The importance of body composition and muscle mass during the COVID-19 pandemic

The importance of body composition and muscle mass during the COVID-19 pandemic – 3 questions to Dr. Mirey Karavetian, Associate Professor at Zayed University, Dubai

What risks do you see during the current COVID-19 pandemic with regard to overweight and nutrition? Will the pandemic lead to increasing numbers of obese patients?

There are two important aspects: Firstly, people are afraid to go out of their houses, even now with the current easing of COVID-19 restrictions. Our lifestyle has become even more sedentary than before. Unless you do an extra effort, like work with a personal trainer or use online fitness videos to excersise at home, remote learning, working from home and home schooling cause people to move a lot less.

Secondly, many people have much more time on their hands. A lot of that time is being used unconstructively which often leads to boredom and to careless eating. Instead of healthy proteins and healthy fat, people end up eating useless carbo-hydrated and non-healthy fat. You don’t really go and binge eat chicken breast. That happens with chips, cookies and processed food – salty, fat and carbo-hydrated intake will definitely increase.

Both leads to weight gain on the one hand and loss of muscle mass on the other. Even if you are eating well, if you are not using your musles you will be losing your muscles. So less muscle mass, less energy expenditure, more eating – so for sure, the obesity rate that we were fighting pre-COVID-19 will become worse post-COVID-19.

You are an expert in nutrition management of chronically and critically ill patients – how has COVID-19 influenced your field of expertise? Are there special recommendations for risk groups such as obese patients or people with cardiovascular diseases?

Anyone with comorbidities has a weaker immune system and therefore an increased risk for a severe course of a COVID-19 infection. People with chronic diseases should therefore endeavour to control their illness as best they can. Maybe this is the right time to actually invest in your health and for that, getting exercise and leading a healthy lifestyle are extremely important.

In addition, you need to get enough sleep and as little stress as possible. But: In these times of COVID-19 less sleep and more stress are very common. People have lost their daily structure, are going to sleep very late and wake up in wrong hours of the day. And it is not important how many hours you sleep but that you sleep during the night. In the evening, our neurological system becomes much more alert, unfortunately. You may focus on the negative and if you have pains you feel them more at that time – people are not their best in the evening. They lose control over their willpower. So when people are more awake at night they tend to eat more, sit more and stress more. Sleep is extremely important to maintain your immune system and stress levels, as well as have a healthy metabolism. And this applies to anyone, chronic disease or not.

In your opinion, what role do parameters such as weight, height and vital data play during the COVID-19 pandemic, especially with regard to risk patients?

An inflammatory disease like COVID-19 often causes a break down of muscle mass and a decreased appetite. Usually, this leads to malnutrition and significant weight loss of what matters the most in your body – muscle. Obese patients often already have very low muscle mass and the less muscle you have the less health you have. Muscle is life! The European Society for Clinical Nutrition and Metabolism (ESPEN) provides some clear and practical guidance for the nutritional management of COVID-19 patients, emphasizing the importance of muscle mass. So, assessing body composition and muscle mass during hospitalization and also afterwards is extremely important to protect the patient as well as to manage and monitor their improvement.
 

About Dr. Mirey Karavetian

Dr. Mirey Karavetian is an Associate Professor in the college of natural health sciences, Zayed University, Dubai. She has earned her PhD in “Health Promotion” from Maastricht University, Netherlands and her dietetics degree from American University of Beirut, Lebanon. She has extensive experience in nutrition management of chronically and critically ill patients; she shares her experience in conferences and workshops locally and regionally in the aim of training health care professionals for better health care. Her research focuses on identifying effective strategies to change dietary behavior in chronically ill patients. Her publications focus on malnutrition assessment, dietary management of chronically ill patients and finding the optimal dietitian-to-patient ratio in the Arab world for optimal clinical outcomes.

Dr. Birgit Schilling-Massmann, general practitioner, head of a specialist practice for nutritional medicine in Tecklenburg, Germany and member of the Federal Association of German Nutrionists (BDEM), about obesity in times of COVID-19

Dr. Schilling-Massmann, what risks do you see during the current COVID 19 pandemic with regard to overweight and nutrition?

Due to exit restrictions, home office and limited leisure activities people have been getting much less exercise since the beginning of the pandemic. At the same time, many people are eating much more unhealthy foods, consuming more snacks and alcohol and using convenience products instead of fresh produce. Over this long period of time, this can lead to significant physical changes, such as weight gain and the loss of muscle and fat mass. There is a great risk that the number of obesity cases in Germany will increase drastically as a result of the pandemic and thus the burden and costs for our health care system.

What can obesity patients do in the current situation to improve their situation?

It is important to remain active! Get out and into nature, for example on a bicycle tour or walking. Every activity counts and can have a very positive effect on your mood during this time of limited possibilities.

In addition, those affected should now pay all the more attention to their diet and choice of food: natural products instead of processed foods. Food with a lot of vitamins and fiber and few refined sugars. Do not eat so much in between, i.e. avoid so-called "snacking". And last but not least: stay hydrated and drink a lot of liquids—like water.

Many nutritional practices and consultants offer special support services, such as video consultations with a nutritional physician or advice by phone and e-mail, especially during the corona pandemic. We also promote self-help by recommending apps to our patients that track movement and food intake. They provide an objective impression of your own behavior and can make it easier to take countermeasures.

Currently, the first online self-help groups are already being established, for example through the patient organization Adipositashilfe (https://www.adipositashilfe-deutschland.de/aktuelles.html). There, too, one can seek support and guidance, the exchange with other people in a similar situation often gives strength and motivation.

About Dr. Birgit Schilling-Massmann

Dr. Schilling-Massmann is a specialist in general medicine with additional training in nutritional medicine (DAEM / DGEM). She is head of a general practitioner's group practice and specialty practice for nutritional medicine with a focus on obesity therapy in the Münsterland region in Germany. Dr. Schilling-Massmann is a board member of the Federal Association of German Nutritionists (BDEM e.V.) and co-initiator of SAVe (Safe Obesity Care in Germany). Since 2013, she has been on the FOCUS doctors' list every year as a top doctor for nutritional medicine.

The COVID-19 pandemic has already changed the world in many ways. The challenges outlined here for nutritionists and patients affected by obesity is becoming a "new normality" indefinitely. The relevance of body composition measurement for maintaining and restoring health will increase significantly. The seca medical Body Composition Analyzer (mBCA) is the only device for bioimpedance analysis (BIA) that is fully medically validated [1] and can be used for various medical applications.

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