The Impact of COVID-19 lockdown on the lives of People with Obesity (PwO): A UK primary care based study

Date of ISAC Approval: 
2021-03-23 00:00:00
Lay Summary: 
Obesity is a growing health concern in the UK. It is defined as an excess of body weight and is associated with an increased risk of heart disease, diabetes, stroke, cancers, psychological problems such as depression, and mortality. The Coronavirus lockdown in the UK may mean that people see change in their BMI, move or exercise less frequently, use healthcare less often, and may be at increased risk of experiencing diseases associated with obesity or mental health issues. The overall objective of this study is to investigate the impact of COVID-19 lockdown on People with Obesity (PwO), People with Overweight (PwOv) and people with neither obesity nor overweight (Pw/out). We will investigate change in body mass during lockdown, and people’s use of healthcare resources such as visiting healthcare professionals, taking medications during the COVID-19 pandemic and occurrence of mental health issues in these groups during lockdown.
Technical Summary: 
Obesity is a significant public health problem across the UK. Defined as an excess of body weight, whether overweight (body mass index (BMI): 25-29) or obese (BMI≥30), it is associated with an increased risk of heart disease, diabetes, stroke, cancers, psychological problems such as depression and anxiety, and mortality. The Coronavirus disease‐2019 (COVID‐19), an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2 virus), resulted in several stages of lockdown in the UK in order to disease reduce transmission, which may mean that people have seen a change in their BMI, experienced reduced activity, use healthcare resources more sparingly, and may be at increased risk of experiencing mental health issues associated with overweight or obese. The overall objective of this study is to use Hospital Episode Statistic (HES)-linked Clinical Practice Research Datalink (CPRD) data to investigate the impact of COVID-19 lockdown on People with Obesity (PwO), People with Overweight (PwOv) and people with neither obesity nor overweight (Pw/out). We will investigate change in BMI/weight, use of healthcare resources, such as contact with healthcare professionals, adherence to medications, and incidence, recurrence and exacerbation of anxiety and depression during the COVID-19 lockdown, amongst these populations. Means and standard deviations will be produced to describe changes, and generalised linear models (GLM) for repeated measures will be used to investigate changes in BMI/weight during lockdown (23rd March 2020 - present) relative to baseline (22nd March 2017 – 22nd March 2020 - BMI may be imputed within this period), and investigate effect modification by obesity level. GLM will be used to investigate use of healthcare resources and medication adherence. Incidence of anxiety and depression will be plotted, their correlations with BMI, and trends investigated using survival analysis with a time-varying covariate to indicate periods before and after the initiation of the first lockdown.
Health Outcomes to be Measured: 
Changes in BMI after the initiation of the first lockdown period relative to baseline, and whether these changes are modified by being categorised as People with Obesity (PwO), People with Overweight (PwOv) and people with neither obesity nor overweight (Pw/out) at baseline; The frequency of healthcare provider support interactions, among PwO, PwOv and Pw/out after the initiation of the first lockdown period relative to the baseline period; Change in adherence to cardiorenal metabolic disease medications for hypertension, type 2 diabetes and hyperlipidemia, among PwO, PwOv and Pw/out after the initiation of the first lockdown period relative to the baseline period; Incidence, recurrence or exacerbation of anxiety or depression among PwO, PwOv and Pw/out after the initiation of the first lockdown period relative to the baseline period; The determinants of change in weight/BMI after the initiation of the first lockdown period, including include age, sex, ethnicity, deprivation level and baseline BMI/weight.
Collaborators: 

Kamlesh Khunti - Chief Investigator - University of Leicester

Luis Vaz - Corresponding Applicant - University of Leicester

Clare Gillies - Collaborator - University of Leicester

Tom Yates - Collaborator - University of Leicester

Franceso Zaccardi - Collaborator - University of Leicester

Linkages: 
HES Admitted Patient Care, HES Outpatient, Patient Level Index of Multiple Deprivation