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Background Obesity and rapid weight gain are established risk factors for noncommunicable diseases and have emerged as independent risk factors for severe disease following Coronavirus Disease 2019 (COVID-19) infection. Restrictions imposed to reduce COVID-19 transmission resulted in profound societal changes that impacted many health behaviours, including physical activity and nutrition, associated with rate of weight gain. We investigated which clinical and sociodemographic characteristics were associated with rapid weight gain and the greatest acceleration in rate of weight gain during the pandemic among adults registered with an English National Health Service (NHS) general practitioner (GP) during the COVID-19 pandemic. Methods and findings With the approval of NHS England, we used the OpenSAFELY platform inside TPP to conduct an observational cohort study of routinely collected electronic healthcare records. We investigated changes in body mass index (BMI) values recorded in English primary care between March 2015 and March 2022. We extracted data on 17,742,365 adults aged 18 to 90 years old (50.1% female, 76.1% white British) registered with an English primary care practice. We estimated individual rates of weight gain before ([delta]-prepandemic) and during ([delta]-pandemic) the pandemic and identified individuals with rapid weight gain (>0.5 kg/m.sup.2 /year) in each period. We also estimated the change in rate of weight gain between the prepandemic and pandemic period ([delta]-change = [delta]-pandemic-[delta]-prepandemic) and defined extreme accelerators as the 10% of individuals with the greatest increase in their rate of weight gain ([delta]-change [greater than or equal to]1.84 kg/m.sup.2 /year) between these periods. We estimated associations with these outcomes using multivariable logistic regression adjusted for age, sex, index of multiple deprivation (IMD), and ethnicity. P-values were generated in regression models. The median BMI of our study population was 27.8 kg/m.sup.2, interquartile range (IQR) [24.3, 32.1] in 2019 (March 2019 to February 2020) and 28.0 kg/m.sup.2, IQR [24.4, 32.6] in 2021. Rapid pandemic weight gain was associated with sex, age, and IMD. Male sex (male versus female: adjusted odds ratio (aOR) 0.76, 95% confidence interval (95% CI) [0.76, 0.76], p < 0.001), older age (e.g., 50 to 59 years versus 18 to 29 years: aOR 0.60, 95% CI [0.60, 0.61], p < 0.001]); and living in less deprived areas (least-deprived-IMD-quintile versus most-deprived: aOR 0.77, 95% CI [0.77, 0.78] p < 0.001) reduced the odds of rapid weight gain. Compared to white British individuals, all other ethnicities had lower odds of rapid pandemic weight gain (e.g., Indian versus white British: aOR 0.69, 95% CI [0.68, 0.70], p < 0.001). Long-term conditions (LTCs) increased the odds, with mental health conditions having the greatest effect (e.g., depression (aOR 1.18, 95% CI [1.17, 1.18], p < 0.001)). Similar characteristics increased odds of extreme acceleration in the rate of weight gain between the prepandemic and pandemic periods. However, changes in healthcare activity during the pandemic may have introduced new bias to the data. Conclusions We found female sex, younger age, deprivation, white British ethnicity, and mental health conditions were associated with rapid pandemic weight gain and extreme acceleration in rate of weight gain between the prepandemic and pandemic periods. Our findings highlight the need to incorporate sociodemographic, physical, and mental health characteristics when formulating research, policies, and interventions targeting BMI in the period of post pandemic service restoration and in future pandemic planning., Author(s): Miriam Samuel 1,*, Robin Y. Park 2, Sophie V. Eastwood 3, Fabiola Eto 1, Caroline E. Morton 1,2, Daniel Stow 1, Sebastian Bacon 2, Amir Mehrkar 2, Jessica Morley [...]

Background: COVID-19 pandemic restrictions may have influenced behaviours related to weight. Aim: To describe patterns of weight change among adults living in England with type 2 diabetes (T2D) and/or hypertension during the pandemic. Design and setting: An observational cohort study using the routinely collected health data of approximately 40% of adults living in England, accessed through the OpenSAFELY service inside TPP. Method: Clinical and sociodemographic characteristics associated with rapid weight gain (>0.5 kg/m2/year) were investigated using multivariable logistic regression. Results: Data were extracted on adults with T2D (n = 1 231 455, 43.9% female, and 76.0% White British) or hypertension (n = 3 558 405, 49.7% female, and 84.3% White British). Adults with T2D lost weight overall (median δ = −0.1 kg/m2/year [interquartile range {IQR} −0.7–0.4]). However, rapid weight gain was common (20.7%) and associated with the following: sex (male versus female: adjusted odds ratio [aOR] 0.78 [95% confidence interval {CI} = 0.77 to 0.79]); age (older age reduced odds, for example, aged 60–69 years versus 18–29 years: aOR 0.66 [95% CI = 0.61 to 0.71]); deprivation (least deprived Index of Multiple Deprivation [IMD] quintile versus most deprived IMD quintile: aOR 0.87 [95% CI = 0.85 to 0.89]); White ethnicity (Black versus White: aOR 0.95 [95% CI = 0.92 to 0.98]); mental health conditions (for example, depression: aOR 1.13 [95% CI = 1.12 to 1.15]); and diabetes treatment (non-insulin treatment versus no pharmacological treatment: aOR 0.68 [95% CI = 0.67 to 0.69]). Adults with hypertension maintained stable weight overall (median δ = 0.0 kg/m2/year [IQR −0.6–0.5]); however, rapid weight gain was common (24.7%) and associated with similar characteristics as in T2D. Conclusion: Among adults living in England with T2D and/or hypertension, rapid pandemic weight gain was more common among females, younger adults, those living in more deprived areas, and those with mental health conditions. [ABSTRACT FROM AUTHOR]

Objectives: To describe the direct impact of coronavirus disease 2019 (COVID-19) infection on morbidity and mortality in people with multiple long-term conditions (MLTCs). Design: A systematic review and meta-analysis including observational studies. Setting: Studies conducted between 1 January 2020 and 4 May 2023 across 51 countries were identified from five databases. Participants: A total of 4,084,469 patients with confirmed COVID-19 infection. Main outcome measures: Pooled risk ratios (RRs) for mortality, hospitalisation, severe disease, intensive care unit (ICU) admission and mechanical ventilation were estimated with random effect meta-analysis models. Results: A total of 38,356 studies were identified and 111 included. In most (74%) of the studies, MLTCs referred to having two or more long-term conditions. Others described MLTCs by high weighted indices: the Charlson Comorbidity Index in 11% and the Clinical Frailty Score in 7%. Using the National Institutes of Health quality assessment tool for observational studies, the risk of bias was judged as low and moderate in 86 and 25 studies, respectively. Having MLTCs was associated with increased mortality (RR: 2.61 [95% CI: 2.27 to 3.0]); hospitalisation (2.4 [1.92 to 2.99]); severe disease (2.61 [1.92 to 3.54]); ICU admission (1.22 [1.07 to 1.39]) and mechanical ventilation (1.83 [1.18 to 2.84]) compared with those with no MLTCs. Pooled RRs for adverse outcomes were higher in children and young people compared with all age groups. In meta-regression analyses, men were more likely to need ICU admission (p = 0.013) and mechanical ventilation (p = 0.002). Conclusions: Public health policies, clinical and preventative interventions should prioritise people with MLTCs to minimise direct adverse outcomes from COVID-19 disease. [ABSTRACT FROM AUTHOR]

Aim: To assess mortality and complication trends in people with type 1 diabetes during the 11 years before the SARS‐CoV2 pandemic (2009–2019). Materials and Methods: Sequential cohorts of people in England with type 1 diabetes aged ≥20 years from the National Diabetes Audit (2006/2007 to 2016/2017) were analysed. Discretized Poisson regression models, adjusted for age, sex, ethnicity, socioeconomic deprivation and duration of diabetes, were used to calculate mortality and hospitalization rates. Results: Demographic characteristics changed little; average diabetes duration increased. All‐cause mortality was unchanged. Cardiovascular and kidney disease mortality declined. Mortality from respiratory disease, diabetes and dementia increased in younger people (aged 20–74 years) as did mortality from liver disease and dementia in the elderly (aged ≥75 years). Younger Asian and Black people had lower all‐cause mortality than those of White ethnicity; elderly Mixed, Asian and Black people had lower all‐cause mortality. People from more deprived areas had higher all‐cause mortality. The deprivation gradient for mortality was steeper at younger ages. In younger people, rates of hospitalization increased for myocardial infarction, stroke, heart failure and kidney disease but only for kidney disease in the elderly. Rates of a composite measure of cardiovascular hospitalizations increased in younger people (rate ratio [RR] 1.07, 95% confidence interval [CI] 1.03–1.11) but declined in the elderly (RR 0.91, 95% CI 0.86–0.95). Conclusion: Between 2009 and 2019, hospitalizations for cardiovascular disease increased at younger ages (20–74 years) and hospitalizations for kidney disease increased at all ages, but mortality from cardiovascular and kidney disease declined. All‐cause mortality rates were unchanged. [ABSTRACT FROM AUTHOR]

Objective: The study objective was to assess participant weight change for the English National Health Service (NHS) Digital Weight Management Programme, the first such digital intervention to achieve population coverage. Methods: A service evaluation was used to assess intervention effectiveness for adults with obesity and a diagnosis of hypertension and/or diabetes, between April 2021 and March 2022, using prospectively collected, national service–level data in England. Results: Of the 63,937 referrals made from general practices, within the time period, 31,861 (50%) chose to take up the 12‐week Programme. There were 31,718 participants who had time to finish the Programme; of those, 14,268 completed the Programme (defined as attending ≥60%), a 45% completion rate. The mean weight change for those who had time to finish the Programme was −2.2 kg (95% CI: −2.25 to −2.16), for those who completed it was −3.9 kg (95% CI: −3.99 to −3.84), and for those who had time to finish the Programme but did not complete it was −0.74 kg (95% CI: −0.79 to −0.70). Conclusions: The NHS Digital Weight Management Programme is effective at achieving clinically meaningful weight loss. The outcomes compare favorably to web‐based weight management interventions tested in randomized trials and those delivered as face‐to‐face interventions, and results suggest that the approach may, with increased participation, bring population‐level benefits. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of multiple longterm conditions (MLTC) at whole English population level, stratifying by age, sex, socioeconomic status and ethnicity. Design: A whole population study. Setting: Individuals registered with a general practice in England and alive on 31 March 2020. Participants: 60,004,883 individuals. Main outcome measures: MLTC prevalence, defined as two or more of 35 conditions derived from a number of national patient-level datasets. Multivariable logistic regression was used to assess the independent associations of age, sex, ethnicity and deprivation decile with odds of MLTC. Results: The overall prevalence of MLTC was 14.8% (8,878,231), varying from 0.9% (125,159) in those aged 0– 19 years to 68.2% (1,905,979) in those aged 80 years and over. In multivariable regression analyses, compared with the 50–59 reference group, the odds ratio was 0.04 (95% confidence interval (CI): 0.04–0.04; p < 0.001) for those aged 0–19 years and 10.21 (10.18–10.24; p < 0.001) for those aged 80 years and over. Odds were higher for men compared with women, 1.02 (1.02–1.02; p < 0.001), for the most deprived decile compared with the least deprived, 2.26 (2.25–2.27; p < 0.001), and for Asian ethnicity compared with those of white ethnicity, 1.05 (1.04–1.05; p < 0.001). Odds were lower for black, mixed and other ethnicities (0.94 (0.94–0.95) p < 0.001, 0.87 (0.87–0.88) p < 0.001 and 0.57 (0.56–0.57) p < 0.001, respectively). MLTC for persons aged 0–19 years were dominated by asthma, autism and epilepsy, for persons aged 20–49 years by depression and asthma, for persons aged 50–59 years by hypertension and depression and for those aged 60 years and older, by cardiometabolic factors and osteoarthritis. There were large numbers of combinations of conditions in each age group ranging from 5936 in those aged 0–19 years to 205,534 in those aged 80 years and over. Conclusions: While this study provides useful insight into the burden across the English population to assist health service delivery planning, the heterogeneity of MLTC presents challenges for delivery optimisation. [ABSTRACT FROM AUTHOR]