New Study Looks at Whether We Got Healthier or Less Healthy During the Pandemic

In March of 2020 in Auckland, New Zealand, Janna Crowley was basking in the glow of her recently completed Ironman 70.3 New Zealand when she, like pretty much everyone else around the world, was sent in to lockdown.

For Crowley, a risk specialist at an insurance company, it was a whole new experience and one that she was not entirely prepared for. “Initially I was quite anxious; I felt isolated and unsure of what would happen. I went from working in a large office to being at home 24/7 on my own. After a couple of weeks, I began to relax and establish a new routine. I am lucky to have a lovely area that I could safely walk and social distance.”

Halfway around the world, Luís Coelho da Silva, a Portuguese an air force pilot stationed at a NATO base in Spain, found himself cut off from his wife and children and in a very dystopian version of the world that seemingly had arisen overnight. For Shannon Greene, a microbiologist in Alexandria, Virginia, the lockdown didn’t bother her at first. She adopted a puppy and took him out for walks.

But all of them—Crowley, Coelho da Silva, and Greene—are also triathletes and the pandemic was about to change much more than their race schedules.

Around the world the various restrictions on activity and gatherings had profound and wide-ranging effects on people’s lives. Now, with the emergence of new strains of the novel coronavirus that are as much as 50-75% more infectious, the specter of new lockdowns is again upon us. What will be the effects?

During last year’s lockdown restrictions there was a sense among many that healthy habits were difficult to adhere to. Many felt they ate poorly, exercised less—and as a result lost fitness and gained weight. “Usually I have a very healthy diet, but once the restrictions were imposed I lost control of it,” Coelho da Silva said. “It is not like my weight went up 100 pounds, but it went up and I can feel it and see it in my habits. And honestly, I’m finding it hard to get back on track. I still eat healthy but I’m having more than I need just due to my current inability to control my cravings.”

Not everyone had that experience though. Crowley found that her diet became surprisingly healthier. “I was very focussed on staying healthy and not getting sick. It was winter in New Zealand, so I didn’t want to risk getting a cold. A lot of people were posting on social media that they were drinking more. I went the opposite way; I didn’t think it would be healthy to be sitting home alone drinking every night, so I didn’t have any.”

Greene had an experience similar to Crowley’s. “I was probably one of the few who lost weight in the pandemic. I was always lean and athletic, but not going out to eat helped a lot. Plus I started ordering vegan meal prep kits each week and the emphasis on veggies was great.”

A recent study in the journal Obesity sought to measure these diverse effects on people more broadly. By surveying almost 8,000 people, the authors quantified people’s eating and exercise habits and how they changed during quarantine.

The study cohort was split almost evenly between those who were normal weight, those who were overweight, and those who were obese—though there was a significant over-selection of older white women, who made up more than two-thirds of the study population. During the lockdown, study participants reported significant changes in diet, with the majority actually eating better.

The senior author on the paper, Dr. Leanne Redman told me: “One of the main reasons healthy eating scores increased overall is that restaurants were closed for dine-in services. As a result, people ate less fast food and fried foods, and cooked more at home. However, snacking, consuming desserts, and drinking sugar-sweetened beverages also increased.” Overall, 1 in 5 participants perceived that they were eating healthier during lockdown than before it, while 36% perceived eating less healthy.

Physical activity also changed during government restrictions, with reported exercise time decreasing by 6% and higher intensity exercise time by 8%. Interestingly, when compared to metrics recorded on fitness devices, exercise time was actually seen to decrease by as much as 13%, reflecting significant underreporting by participants.

For instance, Strava’s year in sport report showed significant increases in activity at the start of the pandemic—similar to data from Garmin and Fitbit, though the specifics varied by country based on the local restrictions. One of the other differences is those companies also all serve users who typically are already on fitness platforms or own fitness devices—ie. Strava or Garmin—as opposed to the more general population.

“Gyms and health clubs were closed. Exercise equipment was hard to come by. Factor in the increase in anxiety and getting less sleep, and it’s not hard to see why people were less motivated to stick to their exercise routines. If you’re tired and grouchy when you get up in the morning, you’re probably not going to exercise as much,” Dr. Redman said.

Eating and exercise habits changed more for people who were overweight or obese than for those who were normal weight. With respect to eating habits, they improved much more among the obese than in any other weight group, but this was offset by the worst decline in exercise among the groups.

This fact was reflected in the overall weight changes reported by the different groups. Overall, 27% of participants reported a weight gain during lockdown, but this was spread across the three groups as 33% of those who were obese, 20% of the overweight, and 24% of the normal weight individuals. By contrast, 17% of individuals (spread evenly across the three groups) reported losing weight during quarantine. The amount of weight gained or lost was not reported in the article.

“Triathletes are not immune to stress and fatigue or the unwise food choices that can accompany them,” said Dr. Redman. “For those working from home and likely for the first time, the proximity of workspaces to the kitchen means people have needed to learn restraint in order to overcome the constant temptation of food availability in the refrigerator and pantry.”

Knowing these aggregate results is helpful in understanding that our experiences as individuals are not necessarily unique. It can also help us prepare for the eventuality that we may face a similar situation again.

“I signed up for the Ironman Virtual Club when it was launched,” Crowley said. “This was a gamechanger for me; it gave me a sense of purpose for my training and it was nice to have something new to focus on.”

Dr. Redman wholeheartedly agrees that for many the availability of online programs, like Ironman VR, was very important. “We think that people have become more dependent on the internet for communication than ever before, so there is an opportunity to engage households in programs that are designed to help manage anxiety in a pandemic and to offer strategies for maintaining healthy eating, exercise, and sleep habits. The health behaviors we evaluated—physical activity, diet, anxiety, and sleep—are entwined. Focusing on any one of these domains will likely have downstream effects on the others.”

Coelho da Silva also found that quarantine had silver linings for his training. “My coach was great setting up Zoom group coaching sessions for his athletes. We would do ‘alternative swim sessions’ or group Zwift races, and that was, from my perspective, a great experience. In an odd way the pandemic brought us closer. Although it doesn’t feel like it, I trained around 15% more than in 2019.”

The pandemic has had lasting effects on our society as a whole, with many of those effects still to be determined. But the effects on the health of even those who aren’t infected are clearly enmeshed with the very measures designed to keep them safe. While there are means to decrease anxiety and manage healthy eating and exercise habits, the best solution for everyone will be to put this behind us as soon as possible.

Train hard, train healthy.

The MedTent will answer your science and medical triathlon-related questions. It’s written by Jeff Sankoff, an ER physician, triathlete, and coach who runs TriDoc coaching and hosts the TriDoc podcast.