Depression, unhealthy eating linked to weight gain during COVID-19 in adults with obesity

The authors report no relevant financial disclosures.


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Nearly 30% of adults with obesity gained 5% or more body weight during the COVID-19 pandemic, and those who gained weight were more likely to have depression and engage in unhealthy eating, according to study data.

“Obesity is a complex disease. Stresses of the COVID-19 pandemic are contributing to negative health behaviors, worsening mental health and weight gain in people with obesity,” Jaime Almandoz, MD, MBA, medical director of the Weight Wellness Program and assistant professor in the division of endocrinology at University of Texas Southwestern Medical Center, told Healio. “Almost 30% of adults gained more than 5% body weight, and almost one in seven gained more than 10%. Also, people with more severe obesity gained more weight.”

Jaime Almandoz, MD, MBA

Almandoz is medical director of the Weight Wellness Program and assistant professor in the division of endocrinology at University of Texas Southwestern Medical Center.

Almandoz and colleagues recruited 404 adults aged 18 years and older with a BMI of 30 kg/m2 or higher (82.6% women; mean age, 52.5 years) to complete a 15-minute online survey on the COVID-19 pandemic’s impact on health and lifestyle behaviors from March to November 2021. Participants reported changes to body weight, lifestyle factors, physical health and mental health from the beginning of the pandemic in March 2020 to the time they completed the survey. Adults were considered to have lost weight if their body weight decreased by at least 5% and were defined as having gained weight if their body weight increased by at least 5%.

The findings were published in Obesity.

Of the study cohort, 29.2% had a body weight gain of at least 5% during the pandemic, whereas 19.6% lost 5% or more body weight. The mean weight change was a 4.3% gain, with wide variability seen in the cohort. When asked about factors that made it difficult to manage weight, 84.9% cited stress, 71.7% reported anxiety, 56.2% cited depression and 46.4% reported a lack of sleep.

“The self-reported higher levels of stress, anxiety and depression were alarming,” Almandoz said. “These likely contributed to the maladaptive eating and health behaviors, like overeating, binge eating, less sleep and exercise, that were reported by around half of participants.”

Weight gain was positively correlated with BMI in those who gained 5% or more body weight (r = 0.2948; P = .0014), and weight loss with negatively correlated with BMI in the weight-loss group (r = –0.2522; P = .0279).

In fully adjusted logistic regression analysis, adults who gained weight were more likely to have difficulty with weight management (adjusted OR = 9.52; 95% CI, 3.21-28.23; P < .001), experience depression-related symptoms (aOR = 2.23; 95% CI, 1.27-3.94; P < .006), consume takeout meals (aOR = 3.87; 95% CI, 2.41-6.23; P < .001) and eat more comfort foods (aOR = 4.12; 95% CI, 2.01-8.42; P < .001) than those who lost weight. Those who gained weight were also more likely to report increases in fast food eating (aOR = 2.74; 95% CI, 1.44-5.2; P = .002), overeating (aOR = 3.43; 95% CI, 1.61-7.3; P = .001) and binge eating (aOR = 3.1; 95% CI, 1.64-5.87; P < .001) than adults who lost weight.

“People with obesity should be screened for anxiety, depression and stress, with appropriate referrals to mental health providers if appropriate,” Almandoz said. “Patients should be counseled on stress management, sleep hygiene and how to curate balanced, calorie-controlled meals even if they are not cooking at home. We need to look after the whole person, including their mental health — not just the number on the scale.”

The researchers wrote that future research should identify factors contributing to more stress and mental health challenges during the pandemic. More research is also needed to explore the differences in self-reported eating behaviors such as overeating and binge eating between those who gain weight and those who lose weight to develop interventions.

For more information:

Jaime Almandoz, MD, MBA, can be reached at

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