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Abstract  ESPEN  congress 2020

Factorspredictingweightgainduring Covid-19 lockdown in patientswithobesity: a National survey

Antonio Caretto, Maria Letizia Petroni, Stefano Pintus, Santo Morabito, Patrizia Zuliani, Rosaria Sturdà, Manlio Scotto Di Carlo
ADI (ItalianDietetic and ClinicalNutritionAssociation) Foundation

Background: For the first time in the last century the world isexperiencing a newgreatpandemicemergencyafter the SpanishFlu (1918), and Italy wasthe first Europeancountrytobeseverely hit. ItalianGovernmentactedquickly in responseofitlimitingfreedomofmovementsofentirepopulation, closingall non essentialactivitiesbetween March 9thto May 18° 2020, thusallowing– at leasttemporarily–tohalt the hugedeathtoll. Apartfrom the dramaticconsequences on national economy and on the care ofthose on chronicmedicalconditions, anotherseriousproblemof pandemia hasbeen the modificationof life style due tolockdown in all social fields: social distancing, needof quarantine, closingof meeting places (bar, restaurants, theaters, churches, stadiums, gyms) but in particular the modificationsof work conditionsformillionsof people withdifferentimplications in termsofearnings, location and timededicated (forcedfurlough, layoffs, smartworking, closingof commercial businesses) increasing the timespent at home and moltiplicating the possibilitiesoffoodaccess, thusamplifying the problemofweightcontrolparticularly in obese subjects.
Moreoverpsychologicaldistressasconsequenceof the lockdownseemstobevery common. The spread of the new coronavirus seemsto impact the mentalhealthof people in differentmannerswithincreaseofanxiety, depression, phobicdisorders, sleep modifications1.
Rationale and aim: wehypothesizedthatCovid-19 lockdownmighthavenegativelyimpacted on weightcontrol in patientswithobesityfollowed up at Specialistnutritionservices. Weaimed at verifyngthishypothesiscomparingmodifications in qualityoffoodconsumption, (dysfunctional) eatingpatterns, physicalexerciseaccordingtopsychologicalfeatures and work status.
Methods: A surveywascarried out at ItalianClinicalNutrition andDieteticServicesbymeansof a structuredquestionnaire (77 items) toget information abouthowtheirpatientswithobesitycopedwith Covid-19 lockdown. The protocolhasbeenapprovedby the EthicalCommitteofPerrino Hospital, Brindisi. The surveyhasbeencarried out between 2ndMay and 25th June 2020 during follow-up phonecallsbydirectquestioning or bysendinginvitationsto complete the questionnaire on the Web. Data wereanalyzedbyChi-square test, ANOVA and MANCOVA as appropriate.
Results: 1046 patientsfrom 23 Centers (41% ObesityClass2to3) completed the questionnaires (71% females, meanage 50,5 ± 14,2 yrs, mean BMI 34.7 ± 7.6 kg/m2). During the lockdownperiod, 22.8%ofpatientsworkedfrom home, whileanother 20.8% losttheir job or was put on furlough. Abouthone-quarterofpatientsdidnothave the possibilitytoleave home, while the majority (51,7%) could go out a fewtimes a week, and 21% coulddidit on a dailybasis. A largeproportion (46%) experiencedboredom. Thirty-fourofpatientsdeclaredincreasedemotionaldifficulties. Fear (51.5%) was the mostfrequent negative emotion, followedby anger (38.0%), anxiety (30.9%), depression (23.4)%). Fifty-ninepercentofpatientsreducedphysicalactivity, while 16% wasabletokeepusuallevels and 6% increaseditduring the lockdown, while the remainingonesdeclaredthemselvesasbeinghabitualsedentary.
Overall, 49,3% ofpatientsincreased and 27.4% reducedtheirweight, whilethiswasunchanged in 19,6%.  Meanweightchangewas +2.3± 4.8 kg (+ 4% in thosewhoexperiencedweightgain). Therewas a significantassociation (p< 0.001) betweenreducedphysicalactivity, emotionaldifficultiesduringlockdown and weightgain. Moreover, thoseworkingfrom home and those on furlough or forcedlayoffexperienced a significantlyhigherweightgainthanthoseallowedto work outside home or retired. Sixty-six% declaredtobe on a weightcontroldietbefore the lockdown, and ofthese, 40% reporteddifficultytofollowtheirdiet. Increasedsnacking and increasedintakeof high calorie foodsrepresented the mostfrequentfoodhabitschanges. A significantassociation (p< 0.001) wasfoundbetweensnacking and anxiety and/or fear.
Conclusions:  during Covid-19 lockdownabouthalfofpatientswithobesity in follow-up at ItalianDieteticServicesdidnotincreasetheirweight or experiencedweight loss. Thismayreflectgainedself-efficacythroughpreviouscounseling and behaviouraltherapy, and/or more timeto dedicate toself-care. However, the remaininghalfexperienced a clinicallyrelevantweightgain. Thosewhoincreasedtheirweightlikelydidmostly so becauseofreducedphysicalactivity and difficultemotionalcoping. Workingfrom home or havinglost the job wasalsoassociatedwith more difficultweightcontrol.

The Authors do notdeclareconflictsofinterest

1) Salari N, Hosseinian-Far A, JalaliR, Vaisi-Raygani A, RasoulpoorS, MohammadiM, RasoulpoorM, Khaledi-PaveB l. Prevalenceof stress, anxiety, depressionamong the generalpopulationduring the COVID-19 pandemic: a systematicreview and meta-analysis. Globalization and Health (2020) 16:57


EASO Congress 2020   [LBP-134]

How did persons with obesity cope with Covid-19 lockdown: an Italian National survey

Antonio Caretto, Maria Letizia Petroni, Stefano Pintus, Santino Morabito, Patrizia Zuliani, Monica Scotto Di Carlo, Rosaria Sturdà
ADI (Italian Dietetic and Clinical Nutrition Association) Foundation

INTRODUCTION: Covid-19 pandemics has forced into a prolonged lockdown the vast majority of the Italian population between 4th March to 18th May 2020. Food insecurity, reduced physical activity, stress, fear and emotional eating were believed to jeopardize weight control attempts. During the lockdown, efforts have been made by most Dietetics Services – Obesity Units across Italy to support patients in charge by carrying out follow-ups in remote, via phone and video call. A survey among Italian Clinical Nutrition and Dietetic Services has been carried out by means of a structured questionnaire to have information about how did persons with obesity cope with Covid-19 lockdown. Ethical clearance was obtained at central ethical committee in Brindisi. METHODS: The present survey has been carried out during follow-up calls by direct questioning or by sending invitations to complete the questionnaire on the Web. The questionnaire was composed of 77 items covering diet, physical activity and psychological aspects. RESULTS: 1046 patients from 23 Centers (41% Obesity Class 2 to 3) completed the questionnaires (71% females, mean age 50,5 ± 14,2 yrs, mean BMI 34.7 ± 7.6 kg/m2). During the lockdown period, 49,3% of patients increased and 27.4% reduced their weight, while this was unchanged in 19,6%. Mean weight change was +2.3 ± 4.8 kg. About 50% of subjects experienced fear and dissatisfaction, boredom and depression were less frequent. In those who experienced weight gain this was on the average about 4%. There was a significant association between reduced physical activity, emotional difficulties during lockdown and weight gain. Moreover, those working from home (“smart” working) and those on layoffs experienced a significantly higher weight gain than those allowed to work outside home or retired persons. Sixty-six% self-declared to be on a weight control diet before the lockdown, and of these, 40% declared that they had difficulty to stick to their diet. Increased snacking and increased intake of high calorie foods were the most frequent food habits changes during the lockdown. Only 4% of patients were on obesity medications, but 14% of patients would have liked to be on obesity medication during the lockdown. CONCLUSIONS: during Covid-19 lockdown about half of patients with obesity in follow-up at Italian Dietetic Services did not increase their weight or experienced weight loss. However, in the remaining half, weight gain was clinically relevant. Those who increased their weight likely did mostly so because of reduced physical activity and difficult emotional coping. Working from home was also associated with more difficult weight control. Especially in those identifiable as being at higher risk appropriate strategies (intensive remote support, pharmacological therapy) should be applied in future similar situations of homebound restrictions to prevent weight gain and clinical deterioration.

Abd Elfatah AA, Ghaly IS, Hanafy SM: Cytotoxic effect of aspartame (diet sweet) on the histological and genetic structures o. Pak J Biol Sci. 2012 Oct 1;15(19): 904-18.

Source: Department of Anatomy and Embryology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.

Abstract: The present study evaluated the effect of aspartame intake on the histological and genetic structures of mother albino rats and their offspring. Sixty adult female albino rats and 180 of their offspring were equally divided into two groups (control and treated), each group divided into three subgroups. Each subgroup consisted of 10 pregnant rats and 30 of their offspring. The experimental design divided into three periods: (1) the gestation period (subgroup one), (2) the gestation period and three weeks after delivery (subgroup two) and (3) animals in the third subgroup treated as subgroup two then left till the end of the ninth week after delivery. Each pregnant rat in the treated subgroups was given a single daily dose of 1 mL aspartame solution (50.4 mg) by gastric gavage throughout the time intervals of experimental design. At the end of each experimental period for control and treated subgroups, the liver of half of both control and treated groups were subjected for histological study while the liver and bone marrow of the other halves were subjected for cytogenetic studies. Body weight of both groups were recorded individually twice weekly in the morning before offering the diet. The results revealed that the rats and their offspring in the subgroups of control animals showed increases in body weight, normal histological sections, low chromosomal aberration and low DNA fragmentation. The treated animals in the three subgroups rats and their offspring revealed decreases in body weight, high histological lesions, increases in the chromosomal aberration and DNA fragmentation compared with control groups. In conclusion, the consumption of aspartame leads to histopathological lesions in the liver and alterations of the genetic system in the liver and bone marrow of mother albino rats and their offspring. These toxicological changes were directly proportional to the duration of its administration and improved after its withdrawal

Marinovich M, Galli CL, Bosetti C, Gallus S, La Vecchia C Aspartame, low-calorie sweeteners and disease: regulatory safety and epidemiological issues. Food Chem Toxicol. 2013 Oct;60:109-15. doi: 10.1016/j.fct.2013.07.040. Epub 2013 Jul 23.

Source: Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy. Electronic address:

Abstract: Aspartame is a synthetic sweetener that has been used safely in food for more than 30 years. Its safety has been evaluated by various regulatory agencies in accordance with procedures internationally recognized, and decisions have been revised and updated regularly. The present review summarizes the most relevant conclusions of epidemiological studies concerning the use of low-calorie sweeteners (mainly aspartame), published between January 1990 and November 2012. In the Nurses’ Health study and the Health Professionals Followup study some excess risk of Hodgkin lymphoma and multiple myeloma was found in men but not in women; no association was found with leukemia. In the NIH-AARP Diet and Health Study, there was no association between aspartame and haematopoietic neoplasms. US case-control studies of brain and haematopoietic neoplasms also showed no association. The NIH-AARP Diet and Health Study and case-control studies from California showed no association with pancreatic cancer, and a case-control study from Denmark found no relation with breast cancer risk. Italian case-control studies conducted in 1991-2008 reported no consistent association for cancers of the upper aerodigestive tract, digestive tract, breast, endometrium, ovary, prostate, and kidney. Low calorie sweeteners were not consistently related to vascular events and preterm deliveries.

Commento di Giuseppe Fatati

I dolcificanti intensi non calorici si sono conquistati, nel  mondo dell’alimentazione, un ruolo preciso e di importanza crescente. Il loro  gusto (migliorato rispetto a quello dei primi composti utilizzati come i ciclammati), e il loro potere dolcificante, in media molto elevato (200-300 volte più del saccarosio), ne fanno infatti strumenti eccellenti per garantire il gusto dolce in assenza di un significativo apporto calorico. I dolcificanti non calorici sono, sul piano normativo, “additivi alimentari” , soggetti alla normativa del settore e alle stringenti regole di valutazione della loro sicurezza d’uso, basate sulla letteratura sperimentale disponibile e periodicamente rivalutate dall’European Food Safety Authority (EFSA). Nonostante queste procedure siano di riconosciuto rigore, è diffusa la percezione di “pericolosità” associata all’uso di questi composti. Tale evidenza  trova, probabilmente, spiegazione nell’intrinseca percezione di pericolosità che parte del pubblico attribuisce agli additivi di sintesi e nell’attenzione che i media dedicano ai report che supportano tale pericolosità, senza valutarne la finalità  scientifica e  la reale rilevanza pratica. Ed è proprio questa differente visione dei dolcificanti uno dei motivi principali che hanno indotto NFI (Nutrition Foundation of Italy) e Fondazione ADI a organizzare a Roma, l’11 gennaio 2012, il Convegno “Dolcificanti intensi non calorici: focus sulla sicurezza d’impiego”. I dati presentati e discussi durante il Convegno hanno ribadito come questi composti possano continuare a entrare nella formulazione degli alimenti che circolano nella Comunità Europea. I due lavori presentati in questa rubrica testimoniano chiaramente questi concetti: da un lato le osservazioni su femmine di ratti albini e la loro prole e dall’altro gli studi epidemiologici sull’uomo. Dal topo all’uomo il passo, in laboratorio, è breve. D’altra parte le due specie differiscono, tra loro, per 1’l% dei propri geni. Gli altri 99 sono comuni; ma basta quell’1% per creare differenze anche sostanziali che ci consentono di affermare che l’uomo non è un topo da esperimento o un ratto albino. Nonostante ciò siamo fermamente convinti che la sicurezza di impiego di qualsiasi prodotto non può e non deve fare a meno dei dubbi sollevati dalla sperimentazione ma tali studi non vanno interpretati in modo acritico. Il processo periodico di rivalutazione dei dolcificanti ad opera dell’European Food Safety Authority è la migliore garanzia della loro sicurezza di impiego.