Cosmos Q&A: COVID and global health

Given the unprecedented nature of the COVID-19 pandemic and subsequent societal changes, it’s not surprising that we’ve shifted our behaviours relating to health and wellbeing.

A study by the Pennington Biomedical Research Centre (PBRC) in Louisiana, US, published in the journal Obesity, reveals the changes wrought by lockdown and notes that they’re magnified among people with obesity.

Cosmos spoke with authors Leanne Redman and Emily Flanagan about the results. Sydney-born Redman heads the reproductive endocrinology and women’s health team at PBRC, where she’s worked since 2005. Flanagan is a postdoctoral research fellow in Redman’s laboratory.

To have run a global survey about these matters back in April suggests the study team had started thinking about lockdown impacts very early. What were the main things that prompted the work?

Stay-at-home orders in Louisiana began on 23 March 2020. We knew that the lockdown would spark sudden and dramatic changes to health behaviours as normal life was disrupted and individuals became confined to their homes. As researchers interested in how health behaviours influence obesity, we thought it would be important to capture the initial responses to stay-at-home orders.

It’s somewhat counter-intuitive that people classed as obese improved their diets the most, but also had the highest incidence of weight gain. What does the study indicate as the cause for that?

The study provided representation of the obesity epidemic both here in the US and Australia. Approximately one third of the respondents had healthy weight (Body Mass Index – BMI – 18.5–24.9), one third was overweight (BMI 25–29.0), and one third of obesity weight (BMI >30). We asked participants to report their weight and height and from those responses we computed BMI.

At the start of the pandemic, respondents with obesity had lowest dietary behaviours scores. Therefore, with the stay-at-home orders, they had the most dramatic changes to their eating behaviours. The overall healthy eating score actually didn’t change among individuals who gained weight. Individuals who reported gaining weight reported the largest declines in physical activity, increases in sedentary behaviour time, and the most drastic changes in sleep timing.

The survey did not capture information on dietary intake in terms of total caloric consumption. For weight gain to occur there would need to be an imbalance between what was being eaten and what was be expended/physical activity.

While residents of more than 50 countries – including Australia – responded to the survey, most respondents are from Louisiana. Can you describe the lockdown regime there in April? Were there the differences between it and stay-at-home rules in a major Australian city such as Melbourne?

The Louisiana state government announced a “stay-at-home” mandate to begin on 23 March. During this time, schools initiated virtual learning so that students and staff could learn from home, all state employees who were considered “non-essential” workers were asked to work from home, “non-essential” business (eg fitness facilities, shops) including retail, restaurants, cafés, movie theatres and entertainment venues temporarily closed their doors, and public parks were closed.

Only grocery stores and gas stations were permitted to remain open with limited operating hours. Banks and medical centres remained open for limited virtual or curb-side appointments. The stay-at-home orders were remarkably similar between Louisiana and Melbourne.

While there’s broad understanding of the link between anxiety/mental health and overall physical health, the findings indicate a surprising – alarming – jump in anxiety levels early in the pandemic. To the best of your knowledge, have these levels endured through 2020? What’s likely to be the long-term effect of people living with such stress?

Since our survey was designed to capture the initial peak of the pandemic, it was expected that we saw increased anxiety and declines to mental health during this time. However, we were also alarmed that the magnitude of increases was equivalent to anxiety responses to natural disasters.

Research has shown us that heightened levels of stress and anxiety drastically increase the likelihood of weight gain and further insults to health behaviours. Since the stay-at-home orders and the COVID-19 pandemic overlap, it is of course difficult to know if the anxiety is due to COVID-19 itself or due to the order to stay at home. Indeed, as a result, many people reported a reduction to their income or loss of employment, which indeed would contribute to stress and anxiety.

We’re now seeing second- and even third-wave COVID outbreaks in many countries. Will you be repeating the survey in an effort to understand the cumulative effect of multiple lockdowns?

Since our survey was completely anonymous, we’re not able to follow up with any of these participants to see how individual health behaviours have changed. For these reasons, we have no plans for follow up. However, we feel it will be important to observe how health behaviours continue to change as the pandemic continues, as well as once we eventually begin to return to normalcy.

The pandemic has progressed six months from the time of the survey. What questions in relation to physical and emotional health would you like to explore now, and why?

Now that we have a sense of how behaviours and mental health changed across the first peak of COVID-19 in a diverse population, health care providers can prepare for how to treat these ancillary impacts of the COVID-19 pandemic. It would also be important to understand how health behaviours have changed over the long-term.