Change in eating habits and physical activities before and during the COVID-19 pandemic in Hong Kong: a cross‐sectional study via random telephone survey

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First detected in December 2019 in the city of Wuhan, China, the novel coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which caused nearly 2.1 million deaths with more than 93.8 million infections in 218 countries as of January 16, 2021. Without population-wide administration of effective and safe vaccines, public health strategies such as social distancing and personal hygiene have been proved to be effective measures to control the pandemic. Considering the beneficial effects of physical activity and healthy dietary habits on health outcomes, several studies have examined the associations between the COVID-19 pandemic, its control measures, and people’s chronic health conditions. Control measures including stay-at-home orders, social distancing recommendations, and closures of parks/fitness rooms were found to be highly effective in reducing the diffusion of infections. However, these initiatives may limit outdoor activities, disrupt physical exercise routines, increase sedentary behavior, and encourage more time spent on electronic screens [1,2,3,4].

Several studies have investigated the influence of COVID-19 outbreaks on dietary changes [5, 6]. One speculation is that death and other negative events during the pandemic may lead to personal stress and anxiety, thus may induce consumption of alcohol and sugar-rich, energy-dense food [5]. In addition, driven by the anxiety of possible food shortages and the idea of minimizing unnecessary travel, people tend to purchase groceries with a longer shelf life that usually have high salt and fat content, while purchasing less fresh produce such as fruits and vegetables [6]. Physical inactivity has also been reported to contribute to a sedentary lifestyle with more snacks between meals or late at night [7]. However, some empirical studies have challenged the unidirectional impact of the pandemic [8, 9]. For instance, a large-scale Polish survey proposed two opposite patterns in lifestyle changes during the COVID-19 pandemic: “pro-healthy changes” in around 30 % of the population and “unhealthy changes” in 20 % of the population [9].

Multiple factors are associated with the pattern of behavioral changes, including the intensity of control measures (e.g., recommended vs. forced home office), society’s macroeconomic environment, and individuals’ age, employment status, family size as well as perceived health status [2, 10]. However, the effects of most factors on lifestyle behavior have been inconsistent among studies. Meanwhile, most empirical studies were conducted online, which may oversample younger individuals while neglecting the poor and elderly population with limited access to the internet.

With a population of 7.4 million and visitor arrivals of nearly six million/month in 2018 [11], the Hong Kong Special Administrative Region has been widely recognized as a tourism destination and international transportation hub. The large number of travelers arriving in Hong Kong posed challenges to infectious disease control. Following confirmation of the first COVID-19 case in Hong Kong on January 23, 2020, the number of confirmed COVID-19 cases increased to 9,452 on January 16, 2021. Throughout the pandemic, Hong Kong adopted a containment strategy of early identification and isolation of cases, with social distancing policies implemented in response to the extent of disease transmission. On 28 March 2020, catering businesses were required to stop selling food or drinks on sites, and public venues for sports and fitness centers were closed. The prohibition of group gatherings to no more than four people in public areas was announced on March 29, 2020 [12]. Thereafter, nightclubs and bars were also instructed to close from early April 2020, while working from home and flexible work arrangements were subsequently recommended [13]. Although these control measures were intermittently relaxed in response to changes in the epidemic, they have been re-imposed in response to surges of transmissions and are anticipated to largely impact people’s lifestyle including diet and physical exercise.

Hong Kong did not impose a complete lockdown for COVID-19 control, yet the city’s healthcare system has not been overwhelmed. In spite of this, the social distancing measures such as restrictions on eateries and closure of sports facilities still disturb the behavior with regard to diet and physical activities. Many studies have shown that an unhealthy/imbalanced diet and physical inactivity increase the risk of obesity, weaken the immune system, increase sleep disorders as well as the prevalence of cardiovascular events, and are associated with a higher all-cause mortality rate [4, 6, 10]. The impact of public health strategies in response to the COVID-19 pandemic on people’s diet and physical activity patterns remains unclear. In this study, we aimed to examine the changes in eating habits and physical activities before and during the COVID-19 pandemic in Hong Kong, and to identify sociodemographic factors related to the behavior change.