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Impact of COVID-19 pandemic on eating styles: A population based-survey during the first lockdown in Italy A Andaloro1, MG Maggio2, MC Stagnitti3, D Marchese3, RS Calabrò41 Cognitive Rehabilitation Center, Messina, Italy 2 Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy 3 Relational Psychotherapy and Cognitive Rehabilitation Center, Messina, Italy 4 Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Brain Injury Center, Messina, Italy
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/jpgm.jpgm_919_21
Keywords: Eating behavior, lockdown, nutritional habits, SARS-CoV-2
Italy was among the countries most affected by the COVID-19 pandemic, entering into quarantine as of March 10, 2020.[1] The new emergency condition has highlighted the need to create new and innovative care pathways, not only in hospitals but especially at home.[2],[3] In the general population, especially the elderly and the chronically ill, physical inactivity and stress resulting from social distancing and confinement are among the most risk factors for the morbidity of various diseases.[4] In particular, the closure of all activities during the lockdown period has had a strong relevance on eating behavior.[5] To maintain health and well-being, correct nutrition is essential, especially when the immune system is under pressure. In addition, travel and commerce restrictions have reduced access to food, so this may adversely affect overall physical and mental health. For many people, quarantine has been a cause of anxiety and worry, being the main cause of the consumption of larger quantities of food, even of poor quality. Finally, the sedentariness resulting from home confinement, in combination with altered eating habits, has led to an increase in weight.[5] The context of social isolation has inevitably led to an imbalance in daily habits, including food. It has been therefore essential to assess the changes in disorderly eating behaviors that have occurred as a result of the COVID-19 pandemic. In the literature, few studies have evaluated the link between stress and eating behaviors during the lockdown,[6],[7] considering the peculiarity characteristic of this new condition due to COVID-19. For this reason, in this study, we sought to evaluate the correlation between emotional aspects and nutritional habits of a group of people living in Sicily, during the COVID-19 quarantine.
Study population, design, and setting We used a cross-sectional survey design with an anonymous online questionnaire, administered through the technological means offered by smartphones (i.e. WhatsApp, Facebook) or by email. To be included in the study, participants had to be at least 18 years of age. They were excluded if they were diagnosed with psychiatric or medical disorders and/or if they were taking psychoactive drugs or substance of abuse, including alcohol. Medical information were verified from the records of participants' family physician. Potential study participants were identified through the medical records of general practitioners working in the province of Messina, Sicily, who had previously contacted their clients to obtain consent for our screening. Of the 200 contacted participants, just under half (i.e. 91 individuals) entered the study. Then, participants completed the self-administered questionnaires in Italian, using an online survey platform (“Google Form”, Google LLC). To ensure a good response rate we used a clear and easy-to-access platform and interview, increased motivation by briefly explaining the importance of the topic during pandemics with the help of the participants' family doctors, and also sent gentle reminders. Data collection took place from April 1 to May 20, 2020, that is, during the first Italian lockdown. The survey consisted of a structured interview regarding the sociodemographic data of the subject, and the administration of specific tests in order to assess how the quarantine resulting from the COVID-19 outbreak has affected their nutritional habits and psychological status. The questionnaire administered were: the Dutch Eating Behavior Questionnaire Italian version (DEBQ)[8] to measure eating styles and the Perceived Stress Scale (PSS)[9] to measure the perception of stress. In addition, participants were asked to report whether they had changed eating habits since the pre-COVID period and what the change in habits consisted of. The present study complied with the principles of the Helsinki Declaration, and all participants provided written informed consent to participate in the study and publication of the data. The study was approved by the Local Ethics Committee (i.e. the IRCCS Centro Neurolesi; approval number: IRCCS-ME 23/2021). Statistical analysis The descriptive statistics were analyzed and expressed as mean ± standard deviation or as median ± first third quartile for continuous variables, as appropriate; frequencies (%) were used for categorical variables. Clinical scale scores were expressed as a mean and standard deviation. We used linear regressions to calculate the univariate associations between socio-demographic characteristics and the scoring of the scales. All tests were two-tailed, with a significance level of P < 0.05. Statistical analysis was performed using SPSS Statistic 22.0 (IBM SPSS Statistics, New York, United States).
The final sample consisted of 91 participants living in the province of Messina, Italy [Table 1]. One hundred and nine, did not answer depite attempts made to ensure their participation.
We observed that the majority (86.7%) of the sample reported having a drastic change in eating habits during the pandemic. In particular, they had a consumption of more caloric foods (homemade desserts, pizzas, chips), and in greater quantities than in the pre-COVID period. Moreover, the results showed that during the COVID-19 pandemic, the participants experienced high stress (18.14 ± 4.1, mean ± SD) [Table 2]. Also their eating behavior was associated with their emotional behaviors (DEBQ EM – 41.74 ± 10.9, mean ± SD). In the present study stress correlated positively with the emotional (P < 0.001) and external (P = 0.003) aspects of eating (Cronbach's alpha were 0.65 and 0.45, respectively) [Table 3].
The present study focused for the first time on the correlation between stress and eating during the first lockdown in Italy by using specific tools, and we found high stress levels related to an increase in both emotional and external eating. In other words, food was seen as a way to cope with psychological problems, with reduced sensitivity to internal cues of hunger and satiety. The subject also paid more attention to external cues, such as the sight and smell of food. These results are in line with various studies.[6],[7],[10],[11],[12] In fact, it has been shown that the main consequence of the quarantine is a change in eating habits, characterized above all by a shift towards unhealthy foods and reduced sports activity. Bracale et al.[7] carried out an analysis on the trend of consumption during the first period of the spread of the coronavirus, on 10769 stores. The authors noted that there was an increase in the consumption of pasta, flour, eggs, long-life milk, and frozen foods, compared to a reduction in fresh food products, as reported by our sample. Indeed, as demonstrated by Torres and Nowson,[10] stress can alter overall food intake, leading to insufficient, or excessive nutrition with a preference for foods that are high in sugar and fat. Mattioli et al.[6] emphasize that during quarantine, there is a regression toward junk foods versus fresh foods. In response to stress, people tend to consume high-energy foods. Moreover, Genis-Mendoza[13] performed an online survey to assess the effect of the pandemic on 1,011 adults. Changes in eating habits were reported in 38.51% of the participants, 67.80% reported having distorted their physical perception of themselves or starting a calorie-restricted diet. Additionally, 2.27% of individuals presented with post-traumatic stress symptoms.[13] Thus, in situations of high stress caused by the pandemic the subject may have higher stress, with possible difficulty in adequately coping with some emotions and feelings such as anger, sadness, loneliness, emptiness, indecision, and confusion.[14] Eating in these situations can be a distraction or “anesthesia” to face the emotional sensations.[15] For this reason, people begin to have an “addiction” to food in order to manage their emotional state. Recent studies carried out in Italy have observed that psychological distress decreased with the relaxation of restrictions, and it was also observed that stress predicted binge eating.[14],[15] Nonetheless, as a novelty, we used specific psychometric tools to better define the eating style to understand the prevailing type of diet and the level of stress in order to more objectively demonstrate a direct correlation between these two variables. Furthermore, the use of online forms for the evaluation of psycho-eating dimensions can be considered an innovative means of investigastion especially during pandemics. Lockdown is associated with increased symptoms of anxiety, depression, and disordered eating behaviors.[2],[3] It has been shown that people can counteract stress with binges, resulting in physical discomfort, weight gain, and risk of disease.[10],[16] Onal et al.[17] found a trend of weight change associated with sociodemographic variables, dietary habits, and the stress level after one year of the pandemic. Moreover, lockdown-related physical inactivity leads to an increase in the inflammatory state, especially in the presence of chronic diseases. Therefore, during the quarantine, subjects, especially those with obesity, may have experienced immense stress that has made them more vulnerable to overeating and a sedentary lifestyle, thus predisposing them to further weight gain.[10],[16] In conclusion, the present study underlines that the first COVID-19 lockdown measures have had an impact on eating habits and emotional stress in an Italian population, supporting the link between stress and pathological eating behaviors, including binge eating and consumption of unhealthy foods. Declaration of patient consent The authors certify that appropriate participants consents were obtained. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
[Table 1], [Table 2], [Table 3]
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