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Columns: A Nutritionist’s View

Effects of Quarantine due to COVID-19 on Dietary Intake

Volpe, Stella Lucia Ph.D., RDN, FACSM, ACSM-CEP

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ACSM's Health & Fitness Journal: 1/2 2021 - Volume 25 - Issue 1 - p 46-48
doi: 10.1249/FIT.0000000000000634
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WHAT IS COVID-19?

Coronavirus disease (COVID-19) is a pandemic affecting every person in the world, whether or not they have been affected directly by the disease itself, or whether a family member, friend, acquaintance, colleague, or another person in their life has been affected. As of September 2020, more than 32 million people have been infected with the coronavirus worldwide. In the United States, more than 200,000 people have died from COVID-19.

Coronavirus disease, also known as COVID-19 (the “19” designates that it began in 2019), is caused by a virus. The virus that causes COVID-19 is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, it is SARS-CoV-2 that causes COVID-19 (1). Because of the COVID-19 pandemic, many stay-at-home orders or quarantines have been set into place for quite some time. In the United States, many quarantines began in March 2020; however, this certainly has varied among states. The purpose of this Nutritionist’s View article is to present data on how dietary intakes and lifestyle behaviors have changed during the quarantine, and how to ensure we eat more healthily and be more physically active during these extraordinary times.

NUTRITIONAL AND LIFESTYLE CHANGES DURING COVID-19 QUARANTINE

Italy was the first country to have a full lockdown due to COVID-19. Using an Italian survey, Di Renzo et al. (2) evaluated eating habits and lifestyle changes that occurred during the lockdown in Italy. The researchers examined the immediate effects of the COVID-19 pandemic in individuals from 12 years of age and older. They conducted their survey from April 5 through April 24, 2020. Di Renzo et al. (2) included 3,533 respondents, 12 to 86 years of age (76.1% girls and women), in their study. They reported that 48.6% of their respondents stated they gained weight, and 3.3% of people who smoked quit smoking. The participants also stated that they slightly increased their physical activity levels. In addition, individuals between 18 to 30 years of age stated that they had a greater adherence to the Mediterranean diet compared to younger and older populations (P < 0.001; P < 0.001, respectively). About 15% of their participants, in particular, those living in North and Central Italy, purchased more fruits and vegetables from farmers. With respect to this study, it appears that people improved their overall dietary intake during the pandemic. Nonetheless, the researchers stated that follow-up studies need to be conducted to ascertain if these trends will continue.

Sánchez-Sánchez et al. (3) conducted a cross-sectional study using a survey, during May 2020 and through Spain’s phase 1 opening. They reported an increased adherence to the Mediterranean diet (P < 0.001). They also reported an increased consumption of homemade baked products (P = 0.004), with a decrease in physical activity (P = 0.004).

An international online survey, called Confinement on Multiple Lifestyle Behaviors during the COVID-19 Outbreak (ECLB-COVID19), was launched in April 2020 (4). This survey, which was provided in seven languages, evaluated the behavioral and lifestyle effects of the COVID-19 quarantine and social distancing measures. More than 1,000 people responded to the survey (54% women), indicating that the quarantine resulted in a negative effect on physical activity, with a concomitant increase in daily sitting from five to eight hours per day. Furthermore, eating behaviors resulted in consuming more snacks between meals and eating out of control (4).

With these aforementioned studies, conducted all around the world, it appears that there were some improvements in eating patterns. However, there were decreases in physical activity and increased sitting times.

EFFECTS OF THE QUARANTINE ON INDIVIDUALS WITH DISORDERED EATING

Individuals with disordered eating may be affected by the pandemic and quarantine differently than those without disordered eating. Phillopou et al. (5) evaluated how the pandemic affected eating and exercise behaviors in those with established eating disorders and in the general population. There were 5,469 total participants in their study, with 180 of them who self-reported having a history of disordered eating. They all completed a questionnaire that asked about eating and exercise patterns since the COVID-19 pandemic. The survey began on April 1, 2020. The researchers reported that individuals who identified as having disordered eating demonstrated greater restrictions on eating and increased purging, binge eating, and exercise patterns. Similar patterns occurred in the general population; however, they reported participating in less exercise than before the pandemic. Phillopou et al. (5) stated that the pandemic may affect those with disordered eating more than those in the general population; however, it is important that health care professionals emphasize the importance of healthy eating and being physically active during the pandemic.

There are several reasons that the quarantine as a result of the COVID-19 pandemic may lead to worsened disordered eating. Rodgers et al. (6) state that interruptions to daily routines can have a domino effect. For example, lower physical activity may lead to feelings of increased body weight, leading to a negative effect on eating, sleeping, and exercising. In addition, decreased social interactions can result in less social support, which can lead to poor coping abilities. Furthermore, fear of contracting COVID-19 might lead to more restrictive diets that may be thought to improve immunity. Finally, exposure to media might increase anxiety and result in worsened disordered eating.

There are several reasons that the quarantine as a result of the COVID-19 pandemic may lead to worsened disordered eating. Rodgers et al. (6) state that interruptions to daily routines can have a domino effect. For example, lower physical activity may lead to feelings of increased body weight, leading to a negative effect on eating, sleeping, and exercising. In addition, decreased social interactions can result in less social support, which can lead to poor coping abilities. Furthermore, fear of contracting COVID-19 might lead to more restrictive diets that may be thought to improve immunity. Finally, exposure to media might increase anxiety and result in worsened disordered eating.

WHAT ADVICE CAN WE PROVIDE TO PEOPLE?

First, it is important to recognize that anyone can be affected by COVID-19, the elderly, underrepresented groups, and individuals who have chronic medical conditions are at the highest risk of contracting the disease (7). Consuming diets that are energy dense and not nutrient dense can lead to obesity, cardiovascular disease, and type 2 diabetes mellitus, increasing the risk for contracting the coronavirus. Those with chronic disease also have a greater risk of having severe symptoms and long-term consequences of the virus (7). Therefore, it is important that healthier foods and physical activity are incorporated into our lives, during the pandemic and beyond.

SUMMARY

The COVID-19 pandemic has affected each of us. There are many ways people can improve their overall eating during the quarantine. First, purchasing more healthy foods overall will simply lead to a decrease in consuming more energy-dense foods. Cutting up fruits and/or vegetables, and having it readily available for a snack or a side dish to a meal, is another way to increase healthy eating. Purchasing frozen fruits and vegetables also is helpful for a couple of reasons. First, it decreases the number of times a person has to go out shopping, and second, it will decrease food waste. Moreover, while it is still important to have comfort foods available, it is important that they do not become the mainstay of our diets.

There are many ways people can improve their overall eating during the quarantine. First, purchasing more healthy foods overall will simply lead to a decrease in consuming more energy-dense foods. Cutting up fruits and/or vegetables, and having it readily available for a snack or a side dish to a meal, is another way to increase healthy eating. Purchasing frozen fruits and vegetables also is helpful for a couple of reasons. First, it decreases the number of times a person has to go out shopping, and second, it will decrease food waste.

References

1. World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. [cited 2020 September 27]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it.
2. Di Renzo L, Gualtieri P, Pivari F, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229.
3. Sánchez-Sánchez E, Ramírez-Vargas G, Avellaneda-López Y, et al. Eating habits and physical activity of the Spanish population during the COVID-19 pandemic period. Nutrients. 2020;12(9):E2826.
4. Ammar A, Brach M, Trabelsi K, et al. Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19 international online survey. Nutrients. 2020;12(6):1583.
5. Phillipou A, Meyer D, Neill E, et al. Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: initial results from the COLLATE project. Int J Eat Disord. 2020;53(7):1158–65.
6. Rodgers RF, Lombardo C, Cerolini S, et al. The impact of the COVID-19 pandemic on eating disorder risk and symptoms. Int J Eat Disord. 2020;53(7):1166–70.
7. Butler MJ, Barrientos RM. The impact of nutrition on COVID-19 susceptibility and long-term consequences. Brain Behav Immun. 2020;87:53–4.

Recommended Resources

Centers for Disease Control and Prevention https://www.cdc.gov/coronavirus/2019-ncov/index.html
World Health Organization https://www.who.int/emergencies/diseases/novel-coronavirus-2019
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