The COVID-19 pandemic is having a detrimental impact on substance use, mental health and weight-related health behaviours among people living with obesity, according to a study by researchers at UT Southwestern and the UTHealth School of Public Health.
The study, ‘Substance use, mental health and weight‐related behaviours during the COVID‐19 pandemic in people with obesity’, published in the journal Clinical Obesity, surveyed nearly 600 patients with obesity who are enrolled in the UT Southwestern Weight Wellness Program, a multidisciplinary weight management and post-bariatric care clinic. Nearly half of the group reported using recreational drugs and alcohol, and 10 percent reported increased use since the start of the pandemic.
"Many patients with obesity are also challenged by mental health conditions,” said study author, Dr Jaime Almandoz, medical director of the Weight Wellness Program and assistant professor of internal medicine at UT Southwestern. “Those who reported anxiety, depression, and trouble sleeping were two to four times more likely to increase their use of substances. For those who reported stress eating, there was a sixfold increase in substance use.”
According to the Centers for Disease Control and Prevention, more than 42 percent 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.
The aim of this study was to examine the impact of the COVID‐19 pandemic on substance use, mental health and weight‐related behaviours in a sample of adults with obesity after lockdown orders were lifted (June‐September 2020). A retrospective medical chart review identified patients with obesity from one university‐based obesity medicine clinic, and two metabolic and bariatric surgery (MBS) practices. Patients who completed an online survey from June 2020 to September 2020 were included. The primary outcome measure was substance use (various drugs, alcohol, tobacco). Substance use and mental health survey questions were based on standardiaed, validated instruments.
A total of 589 patients (83.3% female, mean age 53.6 years, mean BMI 35.4, 54.5% Non‐Hispanic white, 22.3% post‐MBS) were included in the study, of whom 17 patients (2.9%) tested positive for SARS‐CoV‐2 and 13.5% reported symptoms. Nearly half (48.4%) of the sample reported recreational substance use and 9.8% reported increased use since the start of the pandemic.
There was substantial drug use reported (24.3% opioids, 9.5% sedative/tranquilizers, 3.6% marijuana and 1% stimulants) and patients who reported stockpiling food, healthy eating more challenging, difficulty falling asleep and anxiety were more likely to report substance use versus non‐users.
Nearly 70 percent of the patients reported that it was more difficult to achieve their weight loss goals during the pandemic, with about half spending less time on exercise. These findings were similar to another paper authored by Almandoz in 2020, which was one of the first studies to show the impact of shelter-in-place orders on health behaviours in people with obesity.
"This study demonstrates that adults with obesity continued to engage in the same behaviours and struggled with mental health challenges, even after lockdown orders were lifted,” added senior author, Dr Sarah Messiah, an adjunct professor in the UTSW department of population and data sciences and a professor in the department of epidemiology, human genetics, and environmental sciences at the UTHealth School of Public Health. “We need to develop interventions targeting these vulnerable groups, such as telehealth options and outreach efforts.”
The researchers noted that the patients surveyed were predominantly white, college-educated individuals with middle- to high-income levels. Thus, the survey results may not be generalisable to other populations and may not accurately assess the burden of the pandemic on obesity-related health behaviours in lower socioeconomic status and/or ethnic minority populations disproportionately affected more by obesity and COVID-19.
The survey participants were established weight management patients with health insurance - not representative of the average American challenged with obesity, in which less than 2 percent receive anti-obesity medications and fewer than 1 percent undergo bariatric surgery.
“The COVID‐19 pandemic is having a durable negative effect on the health behaviours and mental health of people with obesity. In particular, this group is reporting significant use of substances, increases in anxiety, depression and difficulty sleeping, which are associated with maladaptive eating and physical activity behaviours,” the researchers concluded. “These findings can inform healthcare providers on developing screening and intervention programs for this at‐risk population.”
Other researchers involved in the study include Luyu Xie, Jeffrey N Schellinger, M Sunil Mathew, Nora Bismar, Ashley Ofori, Sachin Kukreja, Benjamin Schneider and Denise Vidot.
This work was funded by the National Institutes of Health's National Institute on Minority Health and Health Disparities.
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