Quarantine weight gain: When is it a cause for concern?

The indirect impact of the COVID-19 pandemic has taken a huge toll on our health wellbeing in many ways. Rates of anxiety, depression, and loneliness are on the rise with more people reporting sleep disturbances.¹ ² ³ Now, recent research is telling us that it's also led to weight gain for many.

A 2021 US study by JAMA Network has revealed that its 269 participants gained an average of 1.5 pounds per month between February 2020 and June 2020. While a few pounds might not sound like much, its cumulative effect over a longer period can be serious. In another survey by the American Psychological Association, researchers found that 42% of Americans reported that they have gained unwanted weight during the pandemic period — with the average being 29lbs.⁴

Furthermore, it seems to be a universal problem affecting other countries too. A global survey involving 19,903 participants from 140 countries found that 35.82% of people reported gaining weight during the pandemic. And 71.25% within this group put on more than 5lbs.⁵

What are the health risks of pandemic weight gain?

More people are obese

Unfortunately, this widespread weight gain has exacerbated an already growing problem in American public health — obesity. In 2011, no US state had reached the 35% mark in obesity prevalence. But in 2020, 16 states have already hit this percentage.⁶

Children and youths in the US were also affected by the pandemic weight gain. A study involving 432,302 people aged 2-19 years found that participants' body mass index (BMI) rate of increase roughly doubled through this period.

Before the pandemic, childhood obesity was increasing at a rate of 0.07% a month. But after COVID-19 started showing up on American shores, it has increased to 0.37%.⁷

Obesity is related to other medical problems and death

The worry about obesity isn't just about the condition itself, but also its many related health effects. People with obesity are more likely to develop multiple health conditions like cardiovascular disease (CVD), diabetes, cancer, osteoarthritis, sleep apnea, depression, and more.⁸ The World Health Organization (WHO) also states that at least 2.8 million people die every year from health issues related to obesity or being overweight.⁹

For children with obesity, they're also at higher risk of adulthood obesity, hypertension, earlier development of cardiovascular disease, premature death, and more.¹⁰

The worrying thing is that even moderate levels of weight gain (as seen during the pandemic) can have long-lasting effects on metabolic processes which lead to diabetes and cardiovascular disease.¹¹ ¹² Furthermore, short-term variability in weight within a period of 6 months has been shown to predict weight increases in the long term (2 years later).¹³

Increased risk of worse COVID-19 outcomes

The Centers for Disease Control and Prevention (CDC) also states obesity and being overweight are also risk factors for poorer COVID-19 outcomes — it can triple your risk of hospitalization in the event of an infection. This was especially so for those under 65 years old.¹⁴ ¹⁵

Children with obesity also face the same increased risk of more serious COVID-19 symptoms. One study involving participants aged 18 years old and younger found that those with obesity were more than 3 times as likely to be hospitalized and experienced severe illness (e.g. requiring mechanical ventilation).¹⁶

The public health body also explains that there are multiple reasons for this. Including the fact that obesity is associated with poorer immune function and lower lung capacity (which makes ventilation more difficult).¹⁷

What caused the pandemic weight gain?

Weight gain typically has multiple genetic, psychological, and environmental contributing factors. However, there were some pandemic-specific reasons that created the perfect storm for packing on the pounds. 

Forced lockdowns resulted in less physical activity

Before the COVID-19 pandemic, lack of physical activity was already a global problem that some experts referred to as its own pandemic. According to the WHO, 31% of people above 15 years old are not getting enough physical activity and it's associated with 3.2 million deaths each year.¹⁸

With the widespread practice of home isolations and social distancing, people were confined to their homes for weeks and months and only allowed to leave for essential purposes.

Because of these government-mandated movement restrictions, a third of Americans reported engaging in less physical activity during that period. Another survey found that people were sitting for an additional 4 hours a day on average compared to pre-pandemic days.¹⁹ ²⁰ This also resulted in 60% of people reporting that they've experienced more aches and pains because of this inactivity.²¹

Other studies that examined global physical activity had similar findings. One group of researchers tracked the steps of 455,404 users from 187 countries through a free app. They found a 5.5% average decrease in steps taken within 10 days of the WHO declaring that COVID-19 was a pandemic. Within 30 days, the decrease had reached 27.3%.²² ²³

Experts say that it's still uncertain whether these pandemic-induced lifestyle behaviours will persist even when COVID-19 is gone. But if we look to previous disasters as an indicator, it would seem possible for such major events to alter the lifestyle of populations. In the instance of the 2011 earthquake and tsunami that affected East Japan, researchers found a significant decrease in child and adolescent physical activity 3 years after the incident.²⁴ ²⁵

Stress, boredom, and emotional eating

Another major culprit of pandemic weight gain was related to emotional eating during this highly stressful period. A survey conducted by the American Psychological Association in Jan 2021 found that 84% of Americans reported feeling a stress-related emotion during the previous 2 weeks. The most common feelings were anxiety (47%), sadness (44%), and anger (39%).²⁶

And a common reaction to these feelings is to eat.

According to a WebMD survey, 70% of adults in the US report that their pandemic weight gain is a result of stress eating. And the international average was 35%.²⁷

Another survey involving 9,000 Americans also found that 36% of participants have been snacking more during the pandemic.

While another study found that increased boredom during the pandemic was associated with increased snacking and less intuitive eating.²⁸ ²⁹

Why people respond to stress by eating is a result of various factors. But medical professionals state that there are biological processes underlying these reactions. For example, our body releases more cortisol hormone in response to stress which can result in increased appetite and feelings of hunger.³⁰

Increase in unhealthy food choices: fast food and alcohol

Unsurprisingly, people often turn to "comfort foods" which are high in sugar and fat to ease the emotional burden of stress. The biological reason behind this is that such foods lead to a release of "feel-good" hormones like dopamine that give a sense of reward. But because the extra sugar is removed from the blood relatively quickly, people need to keep eating to achieve the mental boost again.³¹ ³²

Another such "comfort food" is alcohol, and some reports show that there was a 55% increase in alcoholic beverage sales at the start of the pandemic. As it's often full of empty calories and impedes fat digestion, it can form a big part of the weight gain equation — especially when people consume more than moderate amounts. A WebMD poll indicates that 21% of US respondents and 17% of international users blame their weight gain on alcohol consumption.³³ ³⁴

Weight loss can be of concern too

While weight gain seems to be the more common problem through this pandemic, experts highlight that unusual weight loss can be an issue for some as well. As reported in an American Psychological Association survey, 18% of Americans stated that they had undesired weight loss since the start of COVID-19. And the average amount of weight decrease was 26lbs.

Similar to weight gain, hormonal stress responses are likely at play when it comes to people eating less. Some researchers suggest that increases in adrenaline are what leads to the appetite curb in people, while others have suggested that the communicative system between the brain and gut (called the vagus nerve) gets disrupted in stressful events.³⁵ ³⁶

When are weight changes a cause for concern?

With the combination of movement restrictions, stress, and home isolations, the pandemic created the perfect conditions for weight changes. But of course, some degree of weight fluctuation is normal throughout life (whether or not there is a pandemic). So at what point does it become a cause for concern?

Some experts suggest that if your weight fluctuates more than 6 pounds in either direction within a 6-month time frame, it might be a good time to speak to a health professional. They can discuss what changes might be happening in your life that led to the weight fluctuations and how to get on a healthier path again.³⁷

How to lose the pounds (stressing about it and dieting is not the answer)

When experts talk about making healthier choices, they're not referring to jumping on the latest dieting fad. In fact, years of research have shown that dieting is not effective in the long term as it often leads to weight fluctuations that ultimately end up in an overall weight increase.³⁸ ³⁹ Weight gain is a lot more complicated than simply controlling calorie input and output with multiple societal and psychological factors at play.

Social factors include "weight stigma" from the people around us which can lead to feelings of guilt. People often cope with these difficult feelings through disordered eating patterns like binging which, again, continues the cycle of shame. When weight is tied in with many other emotional and psychological factors, telling people to simply eat less is usually not the most viable solution.⁴⁰ ⁴¹

This is why professionals are advising people to focus on boosting healthy and holistic lifestyle habits — rather than only targeting a number on a scale. Multi-study reviews have concluded that focusing on promoting wellbeing rather than weight loss is better for sustaining healthy habits in the long run.⁴²

Practical steps for promoting holistic wellbeing include:⁴³

  1. Practicing self-compassion: We are living in extremely difficult times and weight changes do happen to many people.  

  2. Think about your health holistically: How is your sleep? Maybe some device-free time before bed can help. 

  3. Make small changes to your routine: How can you incorporate more periods of movement throughout the day? 

  4. Change your environment: Can you work in a different room instead of the kitchen? Can you make snacks less accessible?

  5. Make small, healthy changes to what you are eating: Instead of cutting out ice cream altogether, can you reduce it gradually? Ask yourself how you can incorporate more nutrient-dense food into your daily meals.

Experts also emphasize that weight should not be the only factor in determining one's overall level of health. “You’re more than that number,” says registered dietitian Chelsey Ludwiczak, RD, in an interview with Cleveland Clinic. “Your scale isn’t going to reflect all the positive changes you make. Think about how your food choices are making you healthier. Focus on the amazing mental and physical benefits of regular exercise. Maybe you have more energy to play with your kids. So many victories are not scale-related.”⁴⁴

  1. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic | The Lancet

  2. Loneliness in the Era of COVID-19 | Frontiers in Psychology

  3. How the COVID-19 Pandemic Can Impact Your Sleep | Cleveland Clinic

  4. Slightly More Than 6 in 10 U.S. Adults (61%) Report Undesired Weight Change Since Start of Pandemic | American Psychology Association

  5. Quarantine Weight Gain: 35.82% Gained Weight During Pandemic [19,903 Person Study] | Run Repeat

  6. Obesity Rates Rise During Pandemic, Fueled By Stress, Job Loss, Sedentary Lifestyle | NPR

  7. Obesity in US children increased at an unprecedented rate during the pandemic | The BMJ

  8. The Medical Risks of Obesity (2010)

  9. Obesity | World Health Organization

  10. Obesity and overweight | World Health Organization

  11. “Covibesity,” a new pandemic (2020)

  12. Short-term obesity results in detrimental metabolic and cardiovascular changes that may not be reversed with weight loss in an obese dog model | Cambridge University Press

  13. Short-term variability in body weight predicts long-term weight gain (2015)

  14. Obesity, Race/Ethnicity, and COVID-19 | Centers for Disease Control and Prevention

  15. Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020 | Centers for Disease Control and Prevention

  16. Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children (2021)

  17. Obesity, Race/Ethnicity, and COVID-19 | Centers for Disease Control and Prevention

  18. A tale of two pandemics: How will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another? (2021)

  19. Cross-sectional study of changes in physical activity behavior during the COVID-19 pandemic among US adults (2021)

  20. Survey Reveals Increased Time Sitting at Home During the Pandemic Has Been a Pain in the Butt … Literally | Cision PR Newswire

  21. Survey Reveals Increased Time Sitting at Home During the Pandemic Has Been a Pain in the Butt … Literally | Cision PR Newswire

  22. Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study | Annals of Internal Medicine

  23. Physical Activity Dropped Worldwide During COVID-19, Raising Concerns for Health | UCSF

  24. A tale of two pandemics: How will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another? (2021)

  25. Physical activity and sedentary behavior among children and adolescents living in an area affected by the 2011 Great East Japan earthquake and tsunami for 3 years (2015)

  26. APA: U.S. Adults Report Highest Stress Level Since Early Days of the COVID-19 Pandemic | American Psychological Association

  27. Quarantine Weight Gain Not A Joking Matter | WebMD

  28. America’s pandemic snack: Lay’s potato chips | YouGovAmerica

  29. Differing Experiences of Boredom During the Pandemic and Associations With Dietary Behaviors (2021)

  30. Managing Stress and Emotional Eating During COVID-19 | Brigham Health Hub

  31. Managing Stress and Emotional Eating During COVID-19 | Brigham Health Hub

  32. Unwanted weight gain or weight loss during the pandemic? Blame your stress hormones | The Conversation

  33. Quarantine Weight Gain Not A Joking Matter | WebMD

  34. Alcohol and weight gain | Better Health Channel

  35. Does Stress make you want to Eat More or Less? | The University of Melbourne

  36. Unwanted weight gain or weight loss during the pandemic? Blame your stress hormones | The Conversation

  37. Is Weight Fluctuation Normal? | Healthline

  38. Lockdown weight gain: telling people to eat less has never been the answer | The Conversation

  39. 7 Reasons Why You Don’t Need to Lose Your ‘Quarantine 15’ | Healthline

  40. 7 Reasons Why You Don’t Need to Lose Your ‘Quarantine 15’ | Healthline

  41. The extra weight of COVID-19 | American Psychological Association

  42. The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss | Hindawi

  43. The extra weight of COVID-19 | American Psychological Association

  44. When Is the Best Time to Weigh Yourself? | Cleveland Clinic

The author, Dawn Teh, is a health writer and former psychologist who enjoys exploring topics about the mind, body, and what helps humans thrive.

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