Snacking and anxiety during the coronavirus disease (COVID-19) pandemic: A prospective cohort study

Abstract

Anxiety and snacking increased during the initial coronavirus disease 2019 (COVID-19) lockdowns, but it remains unknown whether this change in snacking persisted and if it related to anxiety levels. We used prospective data to examine changes in snacking frequency from t1 (eased restrictions in England in May-June 2020) to t2 (national lockdown in December 2020-March 2021), the association of anxiety (assessed by the Generalised Anxiety Disorder-7 questionnaire at t1) with the snacking change, and the mediating and moderating effects of disinhibition and flexible restraint (assessed by the Three Factor Eating Questionnaire in 2016-17). Analyses including 2128 adults (mean age 28.4 y) residing in England from the Avon Longitudinal Study of Parents and Children showed that snacking frequency increased over time (mean change 1.23 (95% CI 0.81, 1.65) snacks/wk). Linear regressions of snacking adjusted for sociodemographic covariates showed that having clinical levels of generalised anxiety at t1, versus not, was associated with 1.22 (95% CI 0.07, 2.37) more snacks/wk at t2. Disinhibition partially mediated the association between Generalised Anxiety Disorder and snacking (β_indirect = 0.15, 95% CI 0.01, 0.32), while there was no evidence that flexible restraint moderated the association (β = 0.05, 95% CI -0.57, 0.66). Our longitudinal findings highlight a detrimental anxiety-snacking association partly operating via disinhibition, suggesting future research could target mitigating anxiety and disinhibited eating behaviours to benefit diet-related outcomes following the pandemic.

Keywords: Anxiety; COVID-19; Diet; Eating behaviour; Mental health; Snacking.

Fig. 1

Timeline of measurements for the variables of interest from the Avon Longitudinal Study of Parents and Children. SES = socioeconomic status.

Fig. 2

Bar chart of the proportion of participants reporting different snacking frequencies at t1 (period of eased restrictions in England from May to June 2020) and t2 (period of national lockdown in England from December 2020 to March 2021).

Fig. 3

Bar chart showing the proportion of participants reporting decreases, no change and increases in snacking from t1 (period of eased restrictions in England from May to June 2020) to t2 (period of national lockdown from December 2020 to March 2021). GAD = Generalised Anxiety Disorder.

Fig. 4

Model testing disinhibition mediating the association between Generalised Anxiety Disorder (GAD) and snacking (n = 1418). Mediations are from linear regression models using unstandardised coefficients, adjusted for age, sex, ethnicity, socioeconomic status, BMI and cognitive restraint. c’ pathways represent the direct effect of GAD on snacking when the mediator (disinhibition) is in the model, the product of a and b (a x b) pathway represents the indirect effect where GAD is associated with snacking indirectly through disinhibition.