Declining Mental Health During COVID-19 Pandemic Linked to Worsening Obesity

Gregory Weiss, MD

The COVID-19 pandemic, now in its third year, has led to a host of setbacks in public health in addition to its specific toll on human lives. As a result of widespread lockdowns, many people have been stuck inside with little to do. With greater than 40% of American adults already struggling with obesity, the pandemic was thought to increase social isolation while decreasing access to health care and high-quality nutritious food sources.

A recent investigation by Jaime Amandoz, MD, and colleagues in Texas found nearly one-third of people with obesity gained more than 5% of their body weight in the first year of the COVID-19 pandemic, with 1 in 7 gaining 10%. Amandoz believes the increased anxiety produced in obese patients due to their increased risk for serious COVID-19 illness and death is the driving force behind the dramatic weight gain.¹

“The COVID-19 pandemic is a fascinating model for individual and social stress and showed that changes in mental health can really preclude people from maintaining a healthy body weight,” Amandoz said.

Leveraging surveys, the investigators of this study found very high levels of self-reported stress, anxiety, depression, and maladaptive eating behaviors among adults with obesity during the COVID-19 pandemic.¹ Prior research by this team of investigators looked at the impact of stay-at-home orders on the mental health and behaviors of obese patients. They found that 70% of patients found weight loss to be more difficult during the lockdowns with large portions reporting less exercise and more stress-related eating.¹

In the current report, Amandoz and fellow researchers found that the majority of obese patients surveyed gained around 4.3% of their body weight during the pandemic.¹ Another study cited in their work showed that 48% of all American adults gained weight during the pandemic further supporting these new data.² Those surveyed tended to be of higher education and economic status. The investigators speculate that those of lower socioeconomic status likely faced even greater stress and more weight gain.¹

Factors associated with greater weight gain included eating less healthy food, not sleeping as much, and exercising less.¹ Finally, those people reporting the highest levels of anxiety, depression, and stress gained the most weight.¹

“It’s not just about telling people to eat less and move more, there’s a mental health aspect that has to be integrated into treating the whole person as well,” Amandoz notes.

These results make sense. The stress of a pandemic coupled with isolation and fear put a significant strain on the mental health of obese patients already struggling to lose weight. As we move into and beyond the third year of COVID-19 we as clinicians need to evaluate our patients for stress, anxiety, and depression making available to them enhanced support and targeted interventions. When access to care is limited, we need to find alternatives such as virtual visits and responsible office encounters. Education and encouragement become even more important when our patients are dealing with mental health challenges. Addressing those mental health challenges should be a part of every visit.

Every effort needs to be made to identify those patients at highest risk for weight gain. The challenges experienced by isolated obese patients should not be underestimated. The stigma and mental health problems already experienced by obese patients should be assumed to be significantly worse during the pandemic but with support, understanding, and encouragement, we can mitigate the added strain. Amandoz points out that people in weight management programs typically lose weight.¹

As such, we should do everything we can to get obese patients in and keep them in these programs, programs that should evaluate and address the patients mental as well as physical health.

Reference:

1. Almandoz JP, Xie L, Schellinger JN, et al. Changes in body weight, health behaviors, and mental health in adults with obesity during the COVID-19 pandemic. Obesity (Silver Spring). 2022;1‐12. doi:10.1002/oby.23501
2. Khubchandani J, Price JH, Sharma S, Wiblishauser MJ, Webb FJ. COVID-19 pandemic and weight gain in American adults: a nationwide population-based study. Diabetes Metab Syndr. 2022;16: 102392. doi:10.1016/j.dsx.2022.102392