The correlations between food security, diet quality and weight change among working women of reproductive age during the endemic phase of COVID-19

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TL;DR

This cross-sectional study of 263 working women in Malaysia's Klang Valley during the COVID-19 endemic phase found that 64.3% gained weight (average 4.36 kg) and 12.9% experienced moderate-to-severe food insecurity. Women who failed to achieve minimum dietary diversity gained 1.853 kg more than those who did (p = 0.040), though food security status alone was not significantly correlated with weight change. The findings highlight that poor diet quality, rather than food insecurity per se, was associated with weight gain among working women during the pandemic.

Full summary

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{"Background": "Food security\u2014defined as physical and economic access to sufficient, safe, and nutritious food\u2014was severely disrupted during the COVID-19 pandemic. In Malaysia, unemployment rose from 3.3% (2019) to 4.6% (2021), compromising food access, particularly among low-income groups. Food insecurity can lead to monotonous, energy-dense diets and paradoxically increase obesity risk. Women are especially vulnerable as they often sacrifice their own food for household members. This study aimed to investigate correlations between food security, diet quality, and weight change among working women of reproductive age in the Klang Valley during the endemic phase of COVID-19 (after the federal government declared the pandemic endemic in March 2022).", "Methods": "This cross-sectional study was conducted from 19 July to 16 October 2022. Working women aged 18\u201349 years, employed full-time in the Klang Valley, free from clinically diagnosed eating disorders and physical disabilities, and non-pregnant/non-lactating were recruited via convenience sampling. Of 295 responses collected, 263 were analyzed (completion rate 89.15%). The required sample size was estimated at 260 based on 38.9% women in the labor force (15,970,000 total) at 5% absolute precision and 90% confidence level. Participants self-reported socio-demographics and pre-pandemic body weight (February 2020). Current body weight was measured using a TANITA HD-314 digital scale (nearest 0.1 kg), and height using a SECA 213 stadiometer (nearest 0.1 cm). BMI was categorized per WHO criteria for Asian populations: underweight (<18.5), normal (18.5\u201322.9), overweight (23\u201324.9), obese (\u226525 kg/m\u00b2). Food security was assessed using the 8-item Food Insecurity Experience Scale (FIES; Cronbach's \u03b1 = 0.815), with raw scores categorized as food secure (0), mild (1\u20133), moderate (4\u20136), or severe (7\u20138) insecurity. Diet quality was assessed using the Diet Quality Questionnaire (DQQ) for Malaysia (Cronbach's \u03b1 = 0.779), with the Minimum Dietary Diversity for Women (MDD-W) indicator classifying women as achieving MDD-W (\u22655 food groups consumed in past 24 hours) or not (\u22644 food groups). Statistical analysis used SPSS v26. Normality was confirmed with skewness \u00b12 and kurtosis \u00b13. Paired t-tests compared pre-pandemic and current BMI. Pearson/partial correlation identified confounders (p < 0.25), and linear regression adjusted for age, marital status, ethnicity, educational attainment, and household income examined correlations between food security, diet quality, and weight change.", "Key Results": "Mean age was 35.53 \u00b1 8.31 years; 62.0% were Malay, 65.0% married, 73.4% had tertiary education, and 41.4% earned B40 income (\u2264RM 4,849/month). Pre-pandemic BMI (24.49 \u00b1 4.69 kg/m\u00b2) was significantly lower than current BMI (25.14 \u00b1 4.98 kg/m\u00b2) (t = \u20135.525, p < 0.001), a 2.65% increase. Overweight/obesity prevalence rose from 55.9% pre-pandemic to 60.0% during the endemic phase. Weight change: 64.3% (n = 169) gained weight (mean 4.36 \u00b1 3.19 kg), while 35.7% (n = 94) lost weight (mean \u20133.29 \u00b1 2.81 kg). Food security: 64.3% (n = 169) were food secure, 22.8% (n = 60) mildly food insecure, and 12.9% (n = 34) moderately-to-severely food insecure. Diet quality: the three most consumed food groups were grains/white roots/tubers/plantains (97.7%), meat/poultry/fish (95.1%), and eggs (73.8%); the least consumed were nuts/seeds (28.1% yes), pulses (35.4%), and milk/milk products (53.6%). Overall, 82.5% (n = 217) achieved MDD-W (\u22655 food groups). Linear regression (adjusted for age, marital status, ethnicity, educational attainment, household income) showed: food security was not significantly correlated with weight change (B = 1.124, \u03b2 = 0.079, 95% CI \u20131.656 to 3.904, p = 0.427). However, women who failed to achieve MDD-W gained 1.853 kg more than those who did (B = \u20131.853, \u03b2 = \u20130.148, 95% CI \u20133.620 to \u20130.086, p = 0.040). No significant interaction was found between food security and diet quality on weight change (B = \u20131.106, \u03b2 = \u20130.060, 95% CI \u20134.610 to 2.398, p = 0.535).", "Clinical Implications": "This study demonstrates that poor diet quality, rather than food insecurity alone, was significantly associated with weight gain among working women during the COVID-19 endemic phase. The 4.1% increase in overweight/obesity prevalence (55.9% to 60.0%) and average 4.36 kg weight gain in 64.3% of women underscore the pandemic's impact on women's health. Although 82.5% achieved MDD-W\u2014higher than in Lebanon (38%) or Burkina Faso (31%)\u2014the 17.5% who did not were at significantly greater risk of weight gain. Dietary patterns showed high reliance on starchy staples (97.7%) and animal proteins (95.1%) but low consumption of fruits, vegetables, nuts, seeds, and pulses, deviating from Malaysian Dietary Guidelines. These findings support developing workplace-based and community-based nutrition interventions, employer policies for supportive food environments, and government action to make healthy foods more affordable and accessible. Limitations include potential recall bias for pre-pandemic weight, cross-sectional design precluding causal inference, and single-day DQQ assessment not capturing habitual intake."}