Originally published on Yale Medicine by Kathy Katella
It’s easy to see how you might gain weight during the pandemic, especially if you are spending most of your time at home. Comfort food recipes have been trending on Google. (There is so much baking going on, supermarkets can’t keep flour in stock.) You find yourself thinking that a cookie sounds good—or a beer. So as sheltering-at-home restrictions ease up, people are becoming concerned about “COVID curves” and the “Quarantine 15” (referring to new pounds gained).
Nobody has yet done an assessment of how COVID-19 has impacted the nation’s weight—in fact, there are reports that some people are losing weight. But John Morton, MD, MPH, MHA, medical director of bariatric surgery at Yale New Haven Health System, says he has seen patients in telehealth appointments who have gained five, 10, and even 30 pounds.
“Anecdotally, we are definitely seeing weight gain,” Dr. Morton says. “You can put on 30 pounds really quickly—you can do it in three months.”
In fact, COVID-19 has created a perfect storm for people who struggle with weight. “Life has been disrupted in a major way,” says Artur Viana, MD, clinical director of the Yale Metabolic Health & Weight Loss Program. Gym and park closures have upended exercise routines, and the stress has escalated for parents who suddenly had to work at home while teaching their children. People have had to postpone medical checkups and physicals, where getting updates like blood pressure and cholesterol numbers can be motivation to think about weight, he says.
How has the pandemic led to weight gain?
All this stress can affect weight. “We know that obesity’s causes are multifactorial and that stress is involved,” says Dr. Viana. “Not only are there organic body changes, but we turn to food as a way to cope with stress.” There are also metabolic changes associated with the “fight-or-flight syndrome,” says Dr. Morton. “When you’re stressed, your body will sense it, and it will not give up any calories when it thinks it needs for energy for running away or combat,” he says.
Inflammation is a primary factor, Dr. Morton adds. “It’s hard to establish if it’s the chicken or the egg. Does inflammation lead to more weight or does more weight lead to more inflammation? The answer is, probably, both.”
Is obesity a risk factor for COVID-19?
One reason to keep your weight from getting too far out of control is that obesity is associated with serious complications in people with COVID-19, according to Dr. Morton. “We know obesity is a big risk factor—not just for COVID, but it also caused problems in people with H1N1 [a strain of swine flu that infected people around the world in 2009] and severe acute respiratory syndrome [SARS, a coronavirus that became an epidemic in 2002-2003],” he says. “We’ve known this for a long time. It’s being demonstrated right now even more because this virus has been so pervasive.”
According to the Centers for Disease Control and Prevention (CDC), severe obesity increases the risk of a dangerous breathing problem called acute respiratory distress syndrome (ARDS), which is a serious complication of COVID-19. Also, people with severe obesity are more likely to have other chronic diseases and health conditions that can increase the severity of COVID-19, if they become infected.
Dr. Morton is also concerned about how effective a COVID-19 vaccine will be for people with obesity, if and when one is proven to be safe and effective. “We’ve learned over the years that traditional flu vaccines do not work as well in people with obesity. This probably has a lot to do with the fact that the immune response is altered because of the weight and the inflammatory changes that occur,” he says. “I think as we develop a vaccine, we need to make sure that patients with obesity are over-represented in the trial, because they are at high risk, and we need to have a vaccine that is going to work for them.”
Is weight loss necessary and possible?
Losing five or 10 pounds during the pandemic is entirely possible, says Dr. Morton. He advises starting by stepping on the scale at least once a week. Having spoken to patients during telehealth visits in the past few months, he says, “I was surprised at how few patients have weighed themselves. Weighing yourself is both therapeutic and diagnostic.” The National Weight Loss Registry, which tracks people who have lost significant weight and maintained the loss, has shown that people who weigh themselves are more likely to keep their weight down, he says.
Once you know your weight, you can determine your body mass index (BMI), which is a height/weight ratio that will show where you fall in the weight spectrum. (There are many simple BMI calculators available online.) Your BMI is considered healthy if it falls between 18.5 and 25, and overweight if it is between 25 and 30—a good reason to adjust your diet and exercise routine. When BMI reaches 30, people begin to have an extremely difficult time losing weight without medical support and interventions, Dr. Morton says. The Yale Weight Loss Program offers options such as medication, endoscopic procedures, and surgery for people in need.
If you need to lose 10 or 15 pounds, it should be doable—even with the changes and restrictions of the pandemic, Dr. Morton says. The first step is to come up with a plan, he says. He recommends building new routines around what he calls the four pillars for weight loss: diet, exercise, sleep, and stress management. “You have to have routines. You can’t just be sailing along, hoping for the best. Start with the fundamentals,” he says. “That means getting up in the morning, taking a shower, getting breakfast, and having a plan for the day. Purpose gives direction, and it helps when it comes to weight.”
One or two pounds a week is a reasonable weight loss pace, Dr. Morton says. “If you want to cut back by 500 calories a day, that might mean you are exercising the equivalent of 200 calories and cutting out 300 calories in your diet.”
Strategies for shedding pounds
Dr. Morton and Dr. Viana provided several tips to support a weight management program:
- Create a daily routine.
- Set a daily wake-up time and bed time.
- Plan your meals ahead, if you can.
- Dress up for work every morning—if you wear sweatpants or other loose-fitting clothes every day, it’s easier to ignore weight gain.
- Renew your interest in food and cooking. If you are home more than usual, you might have time to learn more about cooking healthy foods. “When you are eating foods you like, you can learn to get a taste of fullness from taste as opposed to only the quantity of food,” Dr. Morton says.
- It might be helpful to cook a week’s worth of meals (or at least the protein parts of the meals) in one session.
- Be sure to include whole grains, fruits, vegetables, and lean meats.
- Think about how you are eating.
- Control your portions. Try using a salad plate instead of a dinner plate. You can also drink a big glass of water before you eat, then wait about 15 minutes to see if you’re still hungry.
- Eat proteins first, because they will make you feel fuller. Too many carbohydrates can cause swings in blood sugar and leave you feeling like you have less control over your hunger.
- Shop carefully. If you think you’ll eat a whole package of cookies in one sitting, don’t buy them.
- Schedule regular exercise. If social distancing keeps you from your usual gym session or exercise classes, try other forms of activity, such as hiking or an online workout class. Exercise is not the main factor for weight loss, but it plays a role in keeping weight off once you lose it, Dr. Viana says. Weight loss can also help with mood and joint pain, adds Dr. Morton.
- Get a good night’s sleep. This means seven or more hours a night, depending on what your body requires. “There is a lot of evidence that people who don’t get enough sleep are more likely to be overweight or obese,” Drs. Morton and Viana say.
- Decide how to manage stress. People of faith who get support from others in their religious community face a particular struggle right now, as congregating in large groups raises risk of infection. But you can set a regular time for prayer at home and take long walks. Meditation, yoga, and a mindfulness practice can help. Alcohol can seem like a way to calm stress, but it is not helpful for weight loss, Dr. Viana says. “When you have a glass of wine, count that as having a candy bar. It contains calories and the nutritional value is very low.” Alcohol can also disturb your sleep and make you dehydrated, which may prompt eating, says Dr. Morton.
Should you just relax?
Should you just go easy on yourself right now? It’s a question that comes up. “Everybody’s got a tipping point with their weight. A lot of people know this—when they get to a certain weight they start to have problems like reflux or joint pain,” says Dr. Morton. “I would say it’s fine as long as you are in a normal weight range, but if you are getting out of that range, I would do something about it.”
If you are still in a normal weight range, an extra 5 to 10 pounds may not make a significant impact on your health, says Dr. Viana. But if you are overweight or obese, losing 7 to 10% of your weight can have a positive impact on such conditions as heart disease, fatty liver disease, and joint pain, he says.
Whatever your weight goals may be, now is a good time to assess your lifestyle and focus on all the things that keep you healthy, Dr. Viana says. “You might have more time to reshape your priorities and decide what to do about food and exercise,” he says.
While you want to have a plan, you do have to make it sustainable and make allowances, says Dr. Morton. There is no reason to be rigid about it, Dr. Viana adds. “So, don’t have macaroni and cheese every day, but if you want to have it once in a while, I think it’s fine.”