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Americans gained weight after being told to stay out of public places during the COVID-19 pandemic, according to a small longitudinal cohort study.

Once the stay-at-home orders were issued, study participants across the country experienced steady weight gain at a rate of 0.27 kg every 10 days (95% CI 0.17-0.38 kg, P<0.001), regardless of their geographic location or any comorbidities, reported Gregory Marcus, MD, of the University of California San Francisco, and colleagues.

That translates to approximately 1.5 lbs of added weight every month. "Although this may not appear clinically important, prolonged effects as have occurred with the pandemic might lead to substantial weight gain," they wrote in .

"It is important to recognize the unintended health consequences SIP [shelter-in-place] can have on a population level," they added. "The detrimental health outcomes suggested by these data demonstrate a need to identify concurrent strategies to mitigate weight gain, such as encouraging healthy diets and exploring ways to enhance physical activity, as local governments consider new constraints in response to SARS-CoV-2 and potential future pandemics."

During the initial surge of COVID-19 cases in the U.S., 45 state governments issued shelter-in-place orders in March and April 2020 to slow transmission of the disease. Previous research showed that these orders coincided with a decrease in daily step counts, likely due to changes in physical activity and patterns of daily living, the study authors said.

The stay-at-home orders were also associated with self-reported increases in snacking and overeating. "We therefore sought to investigate ambulatory weight changes of a longitudinal cohort during initial SIP orders to better understand the possible downstream health implications of prolonged SIP," Marcus and colleagues wrote.

The study included 269 participants from the who volunteered to report weight measurements from their Bluetooth-connected Fitbit or iHealth smart scale. Participants resided in 37 U.S. states and the District of Columbia. Approximately half were men (48%), three-quarters were white (77%), and their mean age was 52.

Overall, the researchers analyzed 7,444 separate weight measurements, a mean of 28 measurements per study participant from Feb. 1 to June 1, 2020. They analyzed weight change before and after SIP orders via a linear mixed-effects model with a spline point at the day orders were issued for each state.

Marcus said the weight gain problem may persist even after shelter-in-place restrictions have been lifted. "Our study wasn't equipped to determine the specific reasons why individuals experienced weight gain during shelter-in-place, but it's reasonable to assume much of it was related to lack of physical activity plus possibly more constant accessibility to food while working from home," he wrote in an email to 乌鸦传媒.

"It seems very likely that working remotely from home will become a new norm even when the pandemic is behind us," he continued, "suggesting ongoing efforts to mitigate against work-from-home-related adverse health effects are warranted. We don't realize how much exercise we get simply walking up the stairs to a meeting instead of clicking on the next Zoom link or walking across the street to grab some coffee instead of down the hall to our kitchen."

Marcus suggested a few ways to combat the problem. "I regularly encourage my patients to consider how to incorporate physical activity into their daily routine in hopes of forming a habit, rather than viewing it as some special arduous event -- ideally it's woven into the day like brushing your teeth. It can help to think about actually blocking out time on your calendar and treating that time to exercise like an appointment you can't miss."

Identifying types of physical activity that are feasible and enjoyable also helps, he noted. When you can't go to the gym, a long walk, bike ride, or home workout are all good options. "The idea of 'temptation bundling' can help as an incentive to exercise, such as looking forward to streaming a show or movie on your phone while on the exercise bike or listening to music or a good podcast while doing push-ups or [going] out for a run," he advised.

Lauri Wright, PhD, director of the clinical nutrition program at the University of North Florida in Jacksonville, who was not involved in the study, suggested ways to curb excess eating. "Try to get in touch with your internal cues; are you really hungry or are you eating out of boredom or stress? If it is stress, try some meditation or breathing exercises before you eat that donut. If it is boredom, FaceTime a friend or find a new hobby," she wrote in an email to 乌鸦传媒.

An important limitation to the study was that it only included individuals who owned a Bluetooth-connected scale, noted the researchers. "Although idiosyncratic characteristics of those who happen to own a Bluetooth-connected scale may limit the study's generalizability, following individuals over time to assess their objectively measured weight changes during SIP diminishes threats to internal validity," they wrote.

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