The COVID-19 pandemic is having a significant impact on people with obesity as they struggle to manage their weight and mental health during shelter-in-place orders, according to research led by The University of Texas Health Science Center at Houston (UTHealth) and UT Southwestern.
The study, published today in the journal Clinical Obesity, surveyed 123 weight management patients at the UT Southwestern Weight Wellness Program and a community bariatric surgery practice.
"Everyone was told to stay home to protect themselves from infection and this was especially important for people with severe obesity, who are more likely to have serious complications and higher risk of death with the coronavirus," said Sarah Messiah, PhD, MPH, the study's senior author and professor of epidemiology, human genetics, and environmental sciences at UTHealth School of Public Health in Dallas. "But these are also patients who often have comorbidities such as heart disease and diabetes that need consistent care. This was the first assessment of this patient population to see the effects of the upheaval of their daily lives on their health behavior and well-being."
The study revealed that nearly 73% of patient experience increased anxiety and close to 84% had increased depression. Nearly 70% reported more difficulty in achieving weight loss goals, while 48% had less exercise time, and 56% had less intensity in exercise. Stockpiling of food increased in nearly half of patients and stress eating was reported in 61%.
Two of the patients tested positive for SARS-CoV-2, but nearly 15% reported symptoms of the virus. Almost 10% lost their jobs and 20% said they could not afford a balanced meal.
"You don't have to contract the virus to be adversely affected by it. The major strength of this study is that it is one of the first data-driven snapshots into how the COVID-19 pandemic has influenced health behaviors for patients with obesity," said Jaime Almandoz, MD, MBA, first author and an endocrinologist and assistant professor of internal medicine at UT Southwestern. Almandoz is also medical director for the UT Southwestern Weight Wellness Program, a multidisciplinary weight management and post-bariatric care clinic.
According to the Centers for Disease Control and Prevention, more than 42% of American adults are obese. Obesity-related health conditions include heart disease, stroke, Type 2 diabetes, and certain types of cancer that are some of the leading causes of preventable, premature death.
Almandoz pointed out that many patients with obesity already struggle with access to appropriate fresh, healthy foods. Some reside in food deserts lacking grocery stores, where the only options are fast food and processed foods from convenience stores.
"Unchecked diabetes, hypertension, and other obesity-related comorbidities will create a huge backlog of needs that will come back to haunt us. When you throw in disruptions like social isolation, coupled with losing your job and insurance coverage, a potential disaster is waiting to unfold," Almandoz said.
With clinics across the country reporting a decrease in patient visits, Messiah said that people with obesity are potentially missing medical appointments, surgeries, and medications due to the pandemic. People who lost their jobs, and thus their health insurance benefits, may now experience less access to care.
"We don't yet know how many additional lives will be lost to heart disease and diabetes simply because people did not receive care during COVID-19," said Messiah, who is the director of the Center for Pediatric Population Health. "Unfortunately, many of these are ethnic minorities who are already hit hard with disease burdens."
The researchers believe their work can inform clinicians and other health professionals on effective strategies to minimize the physical and psychosocial health impacts from COVID-19 among adults with obesity.
"Those with obesity and severe obesity are already at the highest risk of death from COVID-19. We're concerned that they can be severely affected if a second wave hits in the fall," Messiah said.
The study data came from an online questionnaire conducted April 15 through May 31, 2020. The study population was racially and ethnically diverse, had a mean age of 51, and 87% were women. The mean body mass index for these patients was 40.
UTHealth co-authors on the study included Luyu Xie, PharmD; M. Sunil Mathew; and Ashley Ofori. Other co-authors were Jeffrey N. Schellinger, MCN, RDN, and Chellse Gazda, MD, MPH, of UT Southwestern; and Sachin Kukreja, MD, of Minimally Invasive Surgical Associates, Dallas.
The research was funded through a grant to Messiah at UTHealth School of Public Health from the National Institute on Minority Health and Health Disparities (R01MD011686), part of the National Institutes of Health.