Drieskens et al. Archives of Public Health (2021) 79:22 https://doi.org/10.1186/s13690-021-00542-2 RESEARCH Open Access Short-term impact of the COVID-19 confinement measures on health behaviours and weight gain among adults in Belgium Sabine Drieskens1* , Nicolas Berger1,2, Stefanie Vandevijvere1, Lydia Gisle1,3, Elise Braekman1, Rana Charafeddine1, Karin De Ridder1 and Stefaan Demarest1,3 Abstract Background: In Belgium, confinement measures were introduced on the 13th of March 2020 to curb the spread of the coronavirus disease (COVID-19). These measures may affect health behaviours of the population such as eating habits, physical activity and alcohol consumption, which in turn can lead to weight gain resulting in overweight and obesity, increasing the risk of several chronic diseases, but also of severe COVID-19. The purpose of this study is to assess the impact of confinement measures on health behaviours and their associations with weight gain. Methods: Data were derived from the second national COVID-19 health survey. Data were collected between the 16th and the 23rd of April 2020. The recruitment of participants was based on snowball sampling via Sciensano’s website, invitations via e-mail and social media. The study sample includes participants aged 18 years and over with no missing data on the variables of interest (n = 28,029). The association between self-reported weight gain and health behaviour changes, adjusted for gender, age group and household composition was assessed through OR’s (95% CI) calculated with logistic regression models, using post-stratification weights. Results: Overall, 28.6% reported weight gain after 6 weeks of confinement. Higher odds of weight gain were observed among participants who increased or decreased their consumption of sugar-sweetened beverages (OR = 1.39 (1.15–1.68) and 1.29 (1.04–1.60), respectively), among those who increased their consumption of sweet or salty snacks (OR = 3.65 (3.27–4.07)), among those who became less physically active (OR = 1.91 (1.71–2.13)), and among those who increased their alcohol consumption (OR = 1.86 (1.66–2.08)). Conclusions: The most important correlates of weight gain during confinement were an increased consumption of sweet or salty snacks and being less physically active. These findings confirm the impact of diet and exercise on short term weight gain and plead to take more action, in supporting people to achieve healthier behaviours in order to tackle overweight and obesity, especially during the COVID-19 pandemic. Keywords: Confinement, COVID-19, Weight gain, Change in health behaviours * Correspondence: [email protected] 1Scientific Direction Epidemiology and public health, Sciensano, J. Wytsmanstreet 14, 1050 Brussels, Belgium Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Drieskens et al. Archives of Public Health (2021) 79:22 Page 2 of 10 Background food, to eat more fruits and vegetables, and to have less In Belgium, several confinement measures were intro- unhealthy temptations which usually take place during duced by the National Security Council on the 13th of social gatherings, at work, or during commuting [17]. March 2020 with the aim of curbing the spread of the Another important health behaviour that may be im- coronavirus disease (COVID-19) [1]. The confinement pacted by the confinement is physical activity. Potential measures included among others the closure of hotels, reasons for a decrease in physical activity include the bars and restaurants as well as schools/universities, non- fact that people are recommended to stay at home which essential industries and the restriction of cultural, recre- reduces their movements. Besides, the closure of indoor ational and sports activities. Teleworking became the sport facilities, as well as the combination of work and norm whenever possible, non-essential movements were homeschooling may be additional factors for reducing forbidden and the borders were closed. Parks and other physical activity [18]. The association between physical green spaces generally remained open but were subject inactivity and obesity is well documented [19–21]. Con- to strict physical distancing and any form of group gath- versely, some people may have had more time to be erings was forbidden. A gradual loosening of the con- physically active during the confinement period. finement measures started on the 4th of May 2020. The last risk factor for weight gain that may be Confinement measures may impact health behaviours, impacted due to the COVID-19 confinement is the con- such as eating habits and physical activity, both in a sumption of alcohol. Studies have generally shown that positive and in a negative way [2, 3]. If sustained over a light to moderate alcohol consumption is not associated long period of time, changes towards unhealthy behav- with obesity, but heavy drinking and binge drinking are iours may then affect the health status of the population. [22]. This can be explained by the high sugar level in Specific health behaviours such as overeating, unhealthy some alcoholic drinks and the fact that alcohol stimu- diet and reduced physical activity may contribute to lates the craving for and intake of unhealthy foods [22– weight gain [4]. Besides, there is also evidence that alco- 24]. It is expected that an increase in psychosocial dis- hol consumption is associated with an increase in the tress during confinement might have increased alcohol Body mass index (BMI) [5]. Weight gain may lead to consumption for some, while deteriorating financial situ- overweight and obesity, which may enhance the risk of ation and reduced availability of onsite alcohol areas, cardiovascular diseases, type 2 diabetes and some can- such as bars, might have reduced consumption for cers, and consequently premature mortality, which others [25]. makes it a major public health problem [6]. Moreover, The purpose of this study is to assess the short-term recent studies have shown that obesity increases the risk impact of the COVID-19 confinement measures on of severe COVID-19 (more respiratory complications) health behaviours, such as eating habits, physical activity and consequently a longer stay in the hospital [7–9]. and alcohol consumption, and on the change in body One of the key risk factors for weight gain that may be weight among adults in Belgium. Further, the associa- affected by confinement measures is unhealthy eating tions of these health behaviours with weight gain during habits. Snacking is the intake of specific foods, often confinement were determined. nutrient-poor, energy-dense, between traditional meals. Epidemiological studies have found a positive association Methods between snacking and weight gain among adults [10, Survey methodology 11]. Often, bad nutritional habits are related to a higher To evaluate the impact of the confinement measures on consumption of sugar-sweetened beverages, also a risk the mental health, health behaviours and weight status factor for obesity [12]. of the population, Sciensano, the Belgian institute of Being more often at home during confinement, may public health, organised a series of online health surveys. give easier access to snacks – often also a cheaper alter- The first COVID-19 health survey was launched 3 weeks native to healthier options – and sugar-sweetened bever- after the start of the confinement period (the 2nd of ages, and extra occasions to consume them. April), the second survey took place 2 weeks later (the Furthermore, a high consumption of food prepared 16th of April), the third one started on the 28th of May, out-of-home has also been related to weight gain [13, the fourth on the 24th of September and finally the fifth 14]. The confinement may have affected out-of-home on the 3rd of December 2020. All five surveys were de- food consumption (i.e. closure of restaurants, except veloped using LimeSurvey version 3 and were available home delivery options) and so possibly weight status. online for 1 week. The launch of the surveys and the call However, some countries have found that certain sub- for participation were announced on the website of populations may eat healthier during confinement [2, 15, Sciensano and of other organisations (health insurance 16]. For example, a Dutch study has shown that younger organisations, community centres …), and at the adults tended to spend more time cooking healthier COVID-19 press conference, through the press and on Drieskens et al. Archives of Public Health (2021) 79:22 Page 3 of 10 social media. Recruitment was based on snowball sam- weight status was classified as underweight, normal pling [26]: participants were asked to share the link of weight, overweight and obesity using WHO BMI cut- the survey with their family, friends and acquaintances. offs [27]. Participants who had indicated in a given survey that they would like to take part in the next one received an Sociodemographic and health covariates invitation through the e-mail address they provided.