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Influence of Body Mass Index on Eating Habits and Food Choice BRIEF RESEARCH REPORT published: 12 July 2021 doi: 10.3389/fnut.2021.664240 Influence of Body Mass Index on Eating Habits and Food Choice Determinants Among Brazilian Women During the COVID-19 Pandemic Bruna Caruso Mazzolani 1†, Fabiana Infante Smaira 1†, Gabriel Perri Esteves 1, Edited by: Heloísa C. Santo André 2, Milla Cordeiro Amarante 1, Daniela Castanho 1, Karen Campos 1, Leigh Gibson, 1,2 1 1,3 1,3 University of Roehampton London, Fabiana Braga Benatti , Ana Jéssica Pinto , Hamilton Roschel , Bruno Gualano and 1 United Kingdom Carolina Ferreira Nicoletti * Reviewed by: 1 Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, Faculdade Tania Paulette Markovic, de Medicina FMUSP, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil, 2 School of Applied The University of Sydney, Australia Sciences, State University of Campinas, Limeira, Brazil, 3 Food Research Center, University of São Paulo, Sao Paulo, Brazil Renata Ramalho, Egas Moniz Interdisciplinary Research Center, Portugal Changes in emotional state due to the COVID-19 pandemic may potentially modify eating Uyen Thuy Xuan Phan, habits, which may differ as a function of body mass index (BMI). Using a self-reported, Ho Chi Minh University of Industry, Vietnam questionnaire-based survey we evaluated Brazilian women during the pandemic for: *Correspondence: (i) the influence of BMI on changes in eating habits, food choice determinants, Carolina Ferreira Nicoletti and psychological symptoms; (ii) associations between eating habits, food choice [email protected] determinants and psychological symptoms. General characteristics, anthropometric †These authors have contributed data, eating habits before and during the pandemic, food choice determinants and equally to this work and share first psychological symptoms during the pandemic were collected between June and authorship September, 2020. Participants (n = 1,183) were normal weight (60.4%), overweight Specialty section: (26.2%) and obese (13.4%). A higher frequency of “cooking” (72.3–77.6%, p = 0.004) This article was submitted to and “use of delivery service” (29.8–48.8%, p < 0.001) was reported during, in Eating Behavior, a section of the journal comparison to before the pandemic. Additionally, a higher prevalence of “snacking” Frontiers in Nutrition (57.1–63.8%, p = 0.005) and “eating at table” (78.5–82.7%, p < 0.001) was reported Received: 04 February 2021 during the pandemic, while the number of participants reporting “dieting” decreased Accepted: 22 June 2021 Published: 12 July 2021 (28.7–20.4%, p < 0.001). “Health”, “natural concerns” and “need and hunger” were Citation: less important determinants for participants with overweight/obesity compared to normal Mazzolani BC, Smaira FI, Esteves GP, weight. Regression analysis indicated that (i) “health”, “natural concerns” and “affect Santo André HC, Amarante MC, regulation”; (ii) “health”, “pleasure”, “convenience”, and “natural concerns”; and (iii) “visual Castanho D, Campos K, Benatti FB, Pinto AJ, Roschel H, Gualano B and appeal” and “pleasure” were the food choice determinants more associated with eating Nicoletti CF (2021) Influence of Body habits among women with normal weight, overweight, and obesity, respectively. In Mass Index on Eating Habits and Food Choice Determinants Among conclusion, eating habits were modified during the pandemic despite BMI, whereas food Brazilian Women During the COVID-19 choice determinants differed between overweight/obesity and normal weight women. Pandemic. Front. Nutr. 8:664240. doi: 10.3389/fnut.2021.664240 Keywords: obesity, eating behavior, social isolation, confinement, SARS-CoV-2 Frontiers in Nutrition | www.frontiersin.org 1 July 2021 | Volume 8 | Article 664240 Mazzolani et al. Eating Habits During the COVID-19 Pandemic INTRODUCTION criteria were as follows: women aged ≥18 years, currently living in Brazil, with ability to read, and with internet access. Quarantine and social isolation bring many challenges, including All participants completed an online survey on GoogleR distancing of family and friends, loss of freedom, concern for Forms platform (GoogleR LLC, Menlo Park, CA, USA), one’s health status, and boredom (1). To contain the COVID- which enquired about their demographic, socioeconomic, 19 pandemic, social distancing has been imposed worldwide. and anthropometric characteristics, psychological symptoms, As a consequence, psychological symptoms, stress, irritability, lifestyle, and eating habits. insomnia, feelings of anger, and emotional exhaustion have been reported (1). These changes in emotional state can potentially modify lifestyle habits, including eating habits. It has been suggested that changes to routine, such as those Evaluation Tool that occur during quarantines, can have a greater impact in The online survey included questions categorized into the women since they often hold more responsibilities regarding following sections: (i) participant characteristics (i.e., age, family food choices (2). In addition, women tend to eat ethnicity, marital status, education level, smoking habits, and more in stressful situations when compared to men (3). A chronic medical conditions); (ii) anthropometric data (i.e., self- study evaluating choices, behaviors and food preferences among reported weight and height, which was then used to calculate women with normal weight, overweight or obesity showed that: BMI); (iii) eating habits quarantine (i.e., “cooking”, “participation (i) Taste is fundamental for food choice irrespective of BMI; in grocery shopping”, “use of delivery services”, “alcohol (ii) Price was a greater determinant for food choice among consumption”, “snacking”, “replacing main meals for snacks”, women with overweight and obesity vs. normal weight; (iii) “eating at table”, “eating in front of television/tablet/cellphone”, Health was an influential factor in food choice mostly among and “dieting”). Participants were asked to self-report these eating the participants with normal weight; and (iv) Women with habits as binary outcomes (i.e., “yes”, if participant reported a overweight and obesity report liking a wider variety of foods, certain eating habit, or “no”, if participant reported the absence both healthy and less healthy, and mentioned using food more of a certain eating habit), both before (retrospective), and during often as a mechanism to cope with periods of stress, depression or (current) the quarantine. To the best of our knowledge, there is boredom, whereas their normal weight peers reported eating less no validated instrument to directly assess eating habits available or the same amount of food when facing negative emotions (4). in the literature. Therefore, we based our questions on the Dietary These data collectively suggest that body mass index (BMI) plays Guidelines for the Brazilian Population (7), to better capture the an important role in food choices and preferences among women. most relevant eating habits of our sample. Eating habits and the complex process of food choices Participants also completed previously validated tools are driven by an interplay of physiological mechanisms, commonly used to assess food choice determinants and genetics, epigenetics, economic and behavioral factors, and psychological symptoms. These included: The Brazilian organoleptic characteristics of foods (5, 6). The COVID-19 Portuguese version of The Eating Motivation Survey (TEMS) pandemic resulted in profound changes in women’s daily routine (8, 9), which comprises 45 questions preceded by “I eat that may potentially influence eating habits in unpredictable what I eat,...” and which is used to evaluate food choices ways. Whether, and to what extent, BMI is associated determinants (i.e., “liking”, “health”, “natural concerns”, “need with modifications in eating habits during the pandemic and hunger”, “habits”, “pleasure”, “convenience”, “weight remains unknown. control”, “sociability”, “traditional eating”, “price”, “visual The aims of this study were to evaluate: (i) the influence appeal”, “affect regulation”, “social norms” and “social image”). of BMI on changes in eating habits during the COVID-19 The answers are given in a five-point scale ranging from 1 pandemic; (ii) the influence of BMI on food choice determinants (“never”) to 5 (“always”), with higher scores representing a and psychological symptoms during the COVID-19 quarantine higher impact of a given food choice determinant. The Binge and; (iii) associations between eating habits, food choice Eating Scale (BES) was used to evaluate symptoms of binge determinants, and psychological symptoms during the COVID- eating episodes (10, 11), with higher scores representing more 19 quarantine among Brazilian women. symptoms of binge eating episodes (scores range from 0 to 46). The short version of the Disordered Eating Attitude Scale was employed to evaluate eating attitudes (12), with higher scores METHODS representing more dysfunctional eating attitudes (scores range from 17 to 75). The Depression Anxiety Stress Scale-21 (DASS- Study Design and Participants 21) was used to assess depression, anxiety and stress symptoms This is a cross-sectional, self-reported, questionnaire-based (13, 14) with higher scores representing more symptoms (score survey conducted between June and September 2020, a range for: 0–28). The UCLA Loneliness Scale was used to period during which a set of social distancing measures assess perceived feelings of loneliness (15, 16), with higher
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