Inactive footsteps. Monitoring behavioral risk factors in the post-pandemic era: weight gain, inactivity and active mobility in Emilia-Romagna

Background Restrictive measures due the COVID-19 pandemic and their psychological impact changed human behavior. The aim of the study was to describe the trend in weight gain and sedentary lifestyle among adults (18-69 years) before and after the pandemic outbreak in the Emilia-Romagna region. Methods We analysed data from the Italian-behavioral-risk-factor-surveillance-system (PASSI) from 2008-2021 on excessive weight, sedentary lifestyle prior and after the pandemic outbreak, stratifying the population by sex, age, educational and socio-economic characteristics. Furthermore, preliminary data on active mobility from 2018-2021 was analysed. Results Data from 42122 interviews were collected between 2008- 2021 (3085 in 2019, 927 in 2020, 1834 in 2021). Prevalence of overweight showed an increasing trend in the pandemic period (28,7%, IC 95% [27,1-30,4] in 2019 vs 30,9% [27,8-34,3] in 2020 vs 31,2% [29,0-33,5] in 2021), which broke the declining trend observed over the last decade, with a higher variation among ages 35 to 49. People with lower economic status showed high levels both in 2020 and 2021. Prevalence of obesity showed a slight reduction in 2020, which returned to pre-pandemic values in 2021 (12,2% [11,0-13,5] in 2019 vs 9,7% [7,8-11,9] in 2020 vs 11,3% [9,8-12,9] in 2021). No differences were observed when stratifying by age and sex. As for sedentary lifestyle, there was a foreseeable increase in 2020 with a sudden decrease in 2021 (16,3% [15,0-17,7%] in 2019 vs 16,8% [14,4-19,5] in 2020 vs 14,8% [13,1-16,7] in 2021) which is in line with the decreasing trend observed in over the last decade. In 2020, women and people with a lower economic status were affected the most. Finally, data on active mobility showed a decrease in 2020 both for cycling (19,1% [17,7-20,6] in 2019 vs 15,4% [12,9- 18,3] in 2020) and walking (45,7% [43,9-47,6] in 2019 vs 42,3% [39,1-46,1] in 2020) to go to work in. In 2021 the trend increases towards pre-pandemic levels for cycling (18,1% [16,2-20,1]) but not for walking (37,4% [35,1-39,8]) which continues decreasing. Conclusions The pandemic outbreak had a negative effect on behavioral risk factors specifically regarding excessive weight gain, sedentary lifestyles, the latter having a higher impact on women and people with lower economic status. Data on sedentary lifestyle and active mobility in 2020 is compatible with national lockdown and smart working. As for the 2021 gap between cycling and walking, among other reasons, it may be justified by the quota related to public transportations and the grown fear of using it. Targeted public health interventions are needed to encourage active lifestyles.