HOW THE IMPACT OF COVID-19 HOME STAY ORDERS IS AFFECTING THE PHYSICAL, MENTAL AND FINANCIAL HEALTH AMONG OBESE PATIENTS?
Conditions: Obesity, Morbid
Sponsor: University of Foggia

 
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TITLE: 
HOW THE IMPACT OF COVID-19 HOME STAY 
ORDERS IS AFFECTING THE PHYSICAL, 
MENTAL AND FINANCIAL HEALTH AMONG 
OBESE PATIENTS? 
 
RUNNING HEADS: 
Stay-at-home orders for obese patients 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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ABSTRACT 
 
BACKGROUND: Stay-at-home orders in response to the Coronavirus 2 (SARSCoV-2) have forced 
abrupt changes to daily routines.  
The aim of our study is to evaluate the impact of the Stay-at-home orders on the waiting list for 
bariatric surgery in our Department of Medical and Surgical during covid-19 pandemic. 
MATERIALS AND METHODS: In this observational retrospective study, from  the  9th of March  to 
18th  May 2020, the patients of our Department were invited to answer to a 14-questions multiple-
choice questionnaire relative to weight changes, working activity, daily exercise, dietary behaviors, 
and conditions potentially impacting the nutritional choices  
RESULTS: In total, 52 patients completed the questionnaire (86,7%). 58% of patients stated that 
the pandemic negatively affected their mood, 60% of patients confirmed that they changed their 
dietary behaviors during the stay-at-home period, as they consumed more junk food or spent 
longer time to cook. 
71% of patients stated  that the closure of the gyms influenced the worsening of their obesity 
condition and their mental well-being with an increase of a state of anxiety, so telematic support 
from the psychologist and nutritionist would have been helpful.  
CONCLUSIONS: Results showed that the COVID-19 pandemic have had  a significant impact on 
health behaviors, including quality of life, mental health physical activity, weight maintenance, and 
consumption of sweets in obese  patients.  
 
 
 
Key words: SARSCoV-2, obesity, sleeve gastrectomy, lock-down, bariatric surgery, pandemic. 

 
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INTRODUCTION 
The severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) causes the coronavirus disease-
19 (COVID-19) [1-4]. According to the WHO, this virus has been declared pandemic, and to date 
(7th August 2021), a total of 18,902,735 diagnosed cases and 709,511 deaths have been confirmed 
[5,6]. 
However, what is not known is how the COVID-19 social orders such as self-quarantine,lockdown 
and/or mandatory stay-at-home orders are impacting of the are impacting mental andfinancial 
health, in addition to physical health, in vulnerable populations, such as those withobesity. The 
stay-at-home orders forced the cancellation of elective surgeries, includingmetabolic and bariatric 
surgery (MBS), and nothing is known about how this has impacted.  
Stay-at-home orders have curbed the spread of the virus, [7,8] yet the results of these 
unprecedentedgovernment mandates on other indices of health cannot be overlooked. 
Temporary closure to places of employment, restaurants, fitness facilities, and other public places 
forces abrupt changes to habitual dietary and physical activity patterns. Furthermore, social 
isolation has deleterious impacts on mental wellness [9]. Stress is associated with sleep disruption, 
consumption of highly palatable foods, and increased snacking, often resulting in weight gain [10]. 
Non-scientific reports have begun to illustrate the impacts of weight gain throughout the 
pandemic[11-13]. The COVID-19 pandemic therefore has the potential to also threaten non-
communicable diseases such as obesity. 
The aim of our study is to evaluate the impact of the Lockdown period on the mental and physical 
health of obese patients on the waiting list for bariatric surgeryin our Department of Medical and 
Surgical Sciences during covid-19 pandemic. 
 
 

 
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MATERIALS AND METHODS 
An online survey format was administered to all obese patients on the waiting list for bariatric 
surgery in our Department of Medical and Surgical Sciences to obtain information about the 
COVID- 19 pandemic’s impact on patients with obesity starting March 09, 2020 until May 18, 2020. 
Our Health System Institutional Review Board approved the study. Patients were asked to respond 
to 14questions about their experiences during lock-down period during the COVID-19 pandemic as 
it pertains to their health and lifestyle behaviors. Those that agreed to participate signed an online 
consent and authorized researchers to contact them for follow up information. 
 
RESULTS 
52 patients on the waiting list for bariatric surgery in our Department of Medical and Surgical 
Sciences completed the questionnaire (86,7%).   
33% of patients are aged between 31 and 40 years, 25% between 21-30 and 41-50 years, 17% 
between 51-60 years. 
58% of patients stated that the pandemic negatively affected their mood, 60% of patients 
confirmed that they changed their dietary behaviors during the stay-at-home period, as they 
consumed more junk food or spent longer time to cook. Half of the patients said they spent more 
time in the kitchen at the stove (Figure 1, 2, 3). 
 
 
 
 
 
 
 

 
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Figure 1  
 
 
 
 
Figure 2 
 
 
 
Figure 3 
 
 
71% of patients stated  that the closure of the gyms influenced the worsening of their obesity 
condition and their mental well-being with an increase of a state of anxiety, so telematic support 
from the psychologist and nutritionist would have been helpful (Figure 4, 5). 
 
Figure 4 
 
 
 
 
Figure 5 
 
 
 
 
Only 6% of patients on the waiting list contracted the Sars-CoV 2 virus and none of those required 
hospitalization.  
58% 
42% 
Has the obligation to stay at home due to 
the pandemic affected your mood in a 
negative way? 
yes
no
60% 
40% 
Has the obligation to stay indoors due to the 
pandemic affected your eating habits? 
yes
no
63% 
37% 
During the lockdown in the spring, spending 
all day indoors was prone to take in more 
junk food? 
yes
no
71% 
29% 
Do you think that the ban on playing sports 
outdoors and in company and the closure of 
gyms has worsened your obesity condition? 
yes
no
56% 
44% 
Would it have been helpful to have online 
interviews with the team psychologist and 
nutritionist? 
yes
no

 
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During the lock-down period, 100% of patients were still convinced that they wanted to undergo 
bariatric surgery. 
 
DISCUSSION 
Sars-CoV2 infection had a major impact on obese patients, as the requirement to stay home 
during the lockdown period had severe effects on health behaviors and well-being for our sample 
of patients with obesity[14-17]. The results here showed that COVID-19 is having a substantial 
impact on the health of patients with obesity regardless of infection status. 
Most of the obese patients on the waiting list have experienced weight gain, due to a worsening of 
mood, change in eating habits with an increased intake of junk food. 
Telemedicine has been demonstrated, according to two comprehensive review, to be non-inferior 
to in-person treatment programs, as measured by weight loss, with high rates of patients 
satisfaction [18-20]. While less has been published about the use of telemedicine to treat obesity 
in adults, it has been suggested as a novel and powerful way to deliver comprehensive patient 
centered care, and as a tool to increase access to bariatric surgery, where less than 1% of eligible 
patients undergo this procedure, and half of those who initiate a treatment program drop out. 
These observations point to the critical need for implementation of preventive measure during 
periods of lockdown, particularly when their duration is uncertain[21-23]. Such measures might 
include implementation of telemedicine lifestyle programs, practitioners of medicine can offer 
supplemental guidance encouraging families to maintain healthy lifestyle choices, and facilities can 
be designed for implementing exercise programs that minimize viral transmission[24-26]. 
While our report sheds light on how pandemic-related restrictions affect health habits and weight, 
and what can be done about it, there are limitations that need to be considered. Our cross-
sectional study is based on the survey results and, therefore, provided that the data are not 

 
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verifiable and should be treated as estimates. Self-reported responses can be influenced by 
various biases. 
Taken together, these limitations suggest the need for further study, which is feasible, given that 
at the time of writing, the restrictions remain in place in many countries around the world. 
 
CONCLUSIONS 
Results showed that the COVID-19 pandemic have had  a significant impact on health behaviors, 
including quality of life, mental health physical activity, weight maintenance, and consumption of 
sweets in obese  patients. This highlights how the pandemic has changed health habits, and in 
particular, the disproportionate levels of anxiety and weight gain in those who are already 
obese. Authorities should consider that blocking bariatric surgery may have been negatively 
affected psycho-physical well-being of obese patients. Further larger studies of this topic are 
needed to confirm these preliminary results obtained in a limited number of patients. 
 
 
 
 
 
 
 
 
 
 
 

 
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