More Alcohol, Less Smoking Fueled COVID-19 Weight Gain

Miriam E. Tucker

April 04, 2022

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Greater alcohol consumption and lower smoking rates may have contributed to the increase in US adult obesity observed during the COVID-19 pandemic, new research suggests.

The study, based on nationally representative data from the Behavioral Risk Factor Surveillance System (BRFSS) compared the year prior to the start of the pandemic with the first year after. The article was published online April 4 in the American Journal of Preventive Medicine by Brandon J. Restrepo, PhD, a research economist with the US Department of Agriculture, Washington, DC.

Restrepo sought to identify factors that contributed to the weight gain widely reported to have occurred during lockdowns in the first year of the pandemic.

"Previous studies present evidence that intrapandemic changes in risky dietary and other health-related behaviors likely contributed to the rapid rise in body weight during this period. Adults who reported weight gain also reported more frequent snacking and alcohol intake, increased eating in response to sight, smell, and stress, and decreased physical activity," Restrepo writes.

"It seems warranted for clinicians to pay special attention to public-facing reports that signal changes in behaviors that have the potential to increase the risk of obesity," he told Medscape Medical News.

Exercise Increased, So Did Sleep

Compared with BRFSS survey results in 2019 through March 12, 2020, those from March 13, 2020 through March 18, 2021 revealed an increase in BMI of about 0.6% (P < .05) and a 1.1 percentage point increase in obesity or 3% relative to the sample mean (P < .05).

Average alcoholic drink days were 2.7% higher (P < .05), but smoking rates dropped by 0.7 percentage points or about 4% (P < .01).

Increased alcohol intake, previously reported to have occurred early in the pandemic, "can lead to weight gain, particularly when it is not compensated for through reductions in intake of other calorie-dense foods and beverages," Restrepo said.  

As for the drop in smoking, "some research finds that cigarettes and alcohol are substitute products, which may partly explain the opposite-signed changes in alcohol intake and cigarette smoking during the pandemic," he noted.

And notably, exercise participation rates rose by 3.3 percentage points or 4.4% (P < .01), and average sleep hours increased by 1.5% (P < .01).

There are conflicting reports on exercise levels during the pandemic, with a previous study finding a decrease. The differences "may be partly due to differing definitions of activity," Restrepo postulated.

He acknowledged that lack of data on food consumption is a study limitation. "Unfortunately, the BRFSS does not ask about daily calorie intake. While some BRFSS years contain information on fruit and vegetable consumption, these questions were not asked in 2020. Future research should examine how food intake changed during the pandemic," he said.

In the meantime, Restrepo is working on a follow-up study investigating intrapandemic changes in rates of adult obesity by demographic subgroup and socioeconomic status.

Restrepo has reported no relevant financial relationships.

Am J Prev Med. Published online April 4, 2022. Full text

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on Twitter: @MiriamETucker.

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