Abstract: Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of the National Institute of Diabetes and Digestive and Kidney Diseases (DK000172) and conducted in accordance with the Declaration of Helsinki ethical standards. All volunteers provided written informed consent prior to beginning online survey. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
Background: The COVID-19 pandemic significantly impacted global mental health, leading to increased levels of fear, stress, and anxiety [1]. Previous research has suggested associations between functional fear of detrimental mental health outcomes and psychological stressors which may drive maladaptive eating behaviors. This study explored the associations between COVID-19 fear during later stages of the pandemic, psychological distress (anxiety, depression, and stress), maladaptive eating behaviors (emotional, uncontrolled, binge, and nighttime eating), and self-reported body weight.
Methods: This was a global cross-sectional survey conducted from February 2022 to February 2024, involving 4390 adults (70% female) from 25 countries. The survey collected information on demographics, psychosocial impact, eating behaviors, and COVID-19 related behaviors. General linear models, multinomial logistic regression modes, and structural equation modeling were used to analyze the data.
Results: Higher fear of COVID-19 was significantly associated with increased emotional and uncontrolled eating, even after adjusting for psychological distress and other covariates. Specifically, each unit increase in fear of COVID-19 scores was associated with a corresponding increase in emotional eating (β = 0.018) and uncontrolled eating (β = 0.029) behaviors (p-values < 0.0001). Furthermore, fear of COVID-19 was linked to higher odds of engaging in binge eating (OR = 1.05, 95% CI: 1.03, 1.07, p-value < 0.0001) and nighttime eating behaviors (OR = 1.04, 95% CI: 1.03, 1.06, p-value < 0.0001) in models adjusted for covariates; however, these associations were no longer significant when psychological distress variables were included. Fear of COVID-19 was also associated with body weight (β = 0.18) and BMI (β = 0.08) even with adjustments of covariates and psychological distress variables (p-values < 0.01). Structural equation modeling showed that fear of COVID-19 was related to current body weight through its impact on psychological distress and maladaptive eating behaviors.
Conclusions: Maladaptive eating behaviors influenced by the psychological distress experienced during the COVID-19 pandemic have persisted into the later stages of the pandemic. These results underscore an interconnectedness between functional fear and its influence on maladaptive eating behaviors and body weight. Understanding this link is crucial and has the potential to inform the development of public health policies.
Trial Registration: Clinical Trials.gov NCT04896060 Date of Registration: May 21, 2021.
(© 2025. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
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