Physical Health, Obesity, and the Challenge to Stay Active During the COVID-19 Pandemic

The COVID-19 pandemic is having a significant impact on individuals as they struggle to manage their mental and physical well-being.

The onset of stay-at-home orders outside of Asia in March 2020 saw a rapid decrease in step counts recorded on wellness apps. Research conducted by the University of California San Francisco analyzing 19 million daily step count measurements from global smartphone users showed a 5.5% [1] average decrease (287 steps) within 10 days of the declaration of a pandemic. This further decreased by 27.3% within the next 30 days. Social distancing protocols and socioeconomic disparities were cited as key challenges in performing physical recreational activities.

COVID-19 is fueling obesity

The global burden of obesity has reached epidemic proportions, resulting in over four million deaths each year [2].

See also: Obesity: A Silent Pandemic

The ongoing pandemic has further amplified the challenges of fighting obesity: Government interventions in combatting COVID-19 have been associated with an increase in obesity occurrence and metabolic diseases, especially in lower-income groups. Weight loss programs have been suspended; many people have shifted to cheaper, processed foods due to financial insecurity; and added stress has led to an increase in emotional eating.

Researchers at the UConn Rudd Center for Food Policy and Obesity found that those who experienced weight stigma before the pandemic were three times more likely to binge eat during the pandemic [3]. Reports suggest that individuals with higher body mass index (BMI) could be more at risk of increased weight gain, which leads to not only increased all-cause mortality risk, but also increased COVID-19 mortality risk.

See also: COVID-19 and Obesity: How excess weight increases risk of infection, severe illness, and mortality

Challenges related to acquiring proper nutrition and physical inactivity, as well as increases in depression, anxiety, and job loss have made it difficult for obese people to adhere to healthy behaviors. According to a survey conducted among 123 obese adults by Dr. Jaime Almandoz, Medical Director of the Weight Wellness Program and Assistant Professor in the Division of Endocrinology at the University of Texas Southwestern Medical Center, 69.6% of participants struggled to lose weight during the pandemic [4]. A decrease in exercise intensity and duration of exercise was reported by 55.8% and 47.9% of participants, respectively.

Certain COVID-19 measures, including the closure of sport and exercise facilities, as well as remote working practices can lead to sedentary behaviors for both young and old. With less outdoor activity and more indoor time, people reported turning to comfort foods and “pandemic baking.” In fact, grocery stores struggled to keep up with the demand for flour. Dr. John Morton, Medical Director of Bariatric Surgery at Yale New Haven Health Systems, says that during telehealth appointments, he has seen patients who have gained 5-30 pounds [5].

Obesity can significantly increase the risk of hypertension, cholesterol, and diabetes, which may contribute to an increase in cardiovascular disease (angina, coronary heart disease, stroke, and myocardial infarctions), contributing to increased mortality. For example, in the Nurses’ Health Study, the effect of weight change evaluated in 114,281 women indicated that a gain of 11 to 17.4 pounds resulted in a relative risk for diabetes of 1.9, and a gain of 17.5 to 23 pounds raised the relative risk to 2.7 [6].

Routine check-ups and follow-up medical appointments for management of risk factors such as elevated cholesterol and blood pressure, which would normally help keep people accountable for weight management, have been postponed during the pandemic, not only fueling weight gain, but also pausing risk factor monitoring.

Digital health sees an uptick across the globe

Increased obesity will lead to a less healthy society overall. To take the burden off healthcare systems worldwide, governments, policy makers, and healthcare systems need to conduct thorough analyses and take action to implement community-based healthcare programs to counteract sedentary behaviors. Now is also the time for innovation and the development of solutions for digital health engagement.

During lockdown, health and fitness app downloads increased by 46% worldwide, with India seeing the highest increase at 156% [7]. Meanwhile, the Americas saw the smallest increase at 8%, but the adoption rate was higher compared to some other countries. Daily active users (DAUs) also increased, indicating that people were actually using the apps. However, it remains unclear whether, and which, app features help people remain physically active. A first of its kind study showed that lockdown decreased U.S. residents’ regular physical activity and (PA) metabolic equivalent task (MET) levels by 18.2% [8]. The MET is a physiological measure expressing the energy cost of physical activity. It has been suggested that the use of PA apps may help buffer the decline of PA.

See also: New Year, New Users: Are New Year’s resolutions a timely marketing opportunity for wellness products?

In order to tackle the myriad problems that arise due to obesity, the Northwestern Medicine Health Care remote weight loss program, Opt-IN, offers maximum weight loss for the lowest cost. The app-based program helps users predetermine the calories in food before consumption and helps track intake and exercise throughout the day. The data is shared with a coach, helping keep users accountable. This program is believed to be the most successful behavioral non-drug weight management treatment currently available [9].

What the future might hold

An increase in mortality and morbidity risk factors due to poor physical health or lack of adherence to wellness activities is likely to require more obesity management and lifestyle counseling. We also see innovative solutions entering the market that focus on maintaining physical health during and after the pandemic. A shift in consumer behavior and preferences could trigger health and wellness companies to rethink how they connect with consumers, and consider offering more socially distanced physical activities outdoors, more at-home content, and innovative solutions to encourage physical activity. In addition to wellness apps, can we expect to see a surge of virtual reality (VR) and augmented reality (AR) fitness and gaming? If we cannot or will not go outside or to the gym for physical activity, perhaps technology and innovation can bring fitness to our homes.