Trending Topics pieces (Article Analyses, Evidence Clips and Other Topics) are published in timely response to recent media and journal articles, position statements, clinical guidelines, etc. Since they are based on the most recent evidence/publications, they may not be consistent with PEN evidence in other PEN content areas. As soon as possible, when this occurs, the PEN content will be reviewed and updated as needed.
COVID-19 Lockdown Associated with Weight and Dietary Changes Among Adults with Obesity
You may have heard from your clients that the pandemic lockdown has resulted in individuals feeling challenged to manage their weight. The following analysis by a dietetic student looks at a related study in adults with obesity.
In an observational study, researchers evaluated changes in weight and dietary habits among outpatients of a Northern Italian Obesity Unit after one month of a COVID-19 enforced lockdown (1). The participants (n=150), who were enrolled in a 12-month weight loss program, completed a 12-question multiple choice questionnaire. They also self-reported their weight after one month of lockdown, which was compared to a measured weight from before the lockdown period. On average, weight and BMI increased significantly (P<0.05) by 1.51 kg (3.3 lbs) and 0.58 kg/m2, respectively, during the first month of lockdown. Self-reported anxiety/depression was the strongest predictor of weight gain among the participants. Lower physical activity, boredom/solitude, enhanced eating, unhealthy eating and a lower level of education were also significantly associated with increased weight and BMI. The authors suggested that the adverse mental health effects of quarantine could be a major factor in the lifestyle changes of the participants (1), citing Ryan et al. that individuals with obesity are more likely to experience social isolation and depression (2).
There are several reasons why this study’s findings are low quality. A validated questionnaire was not used for this study and data, including follow-up weight, was self-reported. In addition, due to the nature of the study design, causation about the impact of the COVID-19 lockdown on weight and nutritional changes cannot be inferred. Moreover, generalizability of the results is limited to European adults with obesity who were participating in weight-loss counselling.
This low quality data suggests that individuals with obesity experienced weight gain during the first month of COVID-19 lockdown (1). Also in this study, self-reported anxiety/depression, lower levels of education, lower levels of exercise, higher levels of boredom/solitude, increased food consumption and the consumption of “unhealthy” foods were associated with weight gain. Further research is needed before weight-related COVID-19 clinical practice recommendations can be made.
Written by Laura Michailidis, BA Candidate. Reviewed by Justine Horne, PhD, RD and Tanis Fenton, PhD, RD, FDC.
- Pellegrini M, Ponzo V, Rosato R, Scumaci E, Goitre I, Benso A, et al. Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency. Nutrients. 2020 Jul;12(7):2016. doi.org/10.3390/nu12072016. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/32645970
- Ryan DH, Ravussin E, Heymsfield S. COVID 19 and the patient with obesity – the editors speak out. Obesity. 2020 Apr;28(5):847. doi.org/10.1002/oby.22808. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228389
Canadian Clinical Practice Guidelines on Adult Obesity Released
Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons have released new clinical practice guidelines
for the management of adults with obesity. The intent of the guidelines is to improve the access and standard of care for individuals across all regions of Canada. The guidelines include recommendations for: reducing weight bias in obesity management, enabling participation in activities of daily living, physical activity, mental health, medical nutrition therapy, pharmacotherapy, behavioural interventions, bariatric surgery, primary care/primary health care, management in Indigenous Peoples, management in women in reproductive years and more. Health professionals are encouraged to ask clients for permission to discuss their weight, assess and advise on management, agree on client goals and assist with barriers and drivers. These new guidelines will be integrated into PEN Practice Questions and other related content over the coming months and can also be accessed at: International Weight/Obesity Guideline Collection (Children and Adults).
Report Card on Access to Obesity Treatment for Adults in Canada
Obesity Canada has just released an updated 2019 report card on access to obesity treatments for adults in Canada. The report focuses on four key obesity management tools:
- specialists and interdisciplinary teams for behavioural intervention
- medically supervised weight-management programs with meal replacements
- anti-obesity medications
- bariatric surgery (1).
Major findings indicate that since the 2017 report there have been:
- no improvements in treatment
- obesity is still regarded as self-inflicted
- there are a lack of interdisciplinary teams to treat patients
- patients cover their own costs for weight management programs and foods
- obesity drugs are not covered in public programs
- there are no policies or guidelines to treat or manage obesity in Canada
- there are long wait times for bariatric surgery (1).
Five key recommendations are provided as follows:
- “Governments, employers and the health insurance industry should officially adopt the position of the Canadian Medical Association that obesity is a chronic disease and orient their approach/resources accordingly.
- Governments should recognize that weight bias and stigma are barriers to helping people with obesity and enshrine rights in provincial/territorial human rights codes, workplace regulations, healthcare systems and education.
- Governments should include anti-obesity medications, weight-management programs with meal replacement and other evidence-based products and programs in their provincial drug benefit plans.
- Employers should recognize and respond to obesity as a chronic disease and provide coverage for evidence-based obesity programs and Health Canada approved treatments for their employees through health benefit plans.
- Governments and health authorities should increase the availability of interdisciplinary teams and increase their capacity to provide evidence-based obesity management.”(1).
The PEN® Team will be reviewing the included evidence as it relates to existing content.
- Obesity Canada-Obésité Canada. Report Card on Access to Obesity Treatment for Adults in Canada 2019. April 2019. Available from: http://obesitycanada.ca/wp-content/uploads/2019/04/OC-Report-Card-2019-Eng-F-web.pdf
Obesity Prevention and Management
The Canadian Task Force on Preventive Health Care (CTFPHC) recently released a free e-learning course called, Obesity Prevention and Management, to help clinicians understand the guideline recommendations, the evidence underlying the recommendations, strategies for implementing the recommendations, and the differences between the CTFPHC guidelines and guidelines developed by other groups. The CTFPHC guidelines, Obesity in Adults and Obesity in Children, published in 2015, were developed by primary care and prevention experts across Canada and are based on systematic analysis of scientific evidence.
Can an intentional nudge influence decision-making towards choosing a healthier dietary option? A recent study, The Efficacy of Nudge Theory Strategies in Influencing Adult Dietary Behaviour: A Systematic Review and Meta-analysis in BioMed Central (BMC) Public Health, says it can. Nudge theory, or 'nudge' proposed by Thaler and Sunstein (2008) in their book, Nudge: Improving Decisions About Health, Wealth and Happiness, is based on providing indirect suggestions that guide voluntary shifts in behaviour towards choosing the healthier option. The BMC review assessed nudge effectiveness as a strategy in influencing adults (a generic population of men and women; 18-65 years) to change their dietary choices from unhealthy (foods high in fat, salt or sugar) for healthier ones (more nutrient dense, i.e. the consumption or purchase of more vegetables, fruit and whole grains; and lower in calories, salt, sugar, cholesterol or fat). The researchers systematically searched and quantitatively assessed (meta-analysis) 42 studies (31 RCT; two cohort; and nine cross-sectional) aimed at influencing behaviour related to food consumption. The interventions involved knowledge-based changes (e.g. menu labelling), availability of food (e.g. convenience or adjusting portion size), changes to the social environment or emotional priming. Most of the studies took place in a lab setting (48%) or in a cafeteria (17%) and were conducted predominantly in the U.S. The studies were analyzed based on their percent change in frequency of a choice or in the consumption/purchases made (outcome categories were calories, grams or purchases; either quantity purchased or monetary amount). The researchers found that, on average, nudge interventions lead to a 15.3% (95%CI, 7.6 to 23%) increase in healthier consumption/nutritional choices, as measured by the frequency of healthy choices or by overall intake of healthier food. While the generalizability of the findings is limited by the wide variety of interventions included and nudge-related research in more geographically and varied populations is needed, this paper provides some of the basics and justification for implementing nudging strategies into practice.
An Article Worthy of Attention
Recent research in mice suggests a link between modifiable lifestyle factors, particularly poor diet and lack of exercise, and the biological processes of aging. The researchers found that the fast food diet caused adverse changes in body weight, body composition, as well as markers of physical and metabolic health. They also found that those mice randomized to exervise did not develop the adverse health markers. See a March 2016 Mayo Clinic news article for more information: Poor Diet, Lack of Exercise Accelerate Onset of Age-related Conditions in Mice. The control diet was a usual healthy lab diet for mice and the intervention diet was four times higher in fat and 10 to 15 times higher in sucrose, saturated fat and cholesterol where the mice on the fast food diet received high fructose corn syrup in the drinking water (42g/L). Keep a watch out for more human research in this area to see if it could have a potential impact on practice. This research was published in Diabetes, Exercise Prevents Diet-induced Cellular Senescence in Adipose Tissue .Exercise Prevents Diet-induced Cellular Senescence in Adipose Tissue
Global Study on BMI Trends
A new article analyzed BMI trends from 1975 to 2014 in 200 countries and calculated that there is zero probability that global obesity targets, set for 2025, will be met if post-2000 trends continue. Further, the study found that by 2025 that 18% of men and 21% of women globally would be obese. Also of note was the persistence of underweight in parts of Africa and Asia which needs attention as it is associated with increased morbidity, mortality and poor pregnancy outcomes.
Obesity in Canada - A Whole-of-Society Approach for a Healthier Canada is a new report from the Senate Standing Committee on Social Affairs, Science and Technology. It includes 21 recommendations that call for a national campaign to fight obesity and urges the federal government to take aggressive measures to return Canadians to healthy weights and to make it easier for Canadians to make informed decisions about their diet. For information on the Dietitians of Canada involvement, see Media Release.