The current coronavirus disease 2019 (COVID-19) pandemic has caused severe and wide-ranging changes in behavior due to the implementation of various non-pharmaceutical interventions (NPIs) in order to contain the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
A new study published on the preprint server medRxiv* discusses dietary changes as a result of the pandemic, with special reference to high fat, salt, and sugar (HFSS) foods, and their association with specific lifestyle and sociodemographic factors and choices.
Study: Impact of COVID-19 Pandemic on Diet Behaviour Among UK Adults: A Longitudinal Analysis of The HEBECO Study. Image Credit: Syda Productions / Shutterstock.com
The pandemic measures were put in place from the latter half of March 2020 and largely remained effective until June 2020. This was followed by a further period of relaxation until September 2020. The subsequent surge in cases led to the re-imposition of restrictions, culminating in a full-scale lockdown in December 2020.
Severity of COVID-19 is largely related to high body fat and metabolic health. These factors are determined by diet, to a major extent, which therefore contributes significantly to the burden of disease.
Dietary patterns have shifted during the pandemic, probably due to altered health behaviors. These, in turn, are related to changes in accessibility to food, work profiles, domestic life, stress, sleep, physical activity, smoking, and drinking.
As expected, dietary patterns changed more markedly at the beginning of the pandemic and returned to normal later on. Earlier studies show that most people have widely varying responses to the pandemic in terms of food intake, with no overall change.
Dietary behavior is linked to many other factors that impact health and COVID-19 severity, such as physical exercise, body mass index (BMI), and age. This type of behavior also reflects increased mental and emotional turmoil as a result of the pandemic; Thus, the chronic impact of a changing diet may be serious.
The current HElth BEhaviours during the COVID-19 pandemic (HEBECO) study included questions about the average intake of HFSS snacks/meals and fruit and vegetable (FV) intake in adults in the United Kingdom adults. All study participants were monitored at the beginning, 3- and 6-month time points, and throughout the pandemic. The researchers of the current study attempted to estimate sociodemographic, pandemic-related, and behavioral factors linked to changes in these parameters during the study period.
The researchers studied about 1,500 people, of which included a higher proportion of females, as well as older, white, unemployed individuals of low socioeconomic status. More people who lived in households with only adults were isolated, had a higher quality of life, and tended to smoke less, had lower HFSS meal intakes, and had a higher FV intake.
HFSS snacks increased sharply over the first three months of the study until May and June 2020. Their intake then dropped by August-September to below the pre-pandemic threshold. By six months, or November-December, the monthly intake increased to almost identical levels compared to the pre-pandemic intake.
About half the subjects said they were eating more HFSS snacks by 26 portions a month, while half said they had reduced their monthly intake by 24 portions.
HFSS meal intake portions dropped slightly, even before the pandemic began, to about six a month. By three months or August-September 2020, the monthly portion remained steady but increased to 6.6 by November-December. The final intake was still below the pre-pandemic figure.
Over a third of subjects said they were eating fewer HFSS meals. Comparatively, about 45% of respondents said they were eating more HFSS meals, each by an average of five meals a month.
FV intake was about 70% before the pandemic and remained consistent throughout the period of study until the last point where it slightly decreased. Over a tenth of study respondents indicated that they did not eat enough FV to meet recommended daily intakes; however, 8% indicated that they were meeting these thresholds at six months.
Females, as well as those with a lower quality of life, were found to be eating more HFSS snacks during the study period. This was linked to higher HFSS meal intake at different time points.
At all ages, HFSS snack intake went up at the beginning of the pandemic but subsequently decreased between November-December for younger people. At the start of the pandemic, HFSS snack and meal intake were correlated. However, by August-September, HFSS snack intake was decreasing, independent of HFSS meal intake.
By six months, those who were eating more HFSS meals at the beginning continued to do so or returned to their original levels by six months. Those who had lower HFSS meal intakes did not show any increase.
“This study suggests the pandemic is associated with long-term adverse changes in dietary behaviours, which could amplify the existing sub-optimal dietary patterns of U.K. adults.”
The study adds to current knowledge about the impact of the pandemic on diet in relation to other social, mental, and lifestyle/behavioral changes caused by the pandemic.
The researchers found that the average intake of HFSS snacks and meals varied widely in U.K. adults over the pandemic. The snack intake eventually returned to the pre-pandemic levels. Conversely, HFSS meal intake remained below levels found before the pandemic. FV intake remained constant up to the end of 2020, after which fewer people met the recommended intakes.
HFSS snacks were more likely to be used by females and those who had a lower quality of life. Age-related HFSS meals/snacks intake differed at different periods of the pandemic.
Adult-only households were more likely to have a higher HFSS meal intake towards the second half of the study period. This was also true of those with a higher intake of HFSS snacks. This could be due to the effect of adults with a higher HFSS food intake on the eating habits of others at shared mealtimes.
People who had higher BMIs and were less inactive had overall lower FV intakes.
The scientists postulate that these changes could be the effect of business closures that affected food availability, accessibility, or shopping habits. Since HFSS snacks are more convenient, inexpensive, and capable of long storage, these might have been preferred, especially with supposed threats of food shortages during the early phase of the pandemic.
Comfort eating was one form of unhealthy eating, along with eating to assuage boredom or mitigate a low-quality life. These known mechanisms of coping with stress or anxiety are linked to an increase in the intake of unhealthy snacks, coupled with a reduced FV intake. Unfortunately, this initial practice may have strengthened into a habit.
“A poor diet is the largest behavioral risk factor for [disability-adjusted life-years] DALYs lost and second only to smoking for years of life lost, indicating a strong need for policy action to help individuals make healthy dietary choices.”
People at high risk of unhealthy dietary changes should be targeted in campaigns to reduce obesity by increasing the accessibility and availability of healthy foods, as well as reducing advertising of unhealthy foods. The effects of eating as part of a household should also be considered, as should the feasibility of making healthy eating a social or group norm.
This requires making resources available to create changes in eating behaviors, promoting the free choice of healthy foods by individuals and groups, and emphasizing the satisfaction that comes from such patterns.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.