During the era of COVID-19, it can sometimes feel as though we have no control over our own well-being. We may have adopted some unhealthy behaviours in the past couple of months to cope with this perceived lack of control. These behaviours are a natural response to a stressful environment. However, we can improve our wellness with intentional effort and awareness of how our thoughts and behaviours may have changed. Wellness in COVID-19 goes beyond hand hygiene. We must also take inventory of our lifestyle hygiene, which includes taking stock of what we are eating, how much we are moving, our stress levels, our social connections, how much sleep we are getting, and what our purpose is.
Our overall wellness includes having a healthy body mass index (BMI). Data from patients with COVID-19 in New York City has highlighted the important role of body fat in the development of COVID-19 and its consequences. A large study in New York City showed that having a BMI of over 40 increased the odds of hospitalization by a factor of 6.2, making it the strongest predictor of hospitalization apart from age. 1 Furthermore, individuals with a BMI > 35 were more than seven times more likely to require a ventilator to assist with breathing compared to individuals with a BMI < 25.2 The current understanding for this association is that the cells that make up fat release inflammatory chemicals, which adds to the overactive immune response that COVID-19 causes.
Regardless of our BMI, keeping our stress levels in check, having adequate sleep, having a sense of purpose and maintaining social connections play significant roles in our health. A survey by Angus Reed assessing the effects of COVID-19 on individual well-being showed that 44% of respondents were worried, 41% were anxious, 50% reported their mental health was worse, 42% reported their physical health was worse and 32% of relationships with friends outside the home were worse. Putting intentional effort into improving our lifestyle hygiene can help reduce these negative effects and help us come out of these challenging times stronger and more resilient.
Practical tips for improving our lifestyle hygiene in the era of COVID
● Eat as many colors of the rainbow as you can. Colorful fruits and vegetables are packed with micronutrients and fiber that will not only make you feel better physically, but have also been shown to improve your mood and energy level.
● Go to the grocery store with a list of food items you will buy, and buy only those foods. When you make that list, ask yourself how you are going to feel an hour later after eating each of those items. This will help to prevent you from buying those craving foods that make you feel good while you are eating, but make you feel less healthy in the long term. Seek accountability by telling someone you are living with at home or a friend that you are just sticking to buying the items on your list. Most of us turn to comfort food as stress relief. Comfort foods, in the short term, release endorphins that serve as powerful emotional pain relievers. Unsurprisingly, ultra-processed food companies have experienced an uptick of sales during the era of COVID-19.
● Stock up on the healthy and cheap foods with a long shelf life: frozen produce, canned beans and root vegetables are your friends!
● If you are utilizing a food bank and your options are limited, be aware of the limits of your control and do not judge yourself for this. You can eat plant-based on a budget for $5/day using this website: https://www.forksoverknives.com/wellness/healthy-food-on-tight-budget/#gs.6pr3nk
● Some movement is better than none. Movement in any form is beneficial, whether it is a structured workout video from YouTube or dancing in your pajamas in your living room.
● Most of our calories burned come from unstructured activities. If you are on a work call, walk around your work space if you are able to, or park a bit further away from the store so you can walk a little bit longer.
● Try a new exercise every day to prevent boredom. Many workout programs are offering free or discounted trials right now. YouTube is filled with excellent free exercise programs, from yoga to hip hop dancing.
● COVID-19 has presented threat, loss and injustice. Our natural emotion to the perception of threat is anxiety, our perception of loss is sadness and depression, and our perception of injustice leads to anger.
● Take inventory of your stress. Ask a loved one how they think you are coping. Ask yourself about any tension in your relationships you may be experiencing, or if you are relying on substance use to cope.
● Be aware of your permissive thoughts, which are the thoughts you have that permit you to engage in unhealthy behaviors. For example, telling yourself "I'm stressed therefore I deserve the bag of chips." When you feel you may be experiencing a permissive thought, try to utilize the 5 evidence-based strategies below for coping with stress. Which strategy is the most effective depends on the individual person. The more of these you do, the less you will stress.
1. Physical calming: Deep breathing, meditation, praying, reading a book, drinking a cup of tea, petting the dog/cat.
2. Physical discharge: Burning off energy in the form of movement.
3. Emotional expression: Write a letter, write in a journal, have a conversation with a friend about what you are feeling.
4. Social connection: Call an old friend or go for a physically-distanced walk with a friend. Random acts of kindness have been shown to make us happier.
5. Acceptance: Surrender to the moment, and acknowledge that your feelings and emotions are valid. Have the awareness that emotions are transient in nature, much like waves. They come over you, but they are going to pass over you. Have awareness of this temporal pattern while an emotion washes over you.
● Try your best to get between 7-9 hours of sleep per night. A good sleep can reduce the tendency to engage in impulsive behaviors the next day.
● Keep a regular sleep schedule (i.e. go to bed and wake up at roughly the same time every day).
● Use the pandemic as an opportunity to thrive, not just survive. Take this time to work on a project you've always wanted to complete, read a book you've always wanted to read, or learn a new skill you've always wanted to learn.
● Turn this difficult situation into an opportunity.
Humans like behaviour patterns and routines. Try your best to create a daily routine that incorporates these tips. This will help to prevent those maladaptive behaviors that arise out of boredom and lack of structure, like making a trip to the fridge when you aren’t hungry. Remember, the strongest predictor of success is not giving up.
These tips were adapted from the webcast titled “Weight Management and COVID-19: What you need to know”, featuring Drs. Sue Pedersen (Endocrinologist), Sandy Van (Family Medicine physician) and Michael Vallis (Health Psychologist).
Guest Author: Dr. Celeste Bouchard
Dr. Celeste Bouchard is a Family Medicine resident at the Mayo Clinic in Rochester, MN. She intends to pursue a track towards Lifestyle Medicine board certification. Dr. Bouchard joins us from Ontario, Canada.
1. Lighter J, Phillips M, Hochman S, Sterling S, Johnson D, Francois F, Stachel A (2020). Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission, Clinical Infectious Diseases, ciaa415, https://doi.org/10.1093/cid/ciaa415
2. Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, Labreuche J, Mathieu D, Pattou F, Jourdain M (2020). High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). doi: 10.1002/oby.22831. [Epub ahead of print]