Transcript: Episode 39

Lockdown lives: How has COVID-19 changed our lifestyles?

Vivienne Parry  0:02  
Hello and welcome to Coronavirus the whole story. My name is Vivienne Parry. I'm a writer, broadcaster and UCL alumna and host of this award winning podcast that brings together UCL staff and students to discuss their contributions in the fight against Coronavirus. In this week's episode, we're looking at our lives in lockdown, and asking how has the pandemic changed our routine? Those of you still in your pyjamas may say what routine but judging from one tweet I saw from a woman saying she's never going to visit a park ever again after lockdown. I'd say routine is getting to us, and especially in this lockdown. At least back in March. We have beautiful weather, banana bread, and sourdough to distract us now it's wet, muddy and freezing was likely months still to go. The fridge and the bottle have become the go to comfort places for many. But I'm hoping someone from UCL has advice on how to stay well emotionally and physically. Of course there is this is UCL and we're welcoming to researchers here who've been conducting studies during lockdown on exactly that. I'm joined today by Professor Patty Kostkova, who is a Professor of Digital Health in the Institute for Risk and Disaster Reduction, and the Director of UCL IRDR Centre for Digital Public Health and Emergencies. During the pandemic. She's been advising who on digital strategies, and prototyping an app to help monitor compliance and lifestyle changes under government's dead home policies. I'm also joined by Dr. Adrian Brown from the UCL Centre for Obesity Research Ageing, is an NIH our search fellow, an honoree specialist dietitian. He's also been busy during the lockdown working with researchers at Public Health England and Leeds University on a study that seeks to understand the lived experiences of people living with obesity, and how the pandemic has been affecting weight management services. So I want to talk to you, Patty, about your work this past year. But before we start on that just explain to us what digital health is.

Patty Kostkova  2:07  
Well, last year has been amazing in a positive and negative way. And for my research is actually really positive. I've been passionate about digital health for 20 years of my career. And I worked in identifying outbreaks 10 years ago, you know, using Twitter, developing interventions for developing worlds to help people manage their conditions. And it doesn't seem to be of too much of an interest and 2020 arrived and digital health and pandemics and epidemics. The core of my research is a household story. So I'm really excited by the attention. Our work is being given as a kind of positive thing coming out of the pandemics. So back to your question. digital health is, in a nutshell, the use of technology to improve our health. It could be at population level, just like predicting pandemics, early warning systems. We do a lot of big data predictions, but also at the individual level, developing apps, interventions, games to make people better understand their healthcare and better manage their conditions. So that's what we do.

Vivienne Parry  3:15  
Patti, you've been extraordinarily productive during lockdown. You've started no less than five different research projects to understand how Coronavirus has affected our lives. Can you tell us a bit more about them. And in particular, your study my lockdown journal?

Patty Kostkova  3:30  
Yes, in 2020, we really got busy in Digital Public Health Centre for emergencies. And we have quickly use our skills and expertise and code from other projects to launch several new initiatives to help combating COVID-19 our biggest project was a combination of a survey zoom or nostril zoom and a mobile app we quickly developed and launched in April 2020, to help citizens to manage time into lockdown and get a bit of a more sense of what they actually do, how they spending their time, and how they change the activities they have been doing before the lockdown. The app has got over 1100 users now is launched on both platforms. And it's interesting to see how many people have started new activities got really creative. How many people are doing activities more often, for example, sports have been coming out as something people actually do once a day as opposed to before to pandemics. And also it's interesting to see that people are looking after their well being. They meditating and doing yoga more often than before

Vivienne Parry  4:37  
party though, is that a very biassed sample? So people who have the time have the inclination wants to get involved have gone to this app. Does it reflect the general population? Do you think

Patty Kostkova  4:49  
that's a very good question. I think definitely the app is age biassed. So we do have some inclination to have younger people or people who are more it savvy rather than the older generation However, the study was complemented by a survey called Zoo or not to zoom, where we do have the full breadth of the age groups represented. And so far, we've got about 9000 users who have replied to our questionnaire on this Zoo autism survey. And actually, in fact, the results have been complementing the results from the app. So I think people in the UK, across all ages seem to be converting towards doing a bit more meditation and relaxation, and perhaps a bit more sport exercises. But yes, you are right. Obviously, we're not reaching out to the entire population.

Vivienne Parry  5:35  
I'm intrigued by zoom or not to zoom, we might have all started out by saying zoom home office, but ended up absolutely hating it because it's become a tyranny for many just ruling their lives, and also ruining our lives, you know, where we try and struggle with other people in the household. Get them out of the room, and, you know, stop children running through, what have you found on use of zoom.

Patty Kostkova  6:01  
So the initial results have shown that people are actually quite enthusiastic about moving their life to zoom. So we have the full results from the first leg down and summer period. So the amount of activities people have switched to zoom, as opposed to doing a face to face have been actually quite remarkable. There is however, and an H is parenting, and you start to find the data by ages, it seems that the younger population, sort of 18 to 25 years old, seem to be much more having negative mental health response, they irritable, they feel unhappy and low, while the older generation 65 plus seem to be coping much better. Well, it could be down to a 65 year old, not perhaps having so many work and study and financial pressures as the younger generation. Is there

Vivienne Parry  6:46  
a difference between what people were experiencing in the first lockdown and this current lockdown?

Patty Kostkova  6:53  
Definitely there is I think the you know, the element of novelty you mentioned in the question is exactly what is coming through our study, there was so much excitement of trying things new and moving things online in the first lockdown. However, in the second and third lockdown we are in now, people are unfortunately less keen to be conducting their social life, they're much more keen to be choosing a quiet time or family time and definitely offline time.

Vivienne Parry  7:20  
And have they spent a lot more time watching TV or doing things that are probably not that good for their health, either eating and snacking. So it's

Patty Kostkova  7:31  
a self reported data. So we wouldn't have the full picture of what people have been drinking snacking and getting out of the households. However, under study it actually it shows that the categories creative and are chilling out activities seem to be the most popular even in the second lowdown people are reporting doing music, doing craft activities, and even surfing social media and chatting to friends online. But it seems that kind of the the need for a social interaction has to remain static.

Vivienne Parry  8:01  
And I'm going to come to you now because you've also been doing research throughout the pandemic. Just tell me a bit more about your research and what its objectives were.

Adrian Brown  8:09  
So at the start of lockdown, it started to become very apparent from the data that was being released that obesity started to be identified as a significant risk factor for severe illness and respiratory issues for people living with obesity. As a result, we started becoming really interested in how people living with obesity were being impacted by COVID. So was the fact that the government had identified them as being at risk impacting on them. But in addition to that, what we also found out was the NHS England had recommended or given guidance, that behavioural weight management programme should actually cease or stop doing them face to face. And as a result, people that were getting a lot of support from their weight management services suddenly had a lack of support during that time and also bariatric surgery was being stopped. Understandably, people were being redeployed to services in order to help people who were being impacted by COVID. However, this did present an issue for people living with obesity and also how bariatric and weight management services were being impacted. So what we decided to do was we decided to run a national survey looking at people living with obesity. So we really wanted to understand how COVID had impacted on those on those people living with obesity but also particularly those accessing weight management and bariatric services in the UK. So we did a national survey we got in total 543 people living with obesity of those around 213 were actually from weight management services. And interestingly enough, what we noticed was actually health related behaviours. So dark physical activity, were new negatively impacted during the first lockdown. What we did notice is that in relation to diets, we noticed that over 50% reported their darts becoming unhealthier. We noticed that 61% noted a reduction in their physical activity, and an incredible 80% reported that their sleep had got worse. In addition to that, we found that a lot of people actually managing their food through emotions. So over 70% did that. So what we noticed was something slightly different to what Patty was saying, was actually we noticed that people living with the Beastie were really negatively impacted during the lockdown period.

Vivienne Parry  10:40  
And did that change with each of the lockdowns? Because, as I said at the top that, you know, in the first lockdown, it was fantastic weather. I mean, everybody remembers that weather, it was just stunning. And lots of people went outside, they went on walks. But now, I mean, it's been grim, hasn't it?

Adrian Brown  11:00  
I'd have to agree with you, Vivian, when we look at the difference between the first lockdown, and now there is a significant impact from our data, we are just about to do our 12 month review. So we did our initial review back in the first lockdown sort of up to sort of July. And since then we haven't repeated our survey, but have been involved in work with Public Health England related to their report in July at the impact on weight management services. So at the present time, we don't directly have data from our survey. However, when we look at other areas, we we have noticed that this second lockdown, people are really struggling. This is the highest levels of depression and anxiety here to last summer. And also we're noticing that people's diets are generally becoming worse from the peep from the anecdotal discussions that we're having with people living with obesity. All we can do for is wish for spring, to come around as soon as possible to really hopefully help people to start to get outside. But I don't personally have any data on that present time.

Vivienne Parry  12:08  
I feel we've all been like bears, you know, we've been hibernating. And we put on the fats to get us through winter. But I think for people who start off this pandemic period, not being overweight, I think a lot of people have slipped into being overweight. Is that true? Do you think

Adrian Brown  12:28  
I'm not sure we have the data, Vivienne to sort of suggest that actually, people have gained weight necessarily, it's been quite challenging to get data on weight. Because often as Patty was saying, it's it's self reported a lot of this data that we have, what we do notice is that the behaviours that might indicate that people might gain weight, so such as choosing unhealthy foods, or reducing down physical activity, eating emotionally to deal with maybe being shielded or being lonely, have increased in this population. And it also appears to have increased in the general population. So we could, in theory, say, well, it might have impacted but we don't actually have the data at the present time, to my knowledge to say that people have actually become more overweight or started to develop overweight.

Vivienne Parry  13:23  
It is interesting that lots of people have reported sleep problems during lockdown. And there's a complicated relationship between the hormones that drive our appetites, and sleep. So you know, if we are sleep deprived, I mean, people have often experienced this, that if you're very tired, you will go and eat carbohydrates and comfort foods rather than things that are that are healthy. Also, we're seeing a lot of people reporting, extra drinking, which of course, is empty calories. So both of those things, I suspect, make you think that people are putting on weight. And of course, they're all wearing jogging bottoms and and who who's seeing who's seeing the extra rolls. I mean, go on. But let's be honest.

Adrian Brown  14:09  
I mean, everyone is wearing that comfort clothes and not getting ready for work as much as they would do. So identifying that their body weight is changed, which is often could be from their clothes isn't necessarily there. But as you were saying with sleep, I mean, the sleep what we have noticed is the majority have had worsening sleep. But unfortunately, some people have really found it difficult and we had some quotes from people from frontline staff saying they've really found it difficult to sleep during the time getting vivid dreams and waking up early. And that really obviously presents a concern for the people on the front line and the impact on their sleep and their health during the time of the pandemic.

Vivienne Parry  14:53  
Okay, Let's now turn to advice for people. So Patty, what about advice for us listeners,

Patty Kostkova  15:01  
I think it's important to have a long term time view, this will well past the pandemics will be over. And as Andrew said, we all have to just wait for the spring, the weather will improve, and our lives with the excellent vaccination campaign will start getting back to normal. So I think keeping positive and keeping resilient, I think is what people should be focusing on in the next couple of months while hopefully finishing the last national lockdown before things go up.

Vivienne Parry  15:30  
And do you think that from what you've gathered from your different surveys, that people who have taken up creative things to do a fairing rather better than people who've just kind of slumped in front of yet another box set.

Patty Kostkova  15:47  
So from the survey, we wouldn't be collecting this kind of data, we just ask people what they do differently in terms of before and during, and during the second lockdown. However, from the app, we have many additional information people are sharing with us when they record the activities they doing. And they can choose a smiley face kind of like a scale question how much they enjoy the activity they have just recorded? And yes, you are right. All of the activities around kind of social spectrum and the creative spectrum seem to be giving people more joy, they seem to be recorded as something they really enjoyed more.

Vivienne Parry  16:22  
Adrian, how about you? What kind of advice would you give?

Adrian Brown  16:26  
I think the pandemic has impacted on us all, it's had a negative impact on our both our physical and mental health. And at the present time in the lockdown, it can almost seem all consuming. So some advice that I would give to people is to limit their viewing of the news, it can be rather depressing at the present time. And by focusing on it all the time, it can potentially impact on your mental health as well. So sort of limiting it to sort of 30 minutes a day maximum out aim to do something that you really enjoy at least once a day. So to help your mental health, whether that be speak to a friend, whether that be go for a walk, listen to some music, read a book. And it's important not to necessarily focus on the negative aspects, but rather focus on the positive things that we do have. And the things that we are actually grateful for. Keeping a regular bedtime getting into a routine can be really beneficial. I think what's happening at the moment is that a lot of people are getting up, it's dark, they're going to bed, and it's dark, they're not necessarily getting out during the day and getting any sort of light. So aiming to get some sort of routine where you might represent a normal day for you. So for example, if it was a normal working day, getting up in the morning, having a shower, almost getting ready for work. And then potentially, I've recommended this to some people or doing myself is actually go out for a daily walk like you would do if you were going to go to work, and then come back. And if you're then going to be sitting down at your laptop, then you've at least managed to get some sort of normality into your day. Planning is really important related to food. So knowing what sort of foods you might want to choose having foods available, and not necessarily ordering from, let's say, delivery because there's no food in the house. So we know that planning can actually help people to manage their body weight, also around positioning of food in your in your kitchen. So if there's foods and snacks that maybe you don't want to necessarily have put them in an area that's inconvenient for you to get to. So move to healthier foods that are all the foods that you would prefer to eat to the front of the fridge and the ones that you're not really wanting to eat to the back. And what we do know is that when people see the healthier foods or don't actually see the unhealthy foods, they're less likely to grab hold of them. So that includes like foods on the snack on the counter. So if you have biscuit tins or those types of things do tend to try and put them away so they're not necessarily in your view. And this can really help us to start to reduce down and make some healthy changes to our diet.

Vivienne Parry  19:16  
Now I was going to ask you about treats. Because that's always a temptation. If you're at home and you think well, it's 11 o'clock, I deserve a treat. Now I've done you know 12 zoom calls. I deserve a treat. And that kind of treating can get out of hand contest in terms of weight.

Adrian Brown  19:38  
I think everybody copes differently, and rewards relate to food or coping mechanisms as often people have are things that everybody does or the vast majority of people. What I would say is by identifying when you're fancying food, these are what we call triggers. So identifying When when these triggers are in the day. So is it after a particularly stressful phone call that I fancy a reward? And what am I actually looking for? Is it the food itself? Or is it the fact that I'm looking to get away from my laptop and just have a five minutes area for myself? Or am I looking to get something else? Am I just needing that relaxation time. So there are things that we do that connect with foods that maybe we're looking for something else, it's not necessarily the food itself that we're looking for. But it's other things. So it may be looking for other things that give us reward. So that could be reading a book that could be talking to a friend. In essence, during those times where you might fancy something, we could use things like distraction techniques, so people for 15 or 20 minutes, go and do something else. And then after that 1520 minutes, if you still fancy having that and you are physically hungry, then it's then I would say, Fine, have that little snack if you wish to if you're physically hungry, I wouldn't necessarily say avoid them completely, because food is a pleasure as well. But it's just being more aware and more conscious about the decisions that we make during the day.

Vivienne Parry  21:15  
That's really helpful. Now, in this podcast, I give people my Vivian pairing magic wand. And the Vivian Perry magic wand allows you to do one thing to help people during the pandemic, which isn't just waving away Coronavirus. So how would you use it? Patti, what would you do for people with your magic wand?

Patty Kostkova  21:39  
I'd like to wave the wand to improve people's mental health and our sense of coping with the pandemics to see everyone getting through.

Vivienne Parry  21:47  
And is there a particular way that you think that they could do that.

Patty Kostkova  21:50  
So one other thing which has been motivating our our app was also journaling. There's evidence that if people are journaling and writing regularly, what they have done in the day and how they have felt, it helps them to keep certain distance from the events and also a sense of normality and sense of time. So it showed from our research or using the app that people who actually have been regularly journaling using the air did reported this makes them feel better. So I would encourage people to use our app or use any sort of paper based diary if they prefer to write what they do every day, and perhaps look at it retrospectively, to gain some sense of their time, their days, and their weeks, this will help us to get through

Vivienne Parry  22:32  
that's fascinating, partly because actually you think of diaries of a play gear, and all those kinds of things. These are going to be historical, in due course, aren't they? I mean, they are going to allow us to look back and actually realise that, you know, we have moved on to a different place. And we can put that, you know, compartment behind us and allow us to move forward.

Patty Kostkova  22:57  
Absolutely. What was coming out from our research or using using the app or if not just allows people to kind of record what they do and how they enjoyed it and write a story. People have been reporting that they really enjoyed looking back the sense of time we have lost into pandemics and into lockdown, but everyday feels the same actually could be regained if we do regularly, right what we do and then have something to look look at retrospectively. Yes.

Vivienne Parry  23:24  
Yes. Because we've often noted on this podcast, how COVID time is different? I mean, how can it be the end of the week, which is when we're recording when it only seemed to be Monday yesterday? It's a very, very bizarre feeling. Adrian, what would you do with your magic wand?

Adrian Brown  23:42  
I mean, from our research, we did identify as Patty was saying that depression and well being significantly predicted the impact on health related behaviours. And what we have seen is that the support for people living with obesity has significantly reduced during the pandemic for a variety of different reasons. So my magic wand would be to have better mental health support for people living with obesity, to help them during the pandemic. But also one other thing is to help people who have been alone because a lot of people have been shielding. And loneliness is a significant issue. And so I would like if I could magic a wand I would love those people to feel loved and cherished and to feel as lonely, I guess.

Vivienne Parry  24:34  
Well, so I may also take out my magic one myself and say that if people do one thing, it's to ring someone that they know might be feeling lonely, because a call can make a huge amount of difference. It's not much time in your day, but it means very much to someone who doesn't have many calls or much interaction with other people. So, let me wave my magic wand and allow you all to be kind and lovely. And ring somebody. thank you to both Patty and Adrian. It's been fantastic talking to you. You've been listening to Coronavirus the whole story This episode was presented by myself Vivienne Parry, produced by UCL with support from the UCL health of the public and UCL grand challenges and edited by the splendid Cerys Bradley. I was joined today by Professor Patty Kostkova, and Dr. Adrian Brown. If you'd like to hear any more of these podcasts from UCL Minds, and now fantastic, you really want to do that. Subscribe wherever you download your podcasts or visit ucl.ac.uk forward slash Coronavirus. This podcast is brought to you by UCL Minds, bringing together UCL knowledge, insights and expertise through events, digital content and activities open to everyone. Hope to be with you again soon. Bye for now.