Social distancing has changed Brazilian women’s eating habits, study shows

More than 1,000 volunteers completed an online questionnaire designed by Brazilian researchers. The results show that more women are cooking, sitting down to eat, snacking between meals, and ordering takeaway meals, while dieting and supermarket shopping have declined.

By Karina Toledo  |  Agência FAPESP – The confinement and social distancing measures introduced to contain COVID-19 have changed Brazilian women’s eating habits and food choices regardless of weight and nutritional status, according to an online survey conducted in Brazil between June and September 2020, with 1,183 participants.

Several activities became more habitual in the period, including cooking (up 28%), sitting down to eat (up 40%), snacking between meals (up 24%), and ordering meals from restaurants (up 146%). On the other hand, there was a decline in supermarket food purchasing (down 34%) and dieting to lose or control weight (down 41%).

Volunteers of normal weight based on body mass index (BMI) reported concerns with “health”, “natural origin” and “affect regulation” as the main factors influencing their food choices during confinement or lockdown. Overweight women cited “pleasure” and “convenience”, as well as “health” and “natural origin”, while for respondents considered obese the main determinants of food choices were “visual appeal” and “pleasure”. An article detailing the results of the study, which was supported by FAPESP, has been published on medRxiv, in a preprint that has yet to be peer-reviewed.

“The results show that confinement changed the behavior of all respondents regardless of nutritional status, but it’s important to note that the reasons for obese and normal-weight women’s food choices were already different before the pandemic and remained so. So-called ‘emotional eating’ was more frequent among obese and overweight respondents, and this should be taken into account when formulating public policy for the new normal,” said Bruno Gualano, a professor at the University of São Paulo’s Medical School (FM-USP) and a co-author of the article.

The principal investigator for the study was Carolina Nicoletti Ferreira, also affiliated with FM-USP.

According to Gualano, the survey was confined to women because of their key role in determining what families eat in Brazil. In addition, evidence is available in the scientific literature that “emotional eating” is more prevalent among women than men, and that women are more likely to experience anxiety, depression, and loneliness while living in isolation, as has been required during much of the pandemic.

The respondents were aged 18-72, with a median age of 34, and were from various parts of Brazil. Most were white (77.8%) with a university degree (72.4%), and around half were single (55.5%). These characteristics correspond to those of the middle-class and upper-middle-class citizens who were best placed to stay at home during the survey period. Based on BMI, 13.4% were considered obese, 26.2% overweight and 60.4% normal weight.

“The main limitation of the study is that we were unable to gain access to the most vulnerable segment of the population, those who live in the working-class suburbs, despite strenuous efforts to do so,” Gualano said. “Poor women of color with little schooling were severely underrepresented in our sample. It’s very likely that the dietary changes caused by the pandemic were even more harmful to them, and motivated above all by food prices.”

The survey was disseminated with the aid of collaborators in academia, communities, social media, health services, traditional media, and scientific diffusion. To be eligible, participants had to be over 18 and complete an online questionnaire on their personal details. Limited internet access and illiteracy may explain the low proportion of women with little schooling, Gualano surmised.

The study was funded by FAPESP via several projects (17/13552-2, 19/14820-6, 19/14819-8, 15/26937-4 and 20/07860-9). 

State of mind vs. nutritional status

After analyzing the completed questionnaires by statistical methods, the researchers observed a close correlation between eating habits considered unhealthy – such as eating while watching TV, consuming snacks instead of meals, and snacking between meals – and feelings of depression, anxiety, stress, and loneliness.

The researchers were surprised to find that dieting had declined by 41%. The optimistic explanation, according to Gualano, is that women wisely gave up on slimming or otherwise restrictive diets because of the extra stress involved. “It could also be evidence that they were neglecting or getting careless about their health,” he said. “There are studies showing that women are sitting down for longer and getting less physical exercise during the pandemic. In addition, smoking, consumption of alcohol, and ultra-processed foods have increased. There’s a sense that anything goes during a pandemic. The trouble is that the crisis has gone on and on. Working from home is apparently here to stay. Employers are adapting, and many of these women will continue to work from home after the pandemic, so there’s a risk that these temporary habits will become permanent.”

The problem can be combated by means of interventions, Gualano continued, advocating public policies mainly for the more vulnerable, for whom the impact of the pandemic has been worse, including an increase in chronic disease, food insecurity, and unemployment. An example of such policies, he suggested, would be training hospital and health clinic staff, as well as community health workers employed by the Family Health Program (PSF), to offer nutritional advice to the patients they see and other members of their communities.

The article “Influence of nutritional status on eating habits and food choice determinants among Brazilian women during the COVID-19 pandemic” can be read at: www.medrxiv.org/content/10.1101/2020.11.03.20225136v2.full.pdf. 

Mobile unit

The researchers are also monitoring groups of patients treated for chronic conditions such as rheumatoid arthritis and obesity at FM-USP’s general and teaching hospital (Hospital das Clínicas). “Some of the subjects had undergone bariatric surgery just before the onset of the pandemic and were particularly vulnerable at the time,” Gualano said. “They had to become habituated to a different body, a new diet, and other changes in their routine. The hospital needed to use all the available beds for COVID-19 patients and was unable to continue caring for this group.”

He decided to rent a vehicle that served as a mobile unit to pay house calls on the bariatric patients. It was staffed by researchers and graduate students, including Diego Rezende, Sofia Sieczkowska, Gabriel Perris Esteves, Rafael Genário, Michele Nakahara-Melo, Karla Fabiana Goessler and Anthony Damiot.

During the calls, they asked the patients to describe their eating habits, mental health, and physical exercise. They also used accelerometers to corroborate self-reported activities. Most of the patients had high blood pressure; 25% had systemic inflammation; 20% were not following medical advice regarding use of vitamin and mineral supplements; a third had symptoms of depression; and 40% displayed some degree of anxiety. Three patients reported suicidal thoughts and were referred to a specialist.

About 60% did not achieve the recommended minimum amount of exercise. The most inactive exhibited the worst physical and mental health. These individuals were asked to carry out a remotely supervised three-month schedule of exercises. The researchers are currently analyzing the results of this intervention.

Preliminary findings of the study, which is supported by FAPESP and FM-USP’s Rheumatology Discipline, have been published in Obesity, Obesity Surgery and medRxiv. The researchers have also produced a video.