Mental health challenges contributed to weight gain for people with obesity during COVID-19

Over the first year of the COVID-19 pandemic, almost 30% of patients with obesity gained more than 5% of their body weight, and 1 in 7 gained more than 10%. While diet and exercise habits were factors, people with the highest levels of stress, anxiety, and depression reported the most weight gain, UT Southwestern researchers reported in the journal Obesity.

“The COVID-19 pandemic is a fascinating model for individual and social stress and showed that changes in mental health can really preclude people from maintaining a healthy body weight,” said study author Jaime Almandoz, M.D., M.B.A., FTOS, Associate Professor of Internal Medicine in the Division of Endocrinology at UT Southwestern.

According to the Centers for Disease Control and Prevention, more than 42% of American adults have obesity, which increases their risk of heart disease, Type 2 diabetes, and many cancers.  

Early in the pandemic, clinicians who treat obesity began to suspect that lockdowns, social isolation, decreased access to health care, and changes in food availability were negatively affecting many of their patients.

In 2020, Dr. Almandoz and his colleagues at the UT Southwestern Weight Wellness Program and the UT Health Center for Pediatric Population Health were the first to publish on the impact of stay-at-home orders on health behaviors and mental health among people with obesity. They reported that nearly 70% of patients said their weight loss goals were more difficult to achieve during the initial pandemic lockdown, nearly half exercised less and stockpiled food, and 61% admitted to stress eating. A second study found that rates of recreational drug and alcohol use also increased in patients with obesity.   

In the new paper, the team surveyed 404 people during the Delta variant surge between March and November 2021. All participants had been seen for obesity treatment at one of three clinics in Dallas during the prior two years and had a body mass index (BMI) of at least 30.

On average, respondents gained 4.3% of their body weight during the pandemic. Almost a third of people reported gaining more than 5%, with some people gaining more than 25%, or up to 80 pounds. The reported stress and hardships were surprising given the study population’s socioeconomic profiles, Dr. Almandoz said, as almost half had a household income greater than $75,000, and almost 60% were college graduates.

“People who are enrolled in weight management programs typically lose weight,” said Dr. Almandoz. “If people with these levels of privilege are experiencing significant challenges during the pandemic, these stresses are likely amplified in the general population.”

When the researchers looked at factors associated with the weight gain, they found that people who ate less healthy or slept and exercised less tended to gain more pounds. But mental health factors were also highly correlated: People who gained the most reported the highest levels of stress, anxiety, and depression. Even when other factors were controlled for, poor mental health was still associated with weight gain.

“Our findings underscore the complexity of obesity; it’s not just about telling people to eat less and move more,” said Dr. Almandoz. “There’s a mental health aspect that has to be integrated into treating the whole person as well.”

Dr. Almandoz hopes the new findings will help clinicians better screen their patients for mental health challenges when they see weight gain and refer patients to programs that integrate mental health treatment, such as UT Southwestern’s Weight Wellness Program.  

Other researchers involved in the study include Luyu Xie, Jeffrey N. Schellinger, M. Sunil Mathew, Elisa Morales Marroquin, Natia Murvelashvili, Shreeya Khatiwada, Carrie McAdams and Sarah E. Messiah, all of UTSW and UT Health Science Center; and Sachin Kukreja of Minimally Invasive Surgical Associates, Dallas.

This work was funded by the National Institutes of Health’s National Institute on Minority Health and Health Disparities (R01MD011686-S1 and R01MD011686).

About UT Southwestern Medical Center

UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 26 members of the National Academy of Sciences, 17 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,900 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 100,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 4 million outpatient visits a year.