruits and home-cooked meals, has 1 also increased.
But, even for people eating healthier foods, disruption to the routines of daily life – such as going to the grocery store, running errands or traversing a large office – has ended “ambient exercise” people once got while just going about the day.
Public health measures meant to contain the pandemic, “have still been extremely destabilizing”, said Rachel Rodgers, associate professor of psychology at Northeastern University.
Changes to eating habits could be especially lasting for groups, such as “children, adolescents, and new college students who are transitioning to independent life decisions”, said Rodgers. “Having this happen at that juncture could be really important in their life span.”
Evidence about how people’s habits have changed during the pandemic is only now emerging. Diet and exercise studies have been curtailed during the pandemic with subjects, researchers and institutions all reticent to come in-person for studies. That means much of the sleuthing into people’s habits has been left to data from bluetooth fitness devices and surveys.
“Basically, you lock down people in a room and see how their psychological factors and health factors are going to vary,” said Surabhi Bhutani, an assistant professor at the school of exercise and nutritional sciences at San Diego State University in California. “It’s truly like a natural experiment.”
Studies by FitBit, a wearable fitness tracker, has found a global decrease in both steps and daily active minutes, even as people amp up daily meditation, yoga and running practices, which do not require a gym. Similarly, a research letter in the Annals of Internal Medicine found step counts tracked by smartphones down 27% globally within 30 days of the pandemic onset.
A small study of 269 Americans using bluetooth scales found people gained on average 1.5lb a month from February to May 2020. Extrapolated over one year, that could translate to 18lb of extra weight. Notably, the study was not representative of the US. It included mostly white, middle-aged participants, who were likely to be more conscious of their health.
Bhutani and co-authors recently published a survey in the journal Nutrients, in which 40% of people reported gaining weight during the “peak lockdown” months of spring 2020. Although the average weight gain was only 1.5lb, roughly one-third continued to gain weight over the summer and early fall. This study also oversampled white participants relative to the population.
Bhutani said the year-long quarantine may resemble a phenomenon similar to a winter holiday weight gain, less than the so-called “quarantine 15”.
Nevertheless, Rodgers emphasized health does not necessarily mean rigid diet and exercise, but “meeting yourself where you’re at”. She believes many people will return to more exercise and improved diets when the “external” stressors of the pandemic recede.
“It is always important to remember there are strengths and resilience and behaviors we can be practicing to try to protect ourselves,” she said.