Inequality, Stress, and Obesity: Socioeconomic Disparities in the Short- and Long-Term Effects of the COVID-19 Pandemic

In a longitudinal study of a large sample of Americans, we found that people with a low socioeconomic status (SES) gained more weight during the COVID-19 pandemic, further exacerbating their vulnerability to the SARS-CoV-2 virus. The association between SES and weight gain was mediated by stress, but not by the other environmental or psychological factors suggested by prior research (outdoor time, food scarcity, temporal focus, and wellbeing expectations). A serial mediation demonstrated that stress both decreased energy expenditures (through reduced physical activity) and increased energy intake (through higher and less healthy food intake). A follow-up study revealed that the early effects of the pandemic on weight and behavioral changes persisted 20 months later. Furthermore, stress levels decreased among people with a higher SES, but remained high for those with a lower SES. These findings demonstrate how the COVID-19 pandemic exacerbated health inequalities and provides insights for market-based and government solutions.