Eating habits, lifestyle behaviors and stress during the COVID-19 pandemic quarantine among Peruvian adults

Introduction

The ongoing coronavirus disease 2019 (COVID-19) outbreak has led to an unprecedented public health crisis and a global health emergency (Arshad Ali et al., 2020). By the end of October 2020, more than 42 million cases and more than 1.1 million deaths had been reported worldwide (World Health Organization, 2020a). America is the continent with the highest rate of reported COVID-19 cases, with USA, Brazil and Peru as the most affected countries (Acosta, 2020; Rodriguez-Morales et al., 2020).

Due to the rapid widespread and severe public health disruption, the World Health Organization (WHO) recommended various strategies to reduce the COVID-19 transmission. For example, physical distancing, home quarantine, closure of schools, universities and non-essential businesses, among others (World Health Organization, 2020b). Regarding quarantine, although it has had a positive impact on reducing the transmission of COVID-19 (Sen, Karaca-Mandic & Georgiou, 2020; Pan et al., 2020), some studies have reported that it could trigger high levels of anxiety, depressive symptoms and post-traumatic stress disorders (Brooks et al., 2020; Fawaz & Samaha, 2020; Guo et al., 2020). Naturally, this could also predispose to changes in lifestyles and unhealthy nutritional habits (Papandreou et al., 2020; Di Renzo et al., 2020; Górnicka et al., 2020; Ruiz-Roso et al., 2020b).

In Peru, the state of emergency became official on March 16 (Presidencia del Consejo de Ministros, 2010). Since then, physical distancing measures and home quarantine were promoted, and although the quarantine is no longer mandatory (there are only some restriction hours), it was during the first months. To date, few studies have described some lifestyles during the quarantine in Latin America (Werneck et al., 2020; Ruíz-Roso et al., 2020c). However, none of them have been conducted in Peru, which is one of the countries with the highest number of cases and deaths due to COVID-19 worldwide (World Health Organization, 2021).

This study aimed to describe the eating habits, lifestyle behaviors and stress during the COVID-19 pandemic quarantine among Peruvian adults.

Methods

Results

A total of 1,031 adults completed the survey, and 686 considered that they could report their weight with an accuracy of eight points or more. The 82.9% were female, 66% were single, and the median age was 31 (IQR: 25-41). The median BMI was 25.97 kg/m² (IQR: 23.37–29.41) and 68.2% reported a significant variation in their weight (38.9% increased and 29.3% lost weight) from the start of quarantine to the date of the application of the survey.

Tables 1–3 reports absolute and relative frequencies of eating habits, sedentary behavior, stressful scenarios and weight variation during the quarantine. Relative frequencies were calculated by rows variables (Questions). Table 1 shows significant differences in most of the eating habits. All bad habits were significantly associated with weight gain, except for prolonged fasting (that was associated with weight loss, p = 0.028). Almost 50% of the participants who reported gaining weight answered that they had snacks between meals (p = 0.030) or had sugar cravings every day (p = 0.001). Similarly, these participants were the ones who reported having significantly more snacks between meals (p = 0.002). Additionally, a sitting time longer than usual (p = 0.001), being in front of a screen for more than five hours in the last week (p = 0.002), and most of the stressful scenarios were significantly associated with weight gain (Tables 2 and 3). Some of these scenarios included being upset because of something that happened unexpectedly (p = 0.001), felt nervous and stressed (p = 0.001), found that they could not cope with all the things that they had to do (p = 0.024), and felt difficulties were piling up so high that they could not overcome them (p = 0.020).

Discussion

Before describing the eating behaviors during quarantine, it is important to note that it is expected that the availability of food would be restricted during this period. This already makes it difficult to eat healthy foods (Díez, Bilal & Franco, 2019; Bilal et al., 2018). Also, quarantine itself reduces the possibility of physical activity, promoting a sedentary lifestyle (Fernández-Sanjurjo et al., 2018), which can also generate a significant neuropsychiatric burden (Troyer, Kohn & Hong, 2020). This has been evidenced by our results, as the participants manifested different stressful situations during the quarantine. This, in turn, may be related to the excessive intake of “comfort foods” (such as pizzas, fried chicken, burgers, French fries, among others) (Moynihan et al., 2015), which naturally leads to weight gain. These foods, mainly rich in sugar and carbohydrates, can reduce stress as they stimulate serotonin production with a positive effect on mood (Lima et al., 2020). However, this food-craving effect of carbohydrates is proportional to the glycemic index of these “comfort foods”, associated with an increased risk of developing obesity and cardiovascular disease, which increase the risk of more severe complications from COVID-19 (Yannakoulia et al., 2008).

COVID-19 has had a negative psychological impact worldwide, not only due to the risk of infection but also due to the different measures implemented to contain the outbreak spread (Guo et al., 2020; Lal et al., 2020). During the COVID-19 outbreak, several studies have reported an increase in the prevalence of eating disorders (Cooper et al., 2020; Baenas et al., 2020; Phillipou et al., 2020). Similarly, lower psychological health has been associated with higher body shape and weight concerns (Haddad et al., 2020). In this sense, this quarantine can be defined as an unprecedented stressful event that has negatively affected individuals’ eating patterns (Bin Zarah, Enriquez-Marulanda & Andrade, 2020). In our study, many participants frequently reported unhealthy eating habits, such as eating until feeling uncomfortable, eating without feeling physical hunger, and feeling guilty or sad after eating. Our results agree with current evidence that suggests a strong relationship between unhealthy eating behaviors and stress, anxiety and other mental disorders (Yau & Potenza, 2013).

Regular physical activity can be beneficial not only for weight loss but also for strengthening the immune system (Zheng et al., 2015). In fact, low–moderate exercise has proven to be beneficial for the innate immune response against respiratory infections (Matricardi, Dal Negro & Nisini, 2020) and could improve some clinical conditions related with severe COVID-19 (Dwyer et al., 2020). However, this has been limited in some cases due to the closure of gyms and public open spaces. We found a high frequency of sedentary lifestyles and too much time in front of screens during the quarantine. Similar results have been reported in other studies worldwide (Meyer et al., 2020; Zheng et al., 2020; Ruiz-Roso et al., 2020a). We also found that this sedentary behavior was related to weight gain among the study participants.

Our study had some limitations. First, the weight variation was self-reported. However, we do not consider this as a continuous variable but rather as an ordinal scale variable. Additionally, participants were asked -on a scale of 1 to 10- to report how accurate they felt they could be answering this question. Only the reliable answers (defined as a score ≥8) were chosen. Second, the study was conducted using an online survey. Thus, the population included was the one that responded on social networks or via e-mail. This could limit the extrapolation of our results to the adult population that has access to social media platforms.

Some strengths should also be highlighted. The current study provides valuable information on eating habits and lifestyle behaviors in the context of an unprecedented event worldwide. Moreover, it is the first published study that have addressed this topic in Peru, which is one of the countries with the highest number of cases and deaths due to COVID-19 worldwide. Our results may be useful for implementing public policies to promote healthy lifestyles during the pandemic. In addition, our study provides insight for future research to implement and evaluate different coping strategies to avoid comorbidities associated with weight gain, especially for future circumstances that will again require self-quarantine.

In conclusion, almost 4 out of 10 participants reported an increase of 2.5–5 kg in their weight. This was related to some unhealthy eating behaviors and a sedentary lifestyle. The awareness of these factors could be an opportunity to promote nutrition and physical activity programs across the country, especially since most of them are potentially modifiable. Additionally, we recommend implementing community-based strategies to promote coping skills and support resilience during the COVID-19 pandemic.

Supplemental Information