Blaming the COVID-19 Pandemic for Weight Gain – Diabetes In Control

The current COVID-19 Pandemic may be to blame for weight gain in patients at a higher risk of developing diabetes.

The Healthier You: NHS Diabetes Prevention Program (NHS DPP) developed by the National Health Service (NHS) in 2016 was created to delay or avert the emergence of type 2 diabetes (T2D). Adults were identified with non-diabetic hyperglycemia with HbA1c of 6 to 6.4% or fasting plasma glucose (FPG) 99mg/dL to 124mg/dL through supervised lifestyle interventions. A recent systematic review by Garcia-Molina et al. demonstrated that lifestyle interventions considerably lowered HbA1c levels compared to standard patient care. More than 750000 individuals have been referred to the program since its formation in 2016. Fast forward to March 2020, the COVID-19 Pandemic hit, and the program protocol changed from an in-person group-based session to remote sessions through video conferencing, telephone, and specific electronic methods. Moreover, independently documented body measurements were changed to self-reported body measurements.

The individuals’ bodyweight was compared at admittance to the program from April 1, 2020, and March 31, 2021, with the individuals’ weights from admittance over the previous three years, April 1, 2017, to March 31, 2020. Its purpose was to estimate the impact of the Pandemic on the bodyweight of persons with non-diabetic hyperglycemia. The NHS DPP held remote initial intervention meetings with 72611 individuals from April 1, 2020, and March 31, 2021, and 217181 individuals attended an initial intervention meeting during the prior three years. From that, 63% (n= 46069) and 96% (n=208054) individuals had acceptable body weight measurements documented at the program admittance. The percentage of lacking weight data in 2020 to 2021 was greater in unknown ethnic groups, mixed, Black, or other. However, the proportions of lacking data were generally comparable among the characteristics of participants.

The mean body mass index (BMI) was 30.8kg/m2, and mean body weight (BW) was 86.8kg for 2020 to 2021, contrasted with a mean BMI of 30.4kg/m2 and mean BW of 84.4kg over the preceding three years. The unadjusted weight difference was 2.4kg (p<0.0001), markedly more incredible than any annual increase from 2017 to 2019. The high baseline weights were evident from the start of the Pandemic. Baseline weight numbers from 2020 to 2021 were younger persons than those from the prior three years, and other characteristics were generally comparable. Once the adjustment was made for age, ethnicity, socioeconomic deprivation, and sex, the mean body weight recorded from participants who entered the program during the Pandemic was 0.68kg (p<0.0001), which was more than those who entered the program in the three pre-pandemic years. Exciting results have transpired between individual characteristics and the noted distinctions between the periods studied. During the Pandemic, higher weights were noted in younger individuals, females, and in the two quantiles of highest deprivation than older males and the quantiles of lower deprivation. A slight contrast in body weight was observed in individuals with Asian backgrounds compared to Caucasians. No other major difference was noted in other ethnic backgrounds compared to Caucasians. The individuals who entered NHS DPP from 2020 to 2021 were younger than those in the previous years. Despite adjustments, bodyweight documented during the Pandemic was substantially higher than those documented in the previous three years. Individuals <65 years and in the two greatest deprivation quantiles and the baseline body weight increase among the two groups evaluated pre and post-pandemic onset was more than twice as significant as the difference overall sample. This observed increase in body weight will potentially substantially impact future diabetes frequency in these groups. Adjustments after the initial BMI, the odds ratio (OR) was 1.08 of developing diabetes after a 1kg increase in body weight longitudinally. Some limitations to the study were that the data collected was not longitudinal. The dependence of self-reported weights in 2020 to 2021 may have undervalued the actual difference, and missing weight data from 2020 to 2021 may have influenced the weight difference assessment.

Practical Pearls

  • The stay-at-home guidelines due to the COVID-19 Pandemic have increased mean

   body weight in persons at most risk of T2D.

  • The increase in body weight was primarily seen in younger individuals, females, and

   people from disadvantaged areas.

  • It is vital for patients to have sustained access to the NHS DPP or similar programs to

  prevent an increase in body weight, which can lead to a higher incidence of T2D.

Valabhji, Jonathan et al. “Effect of the COVID-19 pandemic on body weight in people at high risk of type 2 diabetes referred to the English NHS Diabetes Prevention Programme.” The lancet. Diabetes & endocrinology, S2213-8587(21)00218-7. 2 Sep. 2021, doi:10.1016/S2213-8587(21)00218-7.

García-Molina, Laura et al. “Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis.” European journal of nutrition vol. 59,4 (2020): 1313-1328. doi:10.1007/s00394-019-02147-6.

Trina Maglalang RPh, 2022 PharmD Candidate University of Colorado