The COVID-19 pandemic led to a nationwide lockdown in Italy from March 11th to May 18th, 2020, significantly impacting various aspects of life, including healthcare access. This study aimed to assess the effects of this lockdown on patients with obesity (PWO), whose follow-up appointments were postponed. Obesity is associated with increased severity and worse prognosis of COVID-19, making its management crucial. Lockdown measures, such as social distancing and home confinement, caused widespread lifestyle changes, including reduced physical activity (PA) and increased time spent at home. This, combined with potential job losses and financial insecurity, could lead to increased stress and psychological distress. These factors, along with increased food availability at home and potential changes in eating habits, could negatively affect weight management in PWO. The study hypothesized that the lockdown negatively affected weight control in Italian PWO followed up at Obesity Centers (OCs) within the Italian Association of Dietetics and Clinical Nutrition (ADI) network. The objectives were to identify changes in weight and weight-related lifestyles during the lockdown; assess the mental and physical well-being of PWO during the lockdown; identify determinants of weight changes, lifestyle modifications, and psychological distress; and assess the impact of maintaining communication with clinicians during the lockdown using telemedicine.

Existing literature highlighted the association between obesity and increased COVID-19 severity, emphasizing the importance of continuous obesity management. Studies have shown that lockdown restrictions and social isolation have led to changes in lifestyle, including decreased PA and increased stress, often leading to increased food consumption and weight gain in individuals with obesity. The lack of access to routine medical care during the lockdown raised concerns regarding the potential negative impact on the management of chronic diseases like obesity. Previous research has shown that changes in diet and physical activity are associated with weight fluctuations and that psychological factors, such as stress and emotional eating, play a significant role in weight management in individuals with obesity. However, the combined effect of these factors during a nationwide lockdown on PWO had not been comprehensively studied in Italy.

A multicenter prospective survey was conducted involving 26 Obesity Centers (OCs) within the ADI network. A structured 77-item questionnaire was administered to PWO via phone calls or online between May 2nd and June 25th, 2020. The questionnaire covered demographics, employment status, dietary habits, physical activity, psychological aspects (emotional difficulties, sleep quality, body dissatisfaction), and use of telemedicine. Participants were asked to report their weight before and after the lockdown. Data analysis involved multiple correspondence analysis (MCA) to reduce the dimensionality of categorical data and identify clusters based on lifestyle changes and psychological factors, as well as multiple linear regression to assess the relationship between weight changes and potential determinants. Data on age, sex, anthropometric data, education level, employment status, lifestyle changes, psychological status, and telemedicine use were collected and analyzed. MCA was used to identify clusters of participants with similar profiles, and multiple linear regression was used to investigate the association between weight changes and potential determinants, including work status, psychological factors, physical activity, and contact with OCs during the lockdown. Regions were categorized into low, medium, and high COVID-19 incidence areas based on cumulative standardized daily incidence at the end of June 2020.

A total of 1232 PWO completed the questionnaires (72% female, mean age 50.2 ± 14.2 years, mean BMI 34.7 ± 7.6 kg/m²). During the lockdown, 48.8% gained weight (+4.0 ± 2.4 kg on average), 27.1% lost weight, and 24.1% maintained their weight. Approximately 37% experienced increased emotional difficulties, mostly fear and dissatisfaction. 61% reduced their physical activity, and 55% experienced a change in sleep quality/quantity. Lack of online contact with the OC during lockdown strongly correlated with weight gain (p < 0.001). MCA identified two clusters: Cluster 1 (unchanged or improved lifestyles) and Cluster 2 (worsened lifestyles). Cluster 2 included unemployed individuals experiencing depression, boredom, dissatisfaction, increased food contemplation, and weight gain. Homemakers reported weight gain and anger due to confinement. Multiple linear regression showed that decreased psychophysical well-being, increased food contemplation, and lack of contact with OCs were associated with weight gain, while increased physical activity was associated with weight loss. Age and sex were not significant predictors of weight change. The majority (62.5%) of PWO maintained contact with their healthcare consultant through various telemedicine methods. Those who gained weight were more likely to consider the use of obesity medications (68.4%).

This study provides valuable insights into the significant impact of the COVID-19 lockdown on the weight and well-being of PWO in Italy. The findings highlight the importance of work status, psychological factors, and access to remote healthcare services in influencing weight management during periods of social and economic disruption. The strong correlation between lack of contact with OCs and weight gain underscores the crucial role of continuous monitoring and support for PWO, particularly during crises. The identification of two distinct clusters emphasizes the heterogeneity of experiences and responses to lockdown among PWO, with certain groups being more vulnerable to negative weight-related consequences. The results reinforce the importance of considering both psychological and social factors, in addition to physiological factors, when developing and implementing interventions for weight management. The study’s findings support the implementation of telemedicine services to ensure continuous care for PWO during times of restricted access to in-person appointments. This could be especially crucial for vulnerable populations.

This study demonstrates the considerable impact of the COVID-19 lockdown on the weight and well-being of PWO in Italy, emphasizing the importance of work status, psychological factors, and access to remote healthcare in influencing weight management during crises. The findings highlight the need for proactive strategies to maintain contact with PWO through telemedicine and provide targeted support for vulnerable groups. Further research could explore the long-term effects of lockdown on PWO and the efficacy of various telehealth interventions in supporting weight management.

The study's limitations include the potential sampling bias due to a 46% non-response rate, which may limit the generalizability of the findings. The cross-sectional nature of the data limits causal inferences. The lack of a control group of PWO not affected by lockdown restrictions prevents direct comparison. The reliance on self-reported data may introduce recall bias, particularly regarding weight and lifestyle changes. The study did not adjust for the timing of interviews, which may have decreased the effect size observed.