Chapter 2
Chapter 2
Chapter 2
This chapter presents the relevant literature and studies that we, the researchers, considered in
strengthening the importance of the present study. It also presents the synthesis of the art to
fully understand the research for better comprehension of the study.
home, being isolated, and keeping social distance, which would substantially reform people’s
lifestyle, physical activity, eating habits, etc. Consequently, those measures might create a
disturbance in weight management and overweight. Therefore, how the COVID-19 pandemic
has changed the physical activities of individuals and its impacts on the Body Mass Index
(BMI) is explored herein. Results showed that the prevalence of overweight was 30.5%
‘before’ the COVID-19 pandemic, which increased to 34.9% ‘during’ the pandemic; that
means 4.4% of the participants significantly gained weight after the pandemic inception.
There was no significant role of socio-demographic (e.g., gender, age, current residence,
after the pandemic inception. However, following a proper diet plan during the COVID-19
pandemic was observed to decrease BMI status significantly. The present study suggests that
a minor portion of the participants reported increasing their overweight status after the
pandemic inception, whereas having a proper diet plan during the pandemic can significantly
decrease BMI status. Therefore, the importance of the appropriate diet plan should be
A study on the direction of the association between body fatness and self-reported
screen time in Dutch adolescents resulted in that time spent watching television predicted
changes in body mass index. Computer utilization time was significantly predicted to
increase skinfolds in boys and girls and BMI in girls alone. Body fatness did not predict any
variation in screen time. Other studies also indicated that the frequency of meal intake
contributed to the development of obesity. Another study result revealed that half of Brits
(47%) had put on weight since their nation started in lockdown. Despite the severity and
health consequences of the COVID-19 outbreak is instigating wider conversations around the
nation’s health as well as the importance of a balanced lifestyle. The primary purpose of this
prospective study was to assess the changes in body weight, BMI, physical activity, and
lifestyle and their association with COVID-19 lockdown among the university students.
Though half of the students maintain the same BMI in lockdown, the students increased BMI
which was associated with physical and lifestyle factors. Interestingly, among the students
who reduced weight may be attributed by reduced intake of fast and fried food during the
COVID-19 lockdown. Poor physical activity was reported by many students and most of
them using a sedentary lifestyle. (Jalal et al., 2021)
Dietary Changes
The relationship between stress and emotional eating is well established. Previous
studies have shown an association between stress and the amount of food consumed. It has
been shown that people under stress crave more high fat and high sugar foods, since the body
under stress requires more energy to function. In addition, the body increases storage of
abdominal fat. It has been hypothesized that the increase in unstructured time and the
psychological impact resulting from the enforced quarantine might induce changes in dietary
habits and lifestyle. Therefore, the primary aim of a recent study was to investigate the effects
of the COVID-19 outbreak during the lockdown on eating habits and other health-related
eating habits and lifestyle. The present findings seem to be consistent with other research that
has observed changes in dietary habits and lifestyle behaviours during the pandemic.
Unhealthy meal patterns were detected in the study, such as skipping breakfast and late-night
snackin. Both behaviours are likely associated with overweight and obesity (Husain et al.,
2020).
Consistent with the literature, this research found skipping breakfast was common
among participants. It was noticed that the rate of skipping breakfast remained consistent,
with a slight increase during the pandemic. Possible explanations for this behaviour include a
lack of time, intentionally skipping breakfast to cut calories and a lack of appetite. However,
other possible explanations for skipping breakfast during COVID-19 include staying up late,
A study among 19,687 Japanese women that found a significant association between a
late dinner or bedtime snack and skipping breakfast, as well as an association of this
behaviour with overweight and obesity. Despite the recommendation to reduce the intake of
fats, sugar and salt during COVID-19 and avoid irregular snacking, chocolate, nuts and crisps
were reported to be the most commonly consumed snacks, and these are loaded with sugar,
fat and salt (Okada et al., 2020). A similar finding was reported, who found that half of the
participants of an Italian sample showed an increase in the consumption of both sweet and
salty comfort foods during COVID-19. These results may be explained by the fact that
feelings of boredom, anxiety and stress (likely heightened due to quarantine, as shown in the
results) lead to higher consumption of energy-dense foods that are high in sugar and fat
Similar findings were also reported which found that many people over-eat sugary
and salty comfort foods for snacking due to stress induced by quarantine and that this habit
may increase the risk of developing obesity. Furthermore, it has been demonstrated that there
was a strong association between weight gain and self-reported anxiety/depression among
consumption. It seems possible that this rise in home cooking is related to attempts to occupy
the increased free time resulting from quarantine. Another explanation is that people wanted
to eat healthier in reaction to the spread of COVID-19 and thus resorted to home cooking
practices at restaurants or from the delivery driver. However, it is difficult to conclude that
people ate more healthily during the pandemic just because they reported consuming more
Regarding food choices within the five main food groups assessed in this study, there
were no significant changes in terms of red meat, chicken, type of fat, milk, bread, fruit and
vegetables, before and during the pandemic, except in the case of fish and seafood. A study
also observed low consumptions of fish during the lockdown among the Chinese population.
This result was expected and can be explained by the fact that the fish markets in Kuwait
were closed on April 2020 as a precautionary measure and so there was a lack of availability
of fresh fish and seafood due to the absence of working fisherman during this period. In
addition, it is often preferred to consume fish and seafood fresh, which may have further
immune system especially during the pandemic, however, the results of this study show that
more than 70% of the participants did not reach the minimum portions of fruits and
vegetables recommended by the USDA of 5 portions a day. This result is in line with findings
from other studies that reported a low consumption of fruits and vegetables among Kuwaiti
adults such as the EMAN study and KNNS. These results are likely related to a lack of
awareness of the current recommendation for the consumption of fruits and vegetables
(unpublished data). A finding from two cross-sectional questionnaire studies among the UK’s
recommendation and low consumption of fruits and vegetables. In addition, another possible
explanation is a predisposition towards energy-dense foods that are high in sugar and fat for
snacking, as shown in the results. Moreover, the limited availability of fruits and vegetables
and restricted food store opening hours due to quarantine during the pandemic could have
caused a reduction in the consumption of fruits and vegetables. The reduction in the
consumption of fresh juice can possibly be explained by the negative impact of the pandemic
on the availability of fruit and vegetables, since Kuwait has very limited agricultural
production, particularly in terms of fruit. Moreover, fresh fruit and vegetables have short
shelf lives. In addition, making fresh juice requires a larger amount of fruit and vegetables
than when simply eating them. Another possible explanation is the limited access to grocery
The COVID-19 pandemic has led to significant changes in daily routines and lifestyle
worldwide and mental health issues have emerged as a consequence. Sleep disturbances have
affected a substantial proportion of the general population during the COVID-19 pandemic
lockdown. These are significantly associated with a self-assessed impact on mental health,
but may also be related to suspect COVID-19 status, changes in habits and self-isolation. In
the current pandemic, the effects of isolation have been described in cohorts from China and
Italy, with poor quality sleep and comorbid psychological disturbances being identified as
significant issues. A current study therefore hypothesised that the COVID-19 pandemic and
the public lockdown significantly impacted on sleep in the general population. They
compared suspected COVID-19 with non-COVID-19, and tested whether there was an
association with mental health impact. In order to survey current sleep problems, the British
Sleep Society (BSS) initiated the National Early Detection Screening for the COVID-19
pandemic. The majority of respondents described an altered sleep pattern and almost half of
the studied population felt sleepier than prior to the lockdown. Reported problems included
dozing off unintentionally in the day, disrupted sleep, difficulties falling/staying asleep and
later bedtimes. Over a quarter of all respondents reported an increased alcohol intake during
daytime symptoms, abnormal behaviours in sleep and symptoms of restless legs compared to
those not self-isolating. Keyworkers reported fewer sleep alterations than others. In those
with suspected COVID-19, nightmares and abnormal sleep rhythm were more common. A
reported impact on mental health was most strongly associated with more difficulties falling
asleep, sleep disruption, nightmares and daytime sleepiness. A change in sleep pattern was
associated with medication use, ongoing COVID-19 symptoms and mental health impact, and
it was negatively associated with age, male gender and general health (Carbonell et al., 2020).
Though there is some evidence on how the COVID-19 pandemic has affected the
behavior of students, there is little known about how behaviors differ between students and
non-students. Thus, the aim of the current study was to examine differences in the sleep
patterns, sexual activity, screen use, and food intake of students and non-students during the
COVID-19 pandemic. We hypothesize that the pandemic had a greater effect on sleep
patterns, sexual behavior, screen time, and food intake for students when compared to non-
students. Understanding the ways in which stressful life conditions and public health
emergencies have differential impact on students’ lives may help in tailoring appropriate and
early intervention for students. Also, the information might be valuable for policy makers
when developing preparedness and strategic plans during future pandemics. The observed
changes in sleep pattern and increase in screen use by students have been previously reported.
A significant deterioration in sleep quality of students during the pandemic may be due to late
night browsing on social media, chatting, and checking online news from mobile devices as
well as the increased use of screens for educational purposes, which is also associated with
late night use of electronic devices. The significant increase in exposure to screens may lead
to longer waking hours and reduce sleep duration as a result of blue light emitted from mobile
screens, inhibiting melatonin production. This adjusts the sleep-wake cycle with a resultant
increase in stresses, depression and negative emotions. Our observation that students reported
changes in sleep pattern and increases in screen use may make the explanations proffered by
prior studies applicable to our study findings. Studies conducted before the pandemic
indicated that changes in sleep pattern increase as age increase, contradicting the findings of
this study. No association between changes in sleep and age was observed (Ellakany et al.,
2022).
These findings may have significant implications for the years after the pandemic.
Students may have increased risk for multiple cardio metabolic risk and neurocognitive
impairment resulting from deterioration of sleep. Increase in screen use may have
index), behavioral (sleeping problems, unhealthy dietary behavior, more sedentary activities
Home confinement, prolonged traumas, and substantial changes in routines are all
associated with sleep disruption. Their impact may be drastic, yet may depend on the
sleep quality, increased insomnia symptoms, and delayed bed and wake times, which were
most common among youth, women, and individuals with high pandemic-related stress and
poor social support. Prior studies were confined to a single country, and most did not assess
pre-pandemic sleep patterns. Stress has also been implicated in poor sleep quality and
disrupted sleep (Sanford et al., 2014). The COVID-19 pandemic has been linked to poor
sleep quality in China (Xiao et al., 2020) and Italy (Casagrande et al., 2020), with over half of
Italian respondents experiencing poor sleep quality. However, in Spain, the quality of
2020). Critically, poor sleep quality has been linked to negative emotions and mood (Baglioni
et al., 2010).
(2020),” sought to examine sleep habits both before and after lockdown measures caused by
the pandemic. The survey polled 1015 Americans between the ages of 18 and 79 (55%
female; 13.4% generation Z; 51.6% millennial; 9.9% baby boomer). Survey findings
included:
53% indicated they spend less time sleeping than before the pandemic
67% believe their sleep was healthier before the beginning of lockdown
68% feel stress or find it hard to sleep, even after lockdown measures were lifted
Moreover, differentiating sleep habits among generations were reported, with generation Z
(18-22 years old) and millenials (23-38 years old) going to bed later than any other
generation after quarantine. This could have major implications for younger people,
particularly adolescents as insomnia has been noted to be a prevalent issue in this age group.
Sleep health interventions in response to pandemics and other crises are limited, as is
research on such interventions. During the COVID-19 pandemic, relevant societies developed
recommendations for how to avoid sleep disturbances and promote sleep health. Such
Certain groups are testing solutions to screening and addressing acute sleep complaints using
evidence-based behavioral sleep interventions are particularly relevant during pandemics and
are generally accessible. Our results may assist in identifying at-risk groups, and facilitating
the development of personalized intervention that target distinct sleep profiles, which may
vary in the intensity of therapy required within a stepped care model and depend upon the
chronicity of the sleep problems. Based upon our results, the dissemination and
demographic and household/family factors, and sleep history (Petrov et al., 2021).
Leisure Activity
Social distancing policies have been implemented around the world to reduce the
spread of coronavirus disease 2019 (COVID-19). These measures have included temporary
restrictions on mass gatherings and the closure of public facilities, limiting the pursuit of
leisure activities such as travel while allowing more time for at-home pursuits, including
creative activities such as gardening and painting. Previous research has demonstrated the
benefits of physical activity for psychological well-being during COVID-19, but less
attention has been given to the potential benefits of creative pursuits, such as arts and music.
Outdoor recreation provides important recreational ecosystem services (e.g. stress relief,
socialization, nature appreciation, etc.) through physical interaction with the natural world
(Scholte et al. 2019). In times of crisis or disaster, outdoor recreation also provides an
Berman and Bettencourt 2020). Limitations to travel across all scales—from intercontinental
(Bao et al. 2020). Though necessary to thwart the spread of the virus, diminished or restricted
access to settings that facilitate outdoor recreation reduce a community’s capacity to cope
with crisis, especially for the outdoor enthusiast subculture—those who are highly dependent
necessary restrictions to access have also complicated the role parks and outdoor recreation
play in the promotion of psychological and physiological recovery during crisis (Rung et al.
2011; Samuelsson et al. 2020). Loss of access to outdoor recreation opportunities inhibits
individuals’ abilities to engage with restorative natural environments and escape the pressures
of the crisis (Rung et al. 2011; Samuelsson et al. 2020). It is therefore imperative that
officials and planners have access to information concerning changes to outdoor recreation
behaviors (De Valck et al. 2016). With challenge comes stress and the need for reprieve. Our
findings indicate that urban outdoor enthusiasts are disproportionately impacted by the
settings, and reducing backcountry recreation to greater degrees than residents of rural areas.
Put another way, those most directly impacted by the pandemic (Stier, Berman and
Bettencourt 2020) have also experienced the greatest impact on their ability to cope with the
pandemic.
Focusing on leisure actives, a web survey in Spain found a large increase in legacy
media and social media consumption, except for watching TV and listening to the radio. In
particular, evidence reported a significant growth in video calls or exchange of messages with
friends and relatives, the use of platforms such as Netflix and social media text-based groups
such as WhatsApp (Aymerich-Franch, 2020). In general, the activities more often carried out
during lockdown were working, studying, cooking, watching movies/streamed TV, social
media/video calling, reading, physical exercise and house cleaning and tidying (Aymerich-
Franch, 2020). Overall, there is little doubt that global lockdown due to the spread of
COVID-19 has profoundly affected leisure choices, activities and companions. How this has
changed among young people, however, is a partially unexplored topic; to what extent
is an issue little investigated in relation to youth leisure. Given the centrality of leisure in
young people’s lives and its vital role in the definition of identities and the development of
relationships, it is certainly worthy of analysis. In this respect, one study reveals that the
respondents differ in their spirit of adaptation: Some have significantly changed their daily
habits, while others have maintained or changed them to a lesser extent. Young people in
particular have significantly re-negotiated their lifestyles and have resorted to a greater
increase in time for lazing around and sleeping, young people seem to be more resilient than
adults, probably thanks to their confidence with digital tools, which created opportunities for
staying in contact with friends and being engaged in entertainment activities (Panarese et al.,
2021).
One study is the first to describe the effects of government COVID-19 related
Australian children, adolescents, and adults. The results of this study suggest that Australian
COVID-19 lockdown restrictions in April/May 2020 may have negatively impacted the
proportion of children, and positively impacted the proportion of adults meeting MVPA
recommendations, with no change among adolescents. There were varying reported effects
on active recreation across age groups and by sex. Potential physical activity promotion
strategies as COVID-19 lockdown restrictions progress and ease include supporting at home
practice and play and recreational activity. These findings can inform government policy and
investment in public health, sport and recreation strategies to maintain adults' physical
activity and (re)engage children and adolescents' physical activity post-COVID-19 (Arundell
et al., 2022).
and restrictions. While these restrictions help to abate the rate of infection, such limitations
result in negative effects by limiting participation in normal daily activities, physical activity
(PA), travel and access to many forms of exercise (e.g., closed gyms, no group gatherings,
increased social distancing). Several countries are enforcing curfews, which limit the time to
participate in outdoor activities, or are excluding outdoor activities entirely. Such restrictions
impose a burden on population health by potentially compromising physical fitness, which is
positively associated with the ability to cope with infections and the immunologic and
poor mental health are among the most important risk factors for major disease morbidity.
This holds true not only for the general population, but specifically for older adults and
mortality. For children and youth, physical activity is closely coupled to school-related
activities, active transport and sport participation. As schools have been closed during the
increasing the risk of longer-term sedentary behaviours. The results of this survey concur
with recent studies demonstrating that the current COVID-19 home confinement could
engagement. The restrictions have reduced overall PA (number of days and number of hours)
and access to exercise. In spite of an increased offering of PA guidance and classes available
on social media, present results indicate that it has not been possible for individuals to
adequately maintain their normal PA patterns with home activities. The decline in PA was
participation is impacted by the current COVID-19 pandemic will be linked to the stringency
regional policies and socio-economic factors were associated with differences in PA. These
factors need to be considered when designing and promoting PA interventions for the
COVID-19 pandemic. It was recently demonstrated that individuals demonstrate a greater use
(15%) of Information and Communications Technology (ICT) during the confinement period.
Social distancing and home deliveries decreased the opportunities for physical
sedentariness, and affecting health and wellbeing. However, it is important to emphasize that
numerous interindividual differences account for different behaviors that may depend on
personal characteristics and that have led some to cook more and devote more time to meals
within the family and others instead to use the food in a disorderly way for boredom, as a
consolation or to quell anxiety. Although most people show good resilience, still a large part
of the community is at risk and predisposed to acquire lifestyle behaviors that are potentially
harmful to their health, regardless of the initial body weight. Indeed, we observed that while
some took advantage of the home confinement to increase physical activity, many people
stopped or reduced sports and recreational activities also facilitated by the closure of gyms
and swimming pools. These findings suggest the need to raise awareness of subjects
regarding lifestyle according to national guidelines, and to tailor strategies for health policies
Mental Health
The COVID-19 pandemic may have brought many changes to how you live your life,
and with it, at times, uncertainty, altered daily routines, financial pressures and social
isolation. You may worry about getting sick, how long the pandemic will last, whether your
job will be affected and what the future will bring. Information overload, rumors and
misinformation can make your life feel out of control and make it unclear what to do. During
the COVID-19 pandemic, you may experience stress, anxiety, fear, sadness and loneliness.
And mental health disorders, including anxiety and depression, can worsen. Surveys show a
major increase in the number of U.S. adults who report symptoms of stress, anxiety,
depression and insomnia during the pandemic, compared with surveys before the pandemic.
Some people have increased their use of alcohol or drugs, thinking that can help them cope
with their fears about the pandemic. In reality, using these substances can worsen anxiety and
Research indicates that mental health worsened during the Coronavirus crisis, in
particular among women and university students. However, few longitudinal studies have so
far investigated the changes in mental health outcomes across three subsequent waves of the
COVID-19 pandemic. The results of the study are consistent if comparing mental health
variables considered as categorical and continuous. Significant changes across gender and
three waves of the COVID-19 pandemic were found in anxiety, perceived stress, self-
reported physical health, and life satisfaction. It means that future systematic reviews and
meta-analyses could be more sensitive at the period of data collecting in particular studies.
Wave of pandemic, as well as gender, should be consider in the future studies as factors
prevention and intervention programs at universities should be a priority in the fight against
The uncertainties and fears associated with the virus outbreak, along with mass
lockdowns and economic recession are predicted to lead to increases in suicide as well as
mental disorders associated with suicide. For example, McIntyre and Lee (2020b) have
reported a projected increase in suicide from 418 to 2114 in Canadian suicide cases
associated with joblessness. The foregoing result (i.e., rising trajectory of suicide) was also
reported in the USA, Pakistan, India, France, Germany, and Italy (Mamun and Ullah, 2020;
Thakur and Jain, 2020). Separate lines of research have also reported an increase in
psychological distress in the general population, persons with pre-existing mental disorders,
as well as in healthcare workers (Hao et al., 2020; Tan et al., 2020; Wang et al., 2020b).
Taken together, there is an urgent call for more attention given to public mental health and
policies to assist people through this challenging time. Several studies identified frequent
symptoms (Gao et al., 2020; Moghanibashi-Mansourieh, 2020). Frequent social media use
amplified anxiety. With the unpredictable situation and a lot of unknowns about the novel
coronavirus, misinformation and fake news are being easily spread via social media platforms
(Erku et al., 2020), creating unnecessary fears and anxiety. Sadness and anxious feelings
could also arise when constantly seeing members of the community suffering from the
pandemic via social media platforms or news reports (Li et al., 2020). Reports also suggested
that poor economic status, lower education level, and unemployment are significant risk
factors for developing symptoms of mental disorders, especially depressive symptoms during
the pandemic period (Gao et al., 2020; Lei et al., 2020; Mazza et al., 2020; Olagoke et al.,
2020;). The coronavirus outbreak has led to strictly imposed stay-home-order and a decrease
in demands for services and goods (Nicola et al., 2020), which has adversely influenced local
businesses and industries worldwide. Surges in unemployment rates were noted in many
countries (Statistics Canada, 2020; Statista, 2020). A decrease in quality of life and
uncertainty as a result of financial hardship can put individuals into greater risks for
Figure 1 shows a modified schema that visualizes the relationship of the following variables.
The diagrammatic paradigm above depicts a more accurate way this framework is trying to convey.
The independent variable which is the profile of the respondents are the: (a) age, (b) sex, (c) year
level, (d) body mass index, and (e) Self-report of overall health of the respondents. The dependent
variable are the lifestyle changes due to COVID-19 in terms of: (a) dietary changes, (b) sleeping
pattern, (c) lifestyle changes and the (d) overall mental health of the respondents. The diagram shows
There is no significant relationship between the demographic profile of the respondents (age,
sex, year level, body mass index, and self-report of overall health) to the lifestyle changes due to
COVID-19 (dietary changes, sleeping pattern, leisure activity, and overall mental health).