Translate this page into:
Effect of quarantine on eating behaviors and weight change among King Saud University students in Riyadh
⁎Corresponding author. nalafeef@ksu.edu.sa (Nora O. Alafif)
-
Received: ,
Accepted: ,
This article was originally published by Elsevier and was migrated to Scientific Scholar after the change of Publisher.
Peer review under responsibility of King Saud University.
Abstract
Background
To determine the effect of quarantine on eating habits and weight change, as well as the primary changes in weight and eating habits among King Saud University students.
Aim
This study aims to identify the effects of quarantine on eating behaviours and weight changes. Also, it determines the main changes in eating behaviours and weight among KSU students in Riyadh from March 23 to June 21, 2020.
Methods
This is a cross-sectional study of a random sample of KSU students. Saudi male and female (non-pregnant females) bachelor’s degree students at KSU in the Riyadh region, who had not tested positive for COVID-19, satisfied the selection criteria. The total number of responses to the questionnaire was 1053; after the elimination of 320 responses that met the exclusion criteria, 733 students were included in the study.
Results
The current study results confirmed as 52.4% of students ate more of snacks. Among students’ most consumed food items during the quarantine were starches, coffee, dairy, and poultry. Contrastingly, the least consumed food items were energy drinks, fish, and soft drinks. Further, 53.7% of the students gained weight, which was associated with anxiety, boredom, and consumption of red meat and eggs. However, weight loss among students was associated with concerns regarding weight gain, changes in food quantity, changes in appetite, and the consumption of vegetables.
Conclusion
Although lockdowns are an important safety measure to protect public health, the findings of this study show that quarantine affects eating and Emotional Eating (EE) behavior such as consuming more starch, dairy, and poultry among students at KSU. Furthermore, this study can help the Saudi authorities develop guidelines to direct Saudi food markets to increase advertising and promote healthy foods during situations like the COVID-19 pandemic.
Keywords
COVID-19
Students
Eating behaviors
Weight change
Emotional eating
1 Introduction
Coronavirus disease (COVID-19) is considered a major international health problem. It was declared a pandemic by the World Health Organization (WHO) on March 13, 2020 (Organization, 2020). By November 17, 2020, the WHO had reported 54,301,156 confirmed cases and 1,316,994 deaths worldwide (World Health Organization. (2020). The COVID-19 reached Saudi Arabia on March 2, 2020 (Ministry of Health. (2020); thereafter, the Saudi government implemented urgent measures to protect the safety and health of the citizens and residents living in the Kingdom, such as mandatory quarantine and border control. Although quarantine helped in controlling the number of reported cases, it also affected dietary behaviors (Mumena, 2020) and the psychological and mental health of the Saudi population (Al-Musharaf, 2020). Presently, Saudi Arabia has been documented with more than half million infected and recovered cases of COVID-19.
During quarantine, the consumption of unhealthy foods and snacking frequency increased (Ammar et al., 2020, Reyes-Olavarría et al., 2020), especially among those whose work status changed (Ingram et al., 2020). Females were more affected by increased energy consumption (Gallo et al., 2020), unhealthy intake (Drywień et al., 2020), comfort food intake due to anxiety, and having a modified appetite (Di Renzo et al., 2020b). Also, EE scores and stress were positively correlated (Al-Musharaf, 2020). In the United States, it seems that quarantine made participants consume more sweets and salty foods (Bin Zarah et al., 2020). Moreover, obese people were found to be influenced by quarantine—as obese participants had the most significant change in their eating behaviors (Sidor and Rzymski, 2020). Those who were more frightened by COVID-19 had higher restraint to eating behaviors (Haddad et al., 2020). In a Lithuanian study, the majority of participants increased fruit and vegetable intake (Kriaucioniene et al., 2020).
Along with the changes in eating behaviors discussed above, body weight was also affected for many reasons, such as changes in dietary habits and physical activity levels during quarantine (Kriaucioniene et al., 2020). Weight gain was found to be related to decreased physical activity and increased consumption of red meat, carbonated drinks, pastries, and snacks. In contrast, weight loss was associated with increased physical activity and increased consumption of vegetables, fruits (Drywień et al., 2020), and fish (Reyes-Olavarría et al., 2020). In a Polish study, 34% of female participants gained weight and 18% lost weight (Drywień et al., 2020). Another study showed that 29.9% of participants reported weight gain, and 18.6% reported weight loss (Sidor and Rzymski, 2020). Some previous studies have shown that being female (Reyes-Olavarría et al., 2020) or older in age (Kriaucioniene et al., 2020), obese or overweight (Drywień et al., 2020), lower educational level, boredom, and anxiety (Pellegrini et al., 2020) were associated with weight gain and increased physical activity. However, remote work and/or study were associated with weight loss (Drywień et al., 2020).
Emotional Eating (EE) behavior is defined as the tendency to overeat as a coping mechanism for reducing and regulating negative emotions, such as anxiety, depression, and stress (Ganley, 1989). The increased feeling of negative emotions, social isolation, and loneliness generated by the pandemic might have played major roles in the lifestyle changes. Generally, emotional changes and mood disorders influence food choices with the search for comfort foods, such as processed snacks and sweets (Macht, 1999; Macht, 2008). Furthermore, the results from some studies showed that boredom/solitude, anxiety, and depression during the pandemic enhanced the eating and consumption of unhealthy foods, snacks, and sweets. Thus, it resulted in being the most relevant factor in predicting the increase in body weight after adjusting the consumption of unhealthy foods (Pellegrini et al., 2020). Also, it resulted in a gender difference regarding EE. EE is very common among young women during the pandemic (Al-Musharaf, 2020). More so, some studies showed that females appeared to be likelier to “stress-eat” and consume hyper-palatable “comfort” foods than males (Gallo et al., 2020). Therefore, this study aims to identify the effects of quarantine on eating behaviors and weight changes. Also, it determines the main changes in eating behaviors and weight among KSU students in Riyadh from March 23 to June 21, 2020 (28th of Rajab to 29th of Shawwal 1441H).
2 Materials and methods.
2.1 Study design and participants
This was a cross-sectional study that assessed the effect of quarantine on eating behaviors and weight change from March 23 to June 21, 2020. It was performed on a sample of bachelor’s degree students at King Saud University in Riyadh, Saudi Arabia, using a self- administered online questionnaire. The questionnaire was created using Google forms and distributed through WhatsApp and other social media platforms, including Twitter and Telegram, in a snowball sampling fashion, and participants were asked to forward the questionnaire to their colleagues. A consent from the participants was obtained after reading the study’s aim. The questionnaire contained four sections and took approximately 10 min to complete. The study was ethically approved prior to conducting it by the Institutional Review Board (IRB) of King Khalid University Hospital, Riyadh (IRB number: E-20–5386).
2.2 Inclusion and exclusion criteria
The inclusion criteria for participants were Saudi bachelor’s students at KSU, ages 18–26, who were residing in Saudi Arabia during the studied period. The exclusion criteria were non-Saudi nationals, females who were pregnant, and students who were tested positive for COVID-19. Any participants who met the exclusion criteria were automatically excluded and, hence, unqualified to complete the questionnaire.
2.3 Sample size
The statistics of KSU showed that the number of bachelor students was 47,494. The acceptable margin of error was 5%, and the confidence level was 95%. Hence, the appropriate sample size was n = 382. The total number of responses to the questionnaire was 1053; after the elimination of 320 responses that met the exclusion criteria, 733 students were included in the study.
2.4 Data collection
Data were obtained using an online self-administered questionnaire-based survey derived from the three-factor eating questionnaire (Stunkard and Messick, 1985) that was generated in two languages. English and Arabic, and included 36 closed questions developed based on previous studies. The questionnaire comprised four sections. The first section included eight questions about the students’ characteristics. The second section comprised six questions about the students’ anthropometrics and weight change data. The third section comprised 18 questions about the students’ eating behavioral data. Lastly, the fourth section comprised four questions about students’ EE behavioral data.
2.5 Variables measured
General and Sociodemographic Information. These variables included age, nationality, gender, and a yes/no question for females on whether they were pregnant during the quarantine period. Other variables were affiliated with educational level, academic track, and year of study.
2.6 COVID-19-Related knowledge
This question collected information about infection by COVID-19 during the quarantine period from March 23 to June 21, 2020.
2.7 Eating behaviors and body weight information
Questions regarding the mandatory quarantine period included changes in weight (gain/loss/no change), changes in food quantity (no change/increased/decreased), following a certain diet (yes/no) and the purpose of following such a diet, changes in hunger and satiety, changes in the dietary meal routine, intake frequency of food groups, intake of food consumed to increase immunity, consumption of coffee, tea, soft drink, and amount of water intake. Some of these questions were taken from valid questionnaires—COVIDiet Questionnaire and Mediterranean diet adherence screener (MEDAS). Additionally, participants were asked about their exercise patterns and sleeping hours.
2.8 Emotional eating behavior
EE behavior questions were asked to assess the urge to eat under the influence of negative emotions, including anxiety, boring, and depression. Questions were developed based on the Three-Factor Eating Questionnaire.
2.9 Statistical analyses
Data were analyzed using SPSS version 27, and descriptive statistics were performed to accurately interpret and present the results of the students’ characteristics and responses to changes in weight and eating behaviors during the quarantine period. Chi-square test was used to investigate the association between weight changes and eating behaviors of the students. Also, Likart scale was used to interpret the attitude of the students’ responses.
3 Results
3.1 Reliability measures
Using Cronbach’s alpha test, the reliability statistics showed that the Cronbach’s alpha for the two changes in food quantity and changes in appetite items was 0.664, the 11-consumption quantity of food groups items was 0.638, the 15-consumption frequency of food and drinks items was 0.658, and the four EE items was 0.662. Here, this means that the data obtained were reasonably complete, met intended purposes, and were not subject to inappropriate alteration.
3.2 Student characteristics
A total of 733 male and female students were studied. The students’ sociodemographic characteristics (Table 1). Most of the students were in the medical track (32.7%) and Science track (29.5%). Moreover, most of the students were in the third or fourth year of study (40.8%). The students were predominantly females (78.7%), and males were about 21.3%.
Characteristic
Categories
Number of participants
n (%)
Age (years)
18–20
317
43.2%
21–23
367
50.1%
24–26
49
6.7%
Academic track
Science
216
29.5%
Medical
240
32.7%
Humanities
167
22.8%
Administrative
110
15.0%
Year of study
year 1 or 2
238
32.5%
year 3 or 4
299
40.8%
year 5 or 6
196
26.7%
Gender
male
156
21.3%
female
577
78.7%
3.3 wt change during quarantine
Of the 733 students, 587 (80%) reported weight changes during the quarantine period, and 146 (19.9%) reported no changes (p = 0.074). Among those students who reported weight changes, 315 (53.7%) gained weight, while 272 (46.3%) lost weight. Majority of the students who gained weight during quarantine gained over 1–3 kg (42.2%), followed by 29.2% who gained over 3–5 kg, (18.4%) who gained over 5 kg, and (10.2%) gained 1 kg or less. However, 38.6% of the students reported weight loss over 5 kg, 30.5% lost over 1–3 kg, 21.0% lost over 3–5 kg, and 9.9% lost 1 kg or less. The statistical analysis showed that the test used (Chi-square) for weight gain and loss was highly significant (p = < 0.001) (Table 2). *The test is considered significant if the p-value < 0.05 and Highly significant if P-value < 0.001.
Respond
Number of participants
n (%)
p-value*
Did your weight change during quarantine?
yes
587
80.1%
no
146
19.9%
Type of weight change
gain
315
53.7%
0.074
loss
272
46.3%
Weight gain
1 kg or less
32
10.2%
Over 1 kg to 3 kg
133
42.2%
Over 3 kg to 5 kg
92
29.2%
<0.001
Over 5 kg
58
18.4%
Total
315
Weight loss
1 kg or less
27
9.9%
Over 1 kg to 3 kg
83
30.5%
<0.001
Over 3 kg to 5 kg
57
21.0%
Over 5 kg
105
38.6%
Total
272
3.4 Eating behaviors during quarantine
Adherence to different types of diets during quarantine. Most of the students who did not adhere to specific diets during the quarantine period comprised 78.4% of total students. Also, there were 9.1% of the students followed a weight reduction diet, and the percentages of students who followed either intermittent fasting or a ketogenic diet were 5.9% and 1.4%, respectively. Also, 5.3% of the students reported following other types of diets, including vegetarian diet, calorie counting diet, low carbohydrate diet, and high Kcal diet. However, the goals of following the previously mentioned types of diets varied. The majority of students who were following certain types of diets to lose weight comprised 45.6% of the total students.
Changes in food quantity and appetite
Mostof the students who increased the quantity of the consumed foods were 39% of the total students, whereas 35.3% of them decreased the quantity of the foods consumed, and 25.6% of the total students did not change their food quantity. When it comes to changes in appetite, 38.5% of the total students experienced increased appetite during the quarantine period, and 29.1% experienced less appetite during the quarantine period.
Changes in meals and cooking
Regarding dietary changes in meals during the quarantine period, the attitudes of most students indicated no changes in their breakfast (54.6%) or lunch (62.8%) meals, while 15.8% and 10.6% of students canceled their dinner and snacks, respectively. Besides, approximately half of the students (52.4%) reported snacking more during quarantine. Table 3 shows the changes in meals during the quarantine. Regarding the changes in cooking frequency during the quarantine period, the majority of the students (61.2%) reported that they cooked more, and 6.68% of the students did not cook.
Meal
no change
canceled
more
Mean
SD
Attitude
Number of participants
n (%)
Number of participants
n (%)
Number of participants
n (%)
Breakfast
400
54.6%
217
29.6%
116
15.8%
1.61
0.754
No change
Lunch
460
62.8%
199
27.1%
74
10.1%
1.47
0.672
No change
Dinner
421
57.4%
116
15.8%
196
26.7%
1.69
0.865
Canceled
Snacks
271
37.0%
78
10.6%
384
52.4%
2.15
0.933
Canceled
Quantity of foods and drinks consumed
The following are the percentages of the students who changed their consumption of certain food groups. The attitude of the students’ responses showed that the quantity of vegetables, fruits, dairy products, red meat, poultry, eggs, starch, sweets, fast, and salty food consumed is as usual, with percentages of 46%, 40.2%, 53.1%, 45.3%, 57.6%, 46.4%, 48.8%, 26.9%, 24%, and 33.8%, respectively. While 49.8% of the students did not eat fish, 34.5% and 67.5% did not drink either soft or energy drinks, respectively. About half of the students reported that they consumed more sweets (45%) and coffee (47.1%) during quarantine; however, 36.6% and 16.4% of students reported that they consumed fewer fish and fast foods, respectively (Table 4).
Food item
I don't eat it
less
as usual
more
Mean
SD
Attitude
Number of participants
n (%)
Number of participants
n (%)
Number of participants
n (%)
Number of participants
n (%)
Vegetables
171
23.3%
69
9.4%
338
46.1%
155
21.1%
2.65
1.057
As usual
Fruits
168
22.9%
96
13.1%
295
40.2%
174
23.7%
2.65
1.078
As usual
Dairy products
95
13.0%
82
11.2%
389
53.1%
167
22.8%
2.86
0.916
As usual
Redmeat
171
23.3%
99
13.5%
332
45.3%
131
17.9%
2.58
1.034
As usual
Fish
365
49.8%
120
16.4%
205
28.0%
43
5.9%
1.90
1.002
less
Poultry
68
9.3%
58
7.9%
422
57.6%
185
25.2%
2.99
0.839
As usual
Eggs
88
12.0%
91
12.4%
340
46.4%
214
29.2%
2.93
0.945
As usual
Starch
26
3.5%
91
12.4%
358
48.8%
258
35.2%
3.16
0.7171
As usual
Sweets
62
8.5%
144
19.6%
197
26.9%
330
45.0%
3.08
0.990
As usual
Fast foods
79
10.8%
268
36.6%
176
24.0%
210
28.6%
2.71
0.999
As usual
Salty foods
90
12.3%
160
21.8%
248
33.8%
235
32.1%
2.86
1.005
As usual
Frequency of foods and drinks consumed
It has been found that the attitude of students is that they consumed vegetables, fruits, dairy, red meat, eggs, sweets, fast foods, salty foods, and soft drinks 1–3 times a week, with percentages of 59.3%, 62.6%, 42.2%, 55.5%, 51%, 47.7%, 46.1%, 50.9%, and 34.1%, respectively. Also, 45.4%, 61.9% 42.7%, 44.2%, and 59.8% of students consumed dairy products, starch, tea, poultry, and coffee over 4 times a week, respectively. While fish (62.6%), soft (45.2%), and energy drinks (74.9%) were not consumed a week (Table 5).
Food item
None in a week
1–3 times a week
more than 4 times a week
Mean
SD
Attitude
number of participants
n (%)
number of participants
n (%)
number of participants
n (%)
Vegetables
108
14.7%
435
59.3%
190
25.9%
2.11
0.628
1–3 times a week
Fruits
149
20.3%
459
62.6%
125
17.1%
1.97
0.611
1–3 times a week
Dairy
91
12.4%
309
42.2%
333
45.4%
2.33
0.686
1–3 times a week
Red meat
204
27.8%
407
55.5%
122
16.6%
1.89
0.658
1–3 times a week
Fish
460
62.8%
243
33.2%
30
4.1%
1.41
0.570
None in a week
Poultry
75
10.2%
334
45.6%
324
44.2%
2.34
0.655
more than 4 times a week
Eggs
116
15.8%
374
51.0%
243
33.2%
2.17
0.679
1–3 times a week
Starch
34
4.6%
245
33.4%
454
61.9%
2.57
0.581
more than 4 times a week
Sweets
85
11.6%
350
47.7%
298
40.7%
2.29
0.661
1–3 times a week
Fast food
203
27.7%
338
46.1%
192
26.2%
1.98
0.734
1–3 times a week
Salty food
156
21.3%
373
50.9%
204
27.8%
2.07
0.698
1–3 times a week
Soft drinks
331
45.2%
250
34.1%
152
20.7%
1.76
0.775
1–3 times a week
Energy drinks
549
74.9%
114
15.6%
70
9.5%
1.35
0.647
None in a week
Tea
177
24.1%
243
33.2%
313
42.7%
2.19
0.797
more than 4 times a week
Coffee
113
15.4%
182
24.8%
438
59.8%
2.44
0.746
more than 4 times a week
3.5 Lifestyle habits during quarantine
According to the results regarding sleep, the majority of the students slept 5–7 h (38.5%), whereas 7.2% only slept 5 h or less. When it comes to immunity foods/spices, (44.9%) did not ingest any products to increase immunity, (7.9%) chose honey, (6.5%) preferred lemon/orange, and (1.1%) black seeds, (0.5%) consumed ginger or anise, and (1.9%) chose garlic to increase their immunity. Water consumption during quarantine fluctuated between students, as almost half (41.6%) consumed between 1 and 1.5 L per day, 22% drank 1.6–2 L, and 10.8% consumed more than 2 L. When it comes to eating with a company, most of the students ate with their families (65.2%). Physical activity is an important variable during quarantine, as the majority (39.3%) did not exercise at all. Whereas 38.2% exercised sometimes, 22.5% said that they always exercised. Regarding snacking, 47.1% said they sometimes snacked while studying, 23.9% stated they never did, and 29.1% always did. Over half of the students stated that they always used an electronic device while snacking (59.2%). Supplementation of multivitamins was most prevalent among students, as 65.8% regularly consumed them, and 8.1% consumed vitamin C.
3.6 Emotional eating during quarantine
The attitudes of the students during quarantine showed that 37.1%, 30.3%, 30.7%, and 36.2% of the students reported that they sometimes experienced concerns over weight gain, more eating induced by anxiety, depression, and boredom. However, 43.5%, 48.7%, and 45.3% of the students did not experience changes in eating induced by concerns about weight gain, anxiety, and depression, respectively. Moreover, 38.1% of the students reported that they always ate more whenever they felt bored, 30.3% and 30.7% of the students experienced more eating induced by anxiety and depression, respectively, while 36.2% of them experienced more eating when bored (Table 6).
Emotional eating
always
sometimes
never
Mean
SD
Attitude
Number of participants
n (%)
Number of participants
n (%)
Number of participants
n (%)
Concerns of weight gain
142
19.4%
272
37.1%
319
43.5%
2.24
0.756
sometimes
More eating induced by anxiety
154
21.0%
222
30.3%
357
48.7%
2.28
0.788
sometimes
More eating induced by depression
176
24.0%
225
30.7%
332
45.3%
2.21
0.805
sometimes
More eating induced by boredom
279
38.1%
265
36.2%
189
25.8%
1.88
0.790
sometimes
3.7 Gender correlation with weight change and eating behaviors
Using the SPSS program analysis, the Chi-square test was utilized to investigate the association between gender and weight change and eating behaviors, and the association of weight changes with eating behaviors and EE. (p-value, Phi = measures the strength of association). There is a highly significant correlation between gender and weight change, and gender has a weak and moderate positive correlation with weight gain and loss, respectively (<0.001, Phi = 0.292). Moreover, females experienced weight changes more than males during quarantine.
We found a weak positive correlation between gender and lunch consumption (.001, Phi = 0.141). Most students’ lunch patterns remained the same as before quarantine. Nevertheless, females seemed to have a change in lunch more than males. Regarding the quantity of fruits consumed, there is a weak positive correlation between gender and fruit consumption ( 0.005, Phi = 0.133). Consumption of fruits remained the same as before quarantine for most students, especially females, but more students started consuming more fruits than fewer fruits.
Red meat, fish, poultry, sweets, soft drinks, energy drinks, tea quantity, and frequency of consumption have a weak positive correlation with gender—since most students, mainly females, consumed the same amount of red meat, fish, poultry, salty foods, energy drinks, and tea as before quarantine. Furthermore, females increased their consumption of sweets and soft drinks.
Starch consumption frequency has very weak positive correlation with gender (0.047, Phi = 0.091)—since most students, especially females, consumed starch more than four times/week. Water consumption had a moderate positive correlation with gender (<0.001, Phi = 0.301). females consume more water than males, and 249 females consume 1–1.5 L/day. Foods that increase immunity (such as honey, lemon, orange, ginger, etc.) have a weak positive correlation with gender (<0.001, Phi = 0.221). Even though most students did not consume these foods, females ingested them to enhance their immunity more than males. Gender also had a weak positive correlation with eating with company (0.002, Phi = 0.117). Majority of the students had their meals with their families during quarantine, and more than two-thirds of females ate with their families. In conclusion, females seem more associated with changes in weight and eating behaviors.
3.8 wt loss/gain and academic track
No significant association between weight change and academic track was found.
3.9 wt Gain/Loss and eating behaviors
Weight gain/loss and changes in meals, food quantity, and appetite. No significant association was found between changes in meals and weight. Also, there is no association between weight gain and food quantity. Moreover, there is a significant association between weight gain and loss and appetite change (0.011, Phi = 0.230), ( 0.055, Phi = 0.213) with weak correlation, respectively. Also, there is a significant association between weight loss and changes in food quantity (< 0.001, Phi = 0.328) with moderate correlation.
wt gain/loss and quantity of foods and drinks consumed
There is a significant association between weight gain and fruit, (0.027, Phi = 0.245), and eggs (0.002, Phi = 0.291) with weak correlation. And a significant association between weight gain and sweets, with a moderate correlation (0.000, Phi = 0.337). Furthermore, a significant association between weight loss and vegetables, (0.002, Phi = 0.312) eggs (0.000, Phi = 0.370), starch (0.005, Phi = 0.294), sweets (0.000, Phi = 0.382), and salty foods (0.002, Phi = 0.312) with moderate correlations. Also, a significant association between weight loss and fruit (0.005 Phi = 0.295), dairy products (0.008, Phi = 0.286), poultry (0.005, Phi = 0.295) and fast food (0.013, Phi = 0.277) with weak correlations.
wt gain/loss and frequency of foods and drinks consumed
For the frequency of food and drink consumption, weight gain was positively correlated with the consumption of red meat (0.203, Phi ≤ 0.05) and eggs (0.222,Phi ≤ 0.05), both with a weak correlation. However, weight loss was positively correlated with consumption of sweets (0.294, Phi ≤ 0.05) and salty foods (0.275, Phi ≤ 0.05), both with a weak correlation.
3.10 wt gain/loss and lifestyle habits
Regarding lifestyle habits, weight loss was positively correlated with litters of water drank per day (0.003, Phi ≤ 0.05), sedentary eating (0.011, Phi ≤ 0.05), eating in company with family (0.001, Phi ≤ 0.05), physical activity (0.007, Phi ≤ 0.05), and the consumption of supplements, such as multivitamins and vitamin C (0.008, Phi ≤ 0.05) all with a weak correlation. Furthermore, a moderate positive correlation of litters of water drank per day, weak positive correlations of sleeping hours, and physical activity with weight loss among students with values of (0.001, Phi ≤ 0.05), (0.046, Phi ≤ 0.05), and (0.010, Phi ≤ 0.05), respectively.
3.11 wt gain/loss and emotional eating
Lastly, a weak positive correlation was found between weight gain and anxiety (0.116, Phi ≤ 0.05). Also, a weak positive correlation between weight gain and feeling concerned regarding weight gain (0.021, Phi ≤ 0.05). Moreover, the statistics showed a significant association between weight gain and boredom (0.021, Phi ≤ 0 0.05). Finally, there was a strong correlation between weight loss and concerns regarding weight gain (0.296, Phi ≤ 0.05).
4 Discussion.
To the best of our knowledge, this is among the few studies conducted to determine the effects of quarantine on eating behaviors among Saudi students. Expectedly, the findings showed that the majority of students experienced weight changes. This could be because the changes that occur in daily lifestyle habits and eating behaviors are associated with quarantine. About half of the students gained weight, as has been shown in most previous studies. Particularly, females gained more weight than males, as was reported Reyes-Olavarría et al., 2020 and Kriaucioniene et al. (2020), which is similar to our results. As most of the studies discussed weight changes during quarantine, few studies showed that a few participants lost weight. Interestingly, the results of this study showed that 46.3% of the students lost weight. Moreover, most of them (78.4%) did not follow any type of diet during quarantine, unlike the Spanish population, who were likelier to adhere to the Mediterranean diet eating pattern during quarantine (Rodríguez-Pérez et al., 2020). Additionally, increased quantity of consumed food found in this study supports the findings of Pellegrini et al. (2020), Sidor and Rzymski (2020), Kriaucioniene et al. (2020), and Zachary et al. (2020), and this could lead to weight gain as long as the quantity increased is associated with poor eating behaviors and low physical activity levels. Increase in appetite among students that have been reported in this study and in Di Renzo et al. (2020a) could be a leading factor to the increment in food quantity.
Several studies worldwide have demonstrated the effect of the COVID-19 lockdown on the population’s eating behaviors. However, our findings showed that most students indicated no changes in their breakfast, lunch, or dinner and reported an increase in snacking during quarantine. Regarding the quantity of food consumed, students reported increased consumption of sweets (45%), starch (35%), salty foods (32%), fast food (32%), eggs (29%), poultry (25%), dairy products (22.8%), fruits (23.7%), and vegetables (21%). In contrast, a few students reported decreased consumption of fast food, salty, and sweet foods (36.6%), (21.8%), (19.6%), respectively. Additionally, almost half of the students reported that they did not eat fish (49.8%), vegetables (23.3%), or fruit (22.9%), and a few students reported that they did not eat starch (3%). Also, it was found that the majority of students indicated that they did not drink energy drinks (67%), and approximately half of the students (47%) tended to drink more coffee during the quarantine. Since quarantine has been responsible for eating behavior changes, our results support previous findings showing that quarantine due to the COVID-19 pandemic is associated with negative eating behaviors, such as increased snacking and consumption of fried and junk foods. However, some positive changes—such as decreased consumption of fast food, carbonated, and sugary drinks, and increased consumption of protein, fruits, and vegetable intake during quarantine—were also identified (Kriaucioniene et al., 2020, Pellegrini et al., 2020, Reyes-Olavarría et al., 2020).
In this study, 61% of the students reported that they cooked more during the quarantine. Similarly, the findings from other studies showed that the majority of sample studies tended to cook more during quarantine (Kriaucioniene et al., 2020, Sidor and Rzymski, 2020); the reason for the change in mealtime and number of meals per day during quarantine was “boredom” and “having more time to cook” (Mumena, 2020). Besides, women reported cooking more frequently than men during quarantine (Reyes-Olavarría et al., 2020). In contrast to this study’s results, Rodríguez-Pérez et al. (2020) reported that the participants increased their consumption of vegetables and fruits during quarantine, and only 28.5% did not consume fish in a week, while 56.1% had one to three servings of fish a week. In contrast, our findings showed that 62.8% of the students reported that they did not consume fish during quarantine. Also, Rodríguez-Pérez et al. (2020) reported a stronger association between males and fruit consumption, opposing our results that showed females had a stronger correlation with fruit consumption.
In contrast to earlier findings, ours showed no statistical association between changes in snack consumption and either weight gain or loss. Moreover, previous studies have shown that weight gain is related to increased food quantity (Pellegrini et al., 2020, Sidor and Rzymski, 2020). However, this study did not support these findings, as it has been shown that food quantity is associated with weight loss. Interestingly, change in appetite was associated with weight change. Similar to previous studies, which showed that there was an association between the quantity of different food groups and drinks and weight changes during quarantine (Kriaucioniene et al., 2020; Pellegrini et al., 2020). The results of this study confirm this relation, as they show a significant association between fruits, vegetables, starch, eggs, sweets, dairy products, salty, and fast food with weight changes.
Our findings suggest that there is a statistically significant association between the consumption of sweets and weight loss. On the contrary, the results by Pellegrini et al. (2020) indicated that the consumption of sweets is associated with weight gain. In addition to sweets, salty foods are also associated with weight loss. Drywień et al. (2020) observed different results, as they concluded that women who gained weight during the quarantine had a tendency to increase the consumption of salty foods.
Over half of the students (65.2%) stated that they ate with their families. Similarly, to Zachary et al. (2020) study where (59%) of the participants said they often ate with family or friends during the quarantine. Around a quarter of the participants stated that they always exercised during quarantine (22.5%). Apart from this, Di Renzo et al.’s (Di Renzo et al., 2020b) participants had a higher frequency of training during quarantine compared to the previous period, unlike Pellegrini et al. (2020), Rodríguez-Pérez et al. (2020), and Kriaucioniene et al. (2020), where 47%, 59.6%, and 60.6% of their participants stated they reduced their level of physical activity and exercise, respectively. Around 59.2% of the participants said they ate while doing some sort of sedentary activity, such as watching TV or using their phones. Similar to, Ammar et al.’s (Ammar et al., 2020) study, daily sitting time increased from 5 to 8 h per day, which may have contributed to the increased food consumption.
One of the strengths of our study were we have involved the students and one of the limitations of our study was we have recruited only from single city in the kingdom. The main limitation of this study is the limited time, as three months was insufficient to guarantee the appropriate sample and accurate results, as the number of responses was limited due to the restricted time that was given to conduct the study. Likewise, due to time constraints, we received more female respondents than males. Moreover, students’ weight during quarantine period was not taken, as it validates and strengthens the results of this study. This study also showed an association between EE and weight change. Similar to what has been found in the previous studies. Our findings showed that anxiety and boredom contributed to weight gain among students. Furthermore, regarding the feeling of concern about weight gain, 37.1% of participants reported that they sometimes eat in response to concerns of gaining weight. Also, concerns of weight gain were related to weight loss among a majority of students, with a strong association.
5 Conclusion
The findings of this study have several important implications for future practice. For example, developing intensive awareness programs to help people tackle future situations like quarantine, and how they can manage it has either positive or negative effects on health. Furthermore, this study might help the Saudi authorities to develop guidelines to direct Saudi food markets to increase advertising and promote healthy foods during situations similar to COVID-19 pandemic. Also, future studies should be conducted among the general Saudi population to reach more male participants.
Acknowledgement
This research project was supported by a grant from the “Research Center of the Female Scientific and Medical Colleges”, Deanship of Scientific Research, King Saud University.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References
- Prevalence and Predictors of Emotional Eating among Healthy Young Saudi Women during the COVID-19 Pandemic. Nutrients. 2020;12:2923.
- [Google Scholar]
- Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19 international online survey. Nutrients. 2020;12:1583.
- [Google Scholar]
- B.I.N. Zarah A., ENRIQUEZ-MARULANDA, J. & ANDRADE, J. M. Relationship between Dietary Habits, Food Attitudes and Food Security Status among Adults Living within the United States Three Months Post-Mandated Quarantine: A Cross-Sectional Study Nutrients 12 2020 3468
- Psychological aspects and eating habits during COVID-19 home confinement: results of EHLC-COVID-19 Italian online survey. Nutrients. 2020;12:2152.
- [Google Scholar]
- Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. Journal of translational medicine. 2020;18:1-15.
- [Google Scholar]
- The COVID-19 Pandemic Lockdowns and Changes in Body Weight among Polish Women. A Cross-Sectional Online Survey PLifeCOVID-19 Study. Sustainability. 2020;12:7768.
- [Google Scholar]
- The impact of isolation measures due to COVID-19 on energy intake and physical activity levels in Australian university students. Nutrients. 2020;12(6):1865.
- [CrossRef] [Google Scholar]
- Emotion and eating in obesity: A review of the literature. Int. J. Eat. Disord.. 1989;8:343-361.
- [Google Scholar]
- C. Haddad M. Zakhour R. Haddad AL HACHACH, M., SACRE, H. & SALAMEH, P. Association between eating behavior and quarantine/confinement stressors during the coronavirus disease 2019 outbreak Journal of eating disorders 8 2020 1 12
- Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown. Front. Psychol.. 2020;11:2328.
- [Google Scholar]
- Associations between changes in health behaviours and body weight during the COVID-19 quarantine in Lithuania: the Lithuanian COVIDiet Study. Nutrients. 2020;12(10):3119.
- [CrossRef] [Google Scholar]
- Characteristics of eating in anger, fear, sadness and joy. Appetite. 1999;33:129-139.
- [Google Scholar]
- MINISTRY OF HEALTH. (2020 2020 M. M. C R. N. FROM HTTPS://WWW.MOH.GOV.SA/EN/MINISTRY/MEDIACENTER/NEWS/PAGES/NEWS-2020-03-02-002.ASPX
- Impact of COVID-19 curfew on eating habits, food Intake, and weight According to food security status in Saudi arabia: a retrospective study. Progress Nutr. 2020;22
- [Google Scholar]
- ORGANIZATION, W. H. 2020. WHO announces COVID-19 outbreak a pandemic. Retrieved November 17, 2020. https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-.
- Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency. Nutrients. 2020;12(7):2016.
- [CrossRef] [Google Scholar]
- Positive and negative changes in food habits, physical activity patterns, and weight status during COVID-19 confinement: associated factors in the Chilean population. Int. J. Environ. Res. Public Health. 2020;17:5431.
- [Google Scholar]
- Changes in dietary behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study. Nutrients. 2020;12:1730.
- [Google Scholar]
- Dietary choices and habits during COVID-19 lockdown: experience from Poland. Nutrients. 2020;12(6):1657.
- [CrossRef] [Google Scholar]
- The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J. Psychosom. Res.. 1985;29:71-83.
- [Google Scholar]
- WORLD HEALTH ORGANIZATION. (2020, N. C. D. C.-R. N., 2020, FROM HTTPS://WWW.WHO.INT/EMERGENCIES/DISEASES/NOVEL-CORONAVIRUS-2019.
- Self-quarantine and weight gain related risk factors during the COVID-19 pandemic. Obesity research & clinical practice. 2020;14:210-216.
- [Google Scholar]
