To the best of our knowledge, this is the first study to evaluate the influence of COVID-19-related home confinement on changes in weight, dietary habits and physical activity levels in a large sample of Saudi Arabian adult population. Overall, this study has found that quarantine has negatively affected body weight, dietary habits, and physical activity levels.
Data from the current study showed that the majority of the participants (38%) reported weight gain during the lockdown, with a reported gain of around 3–5 kg. Similarly, other studies have reported weight gain of ~ 3–4.5 kg during quarantine . Since quarantine is associated with limiting people’s ability to go to work, the gym, parks, and even practicing normal daily routines, weight gain is expected due to the general decrease in energy expenditure. Moreover, the emotional distress accompanied with being locked at home for months and fear of the novelty and the high spread of COVID-19  might provoke emotional eating and cravings. This result is in line with those of recent studies that captured weight gain concerning COVID-19 home confinement [6, 10, 19]. In this study, however, a comparable percentage of participants (36%) did not notice any weight change. This could be due to an increased level of awareness, or they may have not been as majorly affected by quarantine as people who continued to go to their workplaces during the curfew in comparison to the weight gain group.
The link between the current global lockdown with higher amounts of food intake was previously reported in Poland, Italy and UK [10, 11, 14] . Consistent with previous studies, the present study has demonstrated an increase in food consumption and snacking which were significantly higher in those who gained weight during quarantine. A logical explanation is the nature of quarantine, with people spending most of the day locked at homes with minimal activities available, watching more television and having an abundance of stocked groceries. Prior evidence has shown that increased time spent on watching television was associated with increased risk of weight gain in adults . The availability of large food quantities for many days might lead to overeating, not necessarily due to hunger . During home confinement periods, people tended to stock their kitchens with different foods to reduce unnecessary grocery trips due to the fear of contracting the infection . The majority of these foods are ready-to-eat meals, canned foods, and products with long-shelf-life, which are often dense with calories.
Cooking at home is usually perceived as healthier or at least lower in calories than eating from restaurants. Surprisingly, almost 30% of participants in this study who reported an increase in their home-cooked meals than before the lockdown had gained weight during the quarantine. This result might be elaborated by the fact that not all cooking methods are considered healthy; some people might add large amounts of fat and/or sugar, which could lead to a substantial amount of added calories. Although such ingredients are high in calories, they play a role in increasing the palatability of food, making it more appealing in such stressful situations. Interestingly, it was found by Rodríguez-Pérez et al.  that people in Spain have increased their Google searches of the term “homemade cake” since the start of the lockdown. Homemade bread and cakes intake were also found to be higher during quarantine in Italy [11, 19]; therefore, a similar trend in food and cooking could possibly be applied in Saudi Arabia. However, 19% of those who reported an increase in home-cooked meals have lost weight, which is apparently due to a healthier and less caloric way of cooking. This finding is consistent with that of Rodriguez-Perez et al.  who found a better adherence to healthy types of cooking during the COVID-19 quarantine among the Spanish population. The quarantine is likely to have wide ranging effects on population’s dietary habits. Despite all the negative dietary changes, it was found previously that staying at home during the quarantine period was an opportunity for adapting positive dietary behaviors . The current study supports this finding and showed that around half of the study participants increased their intake of healthy food; however, the definition “healthy food” was not stated in the question and was thus dependent on the perception of each individual. A significantly higher percentage of those who reported an increase in healthy food consumption expressed a decrease in body weight compared to other groups.
The main two reasons indicated in the study sample for changing dietary habits during the quarantine were more due to boredom and emptiness or having more time for meals preparation. Staying home for long periods may raise the feeling of boredom, which is often associated with overeating to escape monotony . This behavior was also reported by Zachary et al.  where participants stated an increase in eating with others, eating because of cravings, and eating in response to stress and boredom.
The current study also inspected changes in the intake of particular foods during the lockdown. Higher water intake was reported by more than half of the participants. This is a positive behavior for the Saudi population, as hydration status has been linked to innate mucosal immunity . This behavior might because of easier access to water and increased awareness of the amount of water consumption during quarantine. An Italian study also showed a sufficient water drinking habit among the Italian population . Similar to the findings of other studies [10, 11, 19], the majority of subjects in the present study have shown an increase in the intake of sweets, including cakes, chocolate, and ice cream. This also accords with this study’s observation of dietary patterns, which showed that subjects in this study increased their snacking frequency during quarantine; thus, it can be assumed that the bulk of snacks consumed were sugary ones rather than savory. During confinement, people were facing incredibly stressful conditions, between continuously reading or watching updates in the news and being afraid to get infected with the COVID-19. Subsequently, stress can urge people to have food cravings, especially to sweets known as “comfort food,” which are loaded with calories . Craving for carbohydrates, in particular, stimulates the production of serotonin (a neurotransmitter found in the brain), which positively affects mood . Such behavior, in turn, could make people at a higher risk for obesity and serious COVID-19 complications. The results of this study also showed that almost half of the subjects increased their fruit and vegetable consumption. This is noteworthy, particularly in a society that relies on an omnivorous diet that is rich in red meat and poor in fruits and vegetables, as discussed by Afshin et al. . Regarding the intake of fruits and vegetables during quarantine in other studies, findings were inconsistent. The intake of fruits and vegetables were increased in Spain , decreased in Poland , and did not changed in Italy .
The study revealed that the most commonly consumed natural food during quarantine was honey, followed by lemon. Consuming honey is part of Saudi culture; furthermore, honey is known for its general potent antiviral effects by many researchers [28,29,30]. Some efforts have been conducted in Saudi Arabia to examine the effect of honey and other natural products on COVID-19 patients . In regards to dietary supplements, this study revealed that half of the participants who admitted to taking dietary supplements reported that they were taking vitamin C supplements, while a quarter reported the intake of multivitamins and vitamin D. It is unsurprising that vitamin C was the most consumed dietary supplement, as it is well known for its immune-boosting effects, especially in individuals with subnormal levels of the vitamin, as stated by Carr et al. .
The Saudi population is at a low physical activity level compared to other populations , which was exacerbated by the lockdown with a decline that was found in this study. Around half of the population reported not practicing any kind of physical activity during the quarantine period; however, the other half reported performing 60–120 min per week of moderate intensity exercise (predominantly walking indoors or outdoors), which is still less than the recommended level of physical activity to provide protective effects against chronic diseases . This study supports recent evidence from an international observation showing a universal decline in all physical activity levels during COVID-19 pandemic .
The study was done in a relatively short period of time as suggested by previous studies . It also took place amid the pandemic’s highest restrictions imposed in Saudi Arabia, that is part of the Middle East and shares many cultural, habitual, and dietary behaviors that can also provide insights into neighboring countries. To the best of the authors’ knowledge, this is the first study to provide the previously mentioned insights in Saudi Arabia. Although this study might be specific to certain circumstances, the outcomes and results are significant in the prevention and preparation of any future incidents that necessitates a lockdown.
Although this study provides a general insight on how dietary habits and physical activity changed during the pandemic, it has some limitations. Many considerations were put in mind when structuring the questionnaire to encourage all societal groups to participate. Although the questionnaire was relatively short and used simple language, it was limited in providing specific information, such as the exact quantities of food consumed and details about food preparation methods. It is also evident that this study used self-reported information, including weight and height measurements and expected weight changes during quarantine due to its anonymous nature, and thus might introduce misreported data. Although data were collected from all regions of Saudi Arabia, the variations in dietary habits and lifestyle between these regions were not considered. However, the aim of this study focused on the overall dietary habits and physical activity changes in the whole country.