Encyclopedia
Please note this is a comparison between Version 1 by Noor Ismail and Version 2 by Conner Chen.
The Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome which is caused by the novel coronavirus SARS-CoV-2. Many governments around the world implemented a ‘lockdown’ strategy to manage and attempt to lower the number of new COVID-19 infections. There was a blanket prohibition on all mass gatherings, regardless of their nature. Numerous other restrictions were also imposed, including but not limited to the closure of public spaces such as restaurants, playgrounds and parks, and shopping centers, as well as an implementation of distance learning, mandatory quarantine for travelers entering the country, and limitations on the number of people that were allowed to go out from each household.
- COVID-19
- lockdown
- dietary behavior
1. Dietary Behavior
The sudden implementation of strict lockdown measures has caused a massive change in the lifestyles and the living environment of people around the world. Normal movement was restricted; people were asked to reduce social contacts and were required to quarantine in their own homes as a way to reduce the spread of COVID-19. This has led to a reduction in the purchase of fresh groceries such as fruits and vegetables as well as an uptick in the purchase of non-perishable goods such as canned foods [1][7]. For a large part, this was caused by the panic buying and stockpiling [2][8] among consumers especially after the restriction announcement. This accumulated to a snowball effect of less fresh food consumption, shifting the pattern of expenditure to food that would last longer—e.g.: pasta, canned tuna and dry soups among others [3][9]. The prolonged consumption of preserved and canned food over fresh food may lead to weight gain as well as an increased chance of contracting chronic non-communicable diseases [4][10] such as heart disease and diabetes. These possible secondary effects of the pandemic will only be noticeable many years from now; an outcome that could perhaps be avoided with an increased consumption of fruits and vegetables, which has been linked to a reduced risk of chronic diseases [5][6][11,12]. This is of particular significance especially in the time of the COVID-19 pandemic, as nutrition plays a vital part in modulating the body’s immune system—a response that is compromised in people suffering from long-term chronic diseases [7][13], which may lead to increased mortality.
The upsurge in the purchase of less fresh food could also be attributed to food insecurity and the instability of food supply chains [3][9] throughout the COVID-19 pandemic. As the virus ravaged communities, many governments implemented lockdown measures of varying degrees. Unfortunately, this meant that many food-processing plants and labor-intensive businesses were forced to close [8][14] with only essential businesses such as grocery stores and hospitals being allowed to open. This has interrupted the food supply chain, leading to disruptions that ranged from minor inconveniences to the formation of bottlenecks in supply chains [9][15]. Farmers and food producers that were reliant on exports, especially those dealing with perishable and specialty foods, suffered when border closures and travel restrictions were announced, with many incurring devastating losses [10][16]. In the earlier phases of the pandemic, some countries in their efforts to maintain the continuity of their resources and ensure food safety for their own population, imposed restrictions on imports of staple foods such as wheat. The reduction in the supply of these products, which remained to be in a sustained demand, directly influenced the prices to be constantly high [11][12][17,18]. This essentially restricted access to certain demographics of the population, further exacerbating food insecurity to further increase consumption of canned and preserved food as well as a reduction in fresh food intake [13][19].
However, some communities experienced an opposite trend, especially among food-secure households and high-income countries, in which a rise in consumption of fresh food was observed due to the sudden boom in home food procurement (HFP) activities. These HFP activities include pursuits that range from home gardens and foraging in the wild to fishing and hunting [14][20]. For some, home gardens are a way to reduce the stress and anxiety [15][21] that they faced during lockdowns but to others, home gardens were an essential financial need to reduce costs of grocery shopping [16][22], particularly in lower-income households. Besides that, people who engaged in home gardens and community gardens were more inclined to incorporate fresh produce into their daily diets [17][23] and be aware of the nutritional content of their food and were thus more inclined to make permanent positive changes to their lifestyles and diets [18][24]. In the long run, this will translate into a reduced risk of chronic diseases. In terms of the food supply chain, initiatives such as this may help to reduce food insecurity and provide an alternative to demographics that would otherwise not be able to access healthy food options due to geographical as well as financial limitations [19][25].
Another aspect in which restriction measures affected dietary behavior is via alcohol consumption. Some nations such as Germany, the United Kingdom and the United States of America reported an increase of 3% to 5% in alcohol consumption in 2020 compared to the previous year [20][26]. Lockdowns and restrictions enforced on social activities may have caused the sales of alcohol in bars and similar establishments to decrease sharply. However, it may have also caused people to shift their consumption of alcohol in the comfort of their homes. Online platforms such as Minibar and Drizzly in the United States observed an increase of sales—which soared past projected expectations during the pandemic [21][27]—as customers inclined to purchase bigger servings of alcoholic beverages [22][28]. The increase in alcohol consumption could, to some extent, be influenced by the increased psychological distress experienced by people during lockdown periods or ‘Shelter-In-Place’ orders. Stress has been shown to be a factor for chronic alcohol use and dependency. Prolonged alcohol use has the potential to permanently alter reward and stress pathways in our neural circuitry [23][29], resulting from the dysfunction of the hypothalamic–pituitary axis causing excessive stimulation, which affects emotional modulation. Such adaptations are far from healthy and may encourage alcohol consumption in response to stressful situations, leading to alcohol dependency and addiction. On the other end of the spectrum, during the short-term period following the implementation of restriction measures, alcohol use may be reduced among certain subsets of the population. The closure of establishments that traditionally sold these beverages such as bars, pubs and liquor stores may have contributed to this trend. This effect would mainly affect younger adults who live in college accommodation as their main avenue of consumption was bars or restaurants [24][30]. Abrupt closures would have meant that they had no alternative way to consume alcohol.
2. Food Options and Food Delivery Usage
Even before the COVID-19 pandemic and its accompanying restriction measures, food delivery apps were experiencing a rapid growth in the last decade—as a part of a trend that demonstrated customers’ shift to e-commerce and other similar means of commerce. This was caused by the interaction of various factors such as an increase in income and access to the Internet, safe e-payment alternatives, longer commuting and waiting times for eating outside as well as a better grasp on the mechanics of e-commerce [25][58]. Restriction and lockdown measures were merely an accelerant to this pattern of obtaining food. Generally, food delivery apps (FDA) can be classified into two main categories—Restaurant-to-Consumer and Platform-to-Consumer delivery [25][58]. For the former, the restaurant itself will receive orders and dispatch delivery riders to fulfill their orders. Thus, third parties are, more often than not, not included in this business model. Some of the more well-known franchises that currently adopt this model include McDonald’s™, KFC™, and Domino’s Pizza™—each with its own delivery applications. The second business model would be the platform-to-consumer delivery model, which the majority of food delivery apps utilize [25][58]. This is where restaurants and small businesses advertise their food products on platforms that will then employ drivers or ‘riders’ to deliver their orders. Examples of these platforms include GrabFood™ in Southeast Asia, Swiggy™ and Zomato™ in India, Just Eat™ and Deliveroo™ in the United Kingdom as well as Grubhub™, Doordash™, and Uber Eats™ in the United States.
In the early phases of the COVID-19 pandemic, restriction measures were implemented to actively discourage people congregating in places that lacked proper ventilation and crowded facilities such as supermarkets, for the purpose of breaking the COVID-19 transmission chain. This, coupled with the fact that the virus was far more dangerous than existing respiratory infections, motivated many people to comply with stay-home orders. Although beneficial in reducing infections, it changed the daily routine of many sections of the community. With the suspension of commuting to work and the implementation of work from home (WFH), many people found themselves reverting to food and grocery delivery to avoid contracting or spreading the disease [26][59]. This directly created a shift in the demand for store-to-door delivery services that propelled the sudden growth of FDAs. The reasoning behind the swift change of this new food obtaining pattern was twofold—people were prepared to pay higher amounts of money, which included delivery fees and tax for the ease and comfort that was afforded by FDAs, while drivers and independent contractors were motivated to work for less as unemployment rates shot up [26][59].
Many also looked to break the monotony of staying at home by ordering food from various cuisines. Because dining out was not an option due to restrictions on social activities, FDAs provided the next best alternative—delivery to the doorstep of their house. This not only provided ease and comfort but also the reassurance of the hygiene and sanitary standards of the food prepared as well as the environment it was prepared in [27][60]. FDA owners realized the importance of this reassurance in driving up sales and began implementing changes such as contactless delivery and body temperature checks at every stage of preparation and delivery. An example of this would be McDonald’s™ Malaysia’s practice of sealing each delivery bag with a sticker stating the temperature of their workers who handled the foods, which included their delivery riders [28][61]. Other more locally well-known platforms such as Foodpanda™ and Grab™ in Malaysia started offering contactless delivery that was enhanced with the introduction of payment methods besides the traditional cash-on-delivery (COD).
However, the ease and convenience of FDAs bring with it a whole set of problems and future complications. Eating out, or in this case, ordering in, has been positively associated with a higher BMI [29][62]. A survey of over 2900 consumers in the United States showed that in the past 90 days [30][63], 41% of their respondents reported having used a platform-to-consumer-based FDA. Of those who had used FDAs, 52% reported ordering food upwards of three times. Although some may argue that FDAs have created an avenue for the consumption of healthier and more nutritious food, most of the existing research says otherwise. One study showed that food that did not meet the Five Food Groups (FFG) requirement was more than two times more likely to be marketed as more popular than its counterparts [31][64]. Similarly, non-FFG compliant food was almost seven times more likely to be marketed as a package, which influenced people to consume more. It follows the marketing psychology of a supermarket [32][65] displaying the more expensive items at eye level to sway customer consumption in their favor. From a nutritional standpoint, non-FFG food is calorie-dense and high in salt, sugar or oil, as well as low in fiber. This poses a threat to public general health, especially in the time of the COVID-19 pandemic, as sustained consumption of such classes of food will only serve to exacerbate the existing obesity epidemic in the long run. In the more immediate time frame, poor nutrition has been linked to increased mortality and increased ICU admissions when infected with SARS-CoV-2 [33][39].
3. Physical Activity and Sedentary Behaviors
The spread of the COVID-19 virus with its current state of transmission has urged public health to heavily depend on social and behavioral change strategies beyond strict hygienic rules. Some of the strategies include isolation, social distancing and quarantine, as per World Health Organization recommendations [34][66]. The success of these strategies occurs with the rapid shifting to lifestyle changes such as work from home (WFH) that has increased steeply and persistently for offices and corporates after the outbreak. These measures have limited the amount of physical activity, as it is fair to assume that WFH implementations will result in an expected reduction of transportation activities. Besides having to deal with work activities infiltrating the comfort of our homes, sports and fitness clubs are also closed—ideally to fulfill the social distancing strategy, hence this potentially reduces the level of physical activity.
Decreased level of physical activity is also attributed to increased sedentary behaviors during the lockdown pertaining to working from home [35][67]. Sedentary behaviors are any behaviors when awake with an energy expenditure ≤1.5 of the metabolic equivalent (METs) in a sitting or lying posture [35][67]. These two entities are entirely independent because an individual may be highly sedentary due to their work requiring a large amount of focus on the computer hence high sitting time, but they may or not be a physically active individual; it depends on whether they meet their physical activity recommendations based on their age outside of work [36][68]. The World Health Organization (WHO) outlined that adults aged 18–64 years are recommended to perform at least 150 min of moderate-intensity, 75 min of vigorous-intensity physical activity, or a balanced combination of moderate-to-vigorous physical activity (MVPA) per week as regular physical activity is proven to prevent non-communicable diseases such as diabetes in addition to improving mental well-being. Any energy expenditure lower than the recommendations would define an individual as inactive, hence the synergistic effect of a sedentary lifestyle and being physically inactive can potentially increase the mortality rate. Staying at home due to COVID-19 is a sedentary measure that reduces physical activity. There is evidence reporting an overall negative change in physical activity among adults during the ongoing COVID-19 outbreak with an excess of leisure time activities in the lockdown environment [37][69]. The active promotion of online activities adhering to rapid lifestyle shift as a COVID-19 preventive measure have also been linked to an expected high prevalence rate of physical inactivity from certain subgroups in the population, such as students who are highly prone to screen exposure that would be enough to postulate extended periods of insufficient physical activity participation turning into sedentary behaviors [38][70].
Physical and social environmental factors influencing physical activity participation are based on availability, utilization and ease of access. It is important to note that the level of physical activity ultimately depends on every individual’s initiative. The plausible reasons are due to the unavailability to exercise with friends and lack of interest to continuously participate in physical activities due to the obvious loss of the competitive element during exercising from the lifestyle shift [39][71]. Despite the dramatic reduction of physical activity from the closure of educational institutions, there are populations of Malaysian university students who are notably more physically active during the lockdown period, demonstrating better engagement in physical activity, even though current findings showed less compliance to WHO recommendations [40][72]. The social ecological framework shapes physical activity behaviors and a simple socioeconomic background such as rural or urban living of an individual can be a causal factor associated with physical inactivity and sedentary behaviors, especially in this drastic era of lifestyle changes due to the COVID-19 outbreak [41][73].
4. Effects of Restrictive Measures towards Dietary Habits and Physical Activity
Plenty of research has been conducted since the COVID-19 pandemic began, particularly on dietary and eating habit changes. Based on an online cross-sectional questionnaire survey conducted at one time point in November 2020 when the Japanese government issued stay-at-home requests, only 8.2% adults out of the 6000 respondents experienced an unhealthier change from their initial dietary habits as they live alone with higher stress levels from the lack of social support, while 71.6% reported unchanged diets [42][74]. The unchanged dietary habit was also noted from 34 provinces across China with 71.4% of the participants noting no changes in their appetite [43][75]. Interestingly, data from Spain showed a high cohesion to the healthy Mediterranean diet with 63.7% declared having not eaten more during the first 3 weeks of confinement period [44][76]. Unlike Spain, Greece had a lower MedDiet score as they adhere less to the diet, showed a greater weight gain and the participants binge ate more between meals [45][77]. As all of the aforementioned countries have different geopolitical and economical statuses that create their own respective impact on dietary and eating habits during COVID-19 pandemic implemented restrictions, the similarity that unites the studies regardless of the participants’ sociodemographic profiles was the reduced level of physical activity. Despite the large portion of participants reporting no changes in dietary habits, adults in China did not perform moderate-intensity (40%) and vigorous-intensity (55%) physical activities [43][75]. A study among young adults in Spain, which objectively measured and compared the physical activity before and during lockdown period using the mean steps taken per day, had shown a significant decrease of 67.7% during the lockdown period [46][78]. Data from Greece similarly showed an apparent increase in inactivity by 40.6% with a dramatic decrease of 84.7% in competition sports held during the lockdown period [39][71]. Japan, which had an initial relatively low infection rate and non-instituted lockdown, still exhibited a decrease in overall step count with a 15% reduction over 24 days, from the data obtained on smartphone algorithms [37][69]. To date, different instrumentations have been used to study the effect of COVID-19 restrictive measures on both physical activity levels and dietary behaviors while taking into account other possible individualistic factors, but the immediate impact observed worldwide is the reduction in physical activity. As dietary behaviors differ with different populations, restrictive measures have impacted our lifestyle completely by reducing as many movements as possible, including through converting homes to workplace settings that directly contribute to an instant decrease in physical activity.
