COMMENTARY

COVID-19: 'Lockdown 15' Weight Gain Metabolic Implications and Risks

Prof Mamas Mamas

Disclosures

May 04, 2020

This transcript has been edited for clarity.

Hi, welcome to Medscape UK. My name is Mamas Mamas. I'm professor of Cardiology based at Keele University and today's programme will focus around weight gain - weight gain during the lockdown.

This lockdown weight gain has been seen and reported in many countries. In Italy, for example, in the United States, in the United Kingdom, and it has been termed many names on social media such as the lockdown 15, the quarantine 15.

Fifteen relates to the weight gain in pounds gained. But is this phenomenon real or is it mainly a social media construct? Well, I ran a poll on CardioTwitter with over 270 participants, of which over 50% reported having gained weight.

In fact, 20% reported having gained over 5 pounds in weight. But there's also other data, data from an electronic scale manufacturer in the United States. They obtained data from several hundred thousand participants, and they showed, importantly, that the average weight gain was rather more modest at 0.2 pounds. Nevertheless, over 20% of individuals reported a weight gain of over 1 pound.

But let's not forget that the individuals that buy these electronic scales - that are state of the art - are very likely not to represent the general population. And so it is likely that the weight gain experienced by the general population is probably higher than this 1 pound.

So what are the causes of this weight gain? Well, they’re likely to be multifactorial. First and foremost, we're exercising less, many of our gyms are closed, and we're no longer going out for fear of catching COVID, particularly the elderly and co-morbid.

Secondly, our dietary habits have changed. Individuals are stockpiling food, and we're snacking and grazing for most of the day.

We're also switching to very carbohydrate rich diets, and this will obviously have an impact on our weight gain.

Interestingly, it has been reported that one of the greatest increases in foodstuffs sold in the United Kingdom is in fact alcohol. The sales of alcohol have increased by 300%, and this will clearly impact on calorie intake and weight gain.

But let us also not underestimate the psychological impact of social isolation during this lockdown. And we know that psychology can have a major effect on both calorie intake and weight gain.

So for the next couple of speakers we're going to focus around weight gain from a number of perspectives.

First and foremost, what are the metabolic implications of gaining weight?

And secondly, what are the future risks of cardiovascular events?

My first guest is Dr Scott Murray. Dr Murray is a consultant cardiologist based at the Royal Liverpool Hospital and he is ex-president of the British Association for Cardiovascular Prevention and Rehabilitation. He will focus around the metabolic effects of this acute weight gain.

Dr Scott Murray

What I want to talk to you today is about the fact that we're living in strange times. We've been taken out of our comfort zone and placed in a very difficult situation.

This often leads us to replace that comfort gap with comfort food and alcohol, and certainly speaking from a personal perspective, I have been over consuming in the past 4 weeks and I'm sure some of you probably feel the same way. Now it does get to a point where we can't continue that hedonistic activity without affecting our health. And I want to give you a couple of specific examples where this behaviour, and certainly environmental dietary behaviour, can have a profound impact on future cardiometabolic health.

Number one is with regard to consuming comfort foods which are high in processed carbohydrates and fats, salt, and sugar. And often this raises our insulin required to deal with these foods.

Unfortunately, that rise in insulin, and occasionally compensatory hyperinsulinemia, can affect some of the metabolic pathways within our body which are normally regulated by tight insulin control.

One is the HMG-CoA reductase enzyme, which produces cholesterol from the liver, the apoB-100 lipoprotein particle, and this is inhibited by statins but if you are over-stimulating insulin, you will produce more cholesterol through this pathway. And that is cholesterol ultimately in the bloodstream, able to be glycated, oxidated and potentially end up in your arterial walls.

On a similar theme, if you are having frequent spikes in blood sugar, maybe four or five times a day with snacks and main meals, this can lead to the kidney being affected and some of the endocrine ability of the kidney. So, if there is frequent delivery of large volumes of glucose to the kidney, SDLT-2 will be affected, you will save sodium and water increasing your blood volume, but you will also stop salt sodium from filtering through to the macula densa, and the macula densa is more likely to react then as if the blood pressure has actually fallen by increasing the production of renin and this can lead to a greater deal of production of angiotensin II, which is a potent vasoconstrictor.

So having more salt, water, more angiotensin and more insulin in the system, will lead to vasoconstriction, hypertension, and as I've just stated, higher cholesterol values.

Often with processed food consumption, we also see an increase in the triglyceride to HDL ratio, which is again a bad sign from a lipid perspective.

So these two things will undoubtedly increase your cardiovascular risk.

If you're combining that with abnormal genetics you've inherited, as well as a history of smoking or some other risk factor, then you're certainly heading on a bad pathway.

So I would ask people to try and stay as mindful as they possibly can in these difficult times, and to make sure that they protect their liver by not over consuming processed food and alcohol, to try and feed their gut as much as they can with nutrients and fibre where possible, to stimulate your muscles when you can to try and give the mitochondria within the muscles a bit of a kicking so that they can improve their metabolic flexibility, and to try and take a break from eating where possible and consider intermittent fasting as this may lead to a reduction in your overall energy toxicity, and under fill your adipocytes, which is something that you want to do in order to maintain metabolic health going forward.

Dr Scott Murray, consultant cardiologist, Wirral University Teaching Hospitals. Dr Murray has no relevant disclosures.

Lockdown Weight Gain Causes and Risks

Epidemiological studies have suggested that changes in weight may be associated with future risk of cardiovascular events.

For example, the TNT study [Treating to New Targets] published in the New England Journal of Medicine suggests that variability in weight gain in patients with underlying coronary artery disease was associated with an increased risk of both future cardiovascular events and total mortality.

Similarly, analyses from the US NHANES programme has suggested that weight gain over a period of 10 years, particularly in young to middle adulthood individuals, is associated with an increased risk of future development of diabetes, cardiovascular events and mortality. Whether this increase in weight gain in a short period of time is associated with an increase in the risk of cardiovascular events is under a lot of speculation. My next guest, Dr Erin Michos, associate professor of medicine, at Johns Hopkins University, will discuss both the causes of the lockdown 15 but also the increases in the risk of cardiovascular events associated with weight gain.

Dr Erin Michos

Hi, I'm Dr Erin Michos. I am the Associate Director of preventive cardiology at Johns Hopkins School of Medicine and I want to thank Medscape and Prof Mamas for the opportunity to talk about the impact of obesity and lockdown for COVID-19.

There are both upstream and downstream impacts of obesity in this crisis.

First, the downstream effects - the lockdown weight gain.

Due to social distancing, staying at home reduces exercise options, markedly decreasing physical activity and skyrocketing screen time.

Increased stress levels can trigger unhealthy eating patterns, such as overeating, emotional eating, and choosing unhealthy foods such as those higher in saturated fats, simple refined carbs, sugar sweetened beverages and alcohol.

And there's decreased access to healthier food items which are more perishable.

Nevertheless, there are ways to incorporate more physical activity to one's day even while at home and with thoughtful planning many healthy food products can still be purchased.

Advice should be given to patients on low-cost, high-nutritious foods that are less perishable.

Lockdown weight gain should be avoided given the downstream cardiometabolic consequences that stem from insulin resistance.

Now upstream of COVID-19, we know that individuals who are already obese are at greater risk of more severe forms of the disease, which is very worrisome since here in the US the prevalence of obesity is 42%.

For example, among individuals age less than 60 with COVID in New York City, those with a BMI of 30 to 34, or greater than 35, were two and four-fold times more likely, respectively, to be admitted to critical care than individuals with a BMI less than 30.

Reasons for this is that obesity may lead to restrictive lung function, dysregulated immune response, increased risk of thrombosis, insulin resistance, and other impairments in cardio-respiratory reserve.

Thus it is crucial to ensure that even in these trying times that cardiovascular prevention efforts remain top health and policy priorities for this and future outbreaks of this virus, and for preventing secondary downstream consequences of cardio-metabolic diseases. Thank you.

Erin Michos, MD, MHS. Associate Director of preventive cardiology, the Ciccarone Center for the Prevention of Cardiovascular Disease, associate professor of medicine, Johns Hopkins Medicine, USA. Dr Michos has no relevant disclosures.

Final Thoughts

So, I think in summary, the phenomenon of weight gain during this pandemic is real.

I don't think, however, that this equates to 15 pounds weight gain. I think most of the studies have suggested that the weight gain is far more modest.

Certainly, however, any weight gain can impact metabolically, both from lipid profile changes to increases in blood pressure, but also, importantly, in dysglycaemia and insulin resistance.

Increases in weight gain can also impact both short- and long-term outcomes.

For example, as Dr Michos discussed, being obese increases your risk of mortality from COVID-19 if infected. And certainly there is epidemiological data, equating an increase in body mass index or weight to the future risk of cardiovascular events. Whether this short increase in weight over a short period of time, and relatively modest means will impact on future cardiovascular risk, who knows?

I suspect that once we go back to our everyday living and we come out of this lockdown, much of the weight that has been gained will probably be lost because of our increased activities, our better eating habits, and also the reduction of stress. Stress after all is a very important factor in driving our eating habits.

Certainly, trying to avoid gaining weight during this period is important. And there are simple measures. Even in the UK, the Government allows 1 hour of activity every day. And so, going out for a run, a cycle ride, or even a long walk, will certainly help burn calories. Avoiding snacking, avoiding refined sugar-rich foods, these are all sorts of things that are well known to healthcare individuals that can reduce the risk of gaining pounds.

I think the most important thing during this period is a period of circumspection. Thinking about what matters and also staying safe. So thank you for joining me. Thank you to our two speakers, Dr Murray and Dr Michos for providing such great insight.

You can follow Mamas Mamas on  Twitter

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