COVID-19 circuit-breaker leads to unhealthy diets among Singapore’s frontliners

During the circuit-breaker, healthcare workers (HCWs) in Singapore often keep unhealthy dietary patterns and see a decrease in their self-regulatory (SR) eating behaviours, according to a recent study.

Those who are able to maintain their SR behaviours and healthful diets are more likely to be stress-free during the pandemic.

Of the 707 surveyed HCWs (mean age 37.6 years, 84.0 percent women), 92.8 (n=656) percent expressed intention of having a healthy diet. Even in this subgroup, however, vegetable intake decreased significantly during the circuit-breaker (p=0.027). [Sci Rep 2022;12:16257]

Similarly, HCWs who had intended to keep a healthy diet also increased their consumption of soft or canned drinks (p=0.003), convenience-store food (p<0.001), and canned or salty food (p<0.001) during the circuit-breaker. Concomitantly, there were significantly more HCWs cooking their own meals, rather than buying food, during the circuit-breaker (p<0.001).

In terms of SR behaviours, survey responses revealed that before the pandemic, 91.8 percent of participants who were intending to have a healthy diet had medium-to-high SR. This dropped significantly to 87.7 percent during the pandemic (p=0.011). In contrast, 70.9 percent were able to maintain or otherwise improve their eating habits, demonstrating medium-to-high SR during the circuit-breaker.

Researchers also noted important differences in SR according to participant ethnicity and job role. For instance, HCWs in administrative positions were nearly 250 percent more likely to have deteriorating SR behaviours than nurses (odds ratio [OR], 2.48, 95 percent confidence interval [CI], 1.02–6.06; p=0.046). This could be attributed to differences in work arrangements: whereas nurses work onsite, administrative staff may be able to work from their homes.

Similarly, patients who were of Chinese (OR, 2.15, 95 percent CI, 1.04–4.46; p=0.39) or Indian (OR, 3.54, 95 percent CI, 1.43–8.74; p=0.006) ethnicity were significantly more likely to have worsening SR than Malay comparators.

Self-regulation, diet, and distress

The researchers then assessed how changes in SR behaviours could impact the participants’ stress levels and their coping mechanism.

HCWs who were able to maintain or improve their SR behaviours during the circuit-breaker were more than twice as likely to be nonstressed as compared with counterparts who let their diet quality deteriorate (OR, 2.11, 95 percent CI, 1.27–3.48; p=0.004).

Indeed, 84.8 percent and 80.3 percent of HCWs whose SR remained unchanged or had improved reported being stress-free, respectively, while such a status was present in only 70.7 percent of participants whose SR deteriorated (p=0.002). Of note, this overall effect was driven mostly by nurses and allied health professionals, in whom a stress-free status remained significantly more common among those with healthy diets.

“Despite the obvious changes in dietary choices available in addition to the restrictions imposed, HCWs who continued to maintain precircuit-breaker SR were more likely to be stress-free and cope with the adversities,” the researchers said.

“Short screening questionnaires based on SR changes should be developed and explored as surveillance tools for assessment of HCWs’ general well-being such that personalized interventions to vulnerable groups of workers could be implemented effectively on the ground,” they added.