Lebanese residents completed the questionnaire during January 2021, 10 months following the start of the pandemic lockdown in Lebanon. Their responses provide an indicator of the bigger picture taking place in the country. It is important to note, however, that the pandemic struck Lebanon at a critical time, layering above multiple crises. Thus, the results may stem from a variety of factors and may not be attributable to the effects of the pandemic alone. The panic caused by the disease and death, in addition to the limitations of individual freedom, exacerbated the tension already among civilians and created variations in usual and routine activities [21]. Hence, changes were observed during the COVID-19 pandemic regarding lifestyle and eating habits. The vast majority of this sample population was abiding by lockdown measures, practicing social distancing and staying at home most of their time. This was the case for about 3 times more females than males participating in this study.

A balanced and healthy diet is well-known to aid in sustaining immunity, and thus, is crucial for avoidance and treatment of infections caused by viruses [22]. Healthy dietary behaviors are vital, and supplementation with certain micronutrients may be helpful, in particular, for persons at risk [23]. Therefore, we can confirm that the nutritional status of an individual plays a vital role in protecting him/her against viral infections [24]. There was a considerable variety in the answers provided for the various questions regarding weight gain and frequency of snacking. For example, even though 43.0% of the participants reported gaining weight during the lockdown, 19.2% reported losing weight, and 34.2% reported no weight changes. The majority in this research reported weight gain, which is similar to data results from comparable studies conducted in Saudi Arabia [25], Kuwait [26], UAE [9], Italy [16], and Poland [27] that also reported weight gain because of the lockdown.

Likewise, although 48.4% of the sample studied reported a daily increase in the number of meals they consumed, 41.5% reported a decline in the number of consumed meals. Similarly, data results from Saudi Arabian [28], Italian [29], Danish [30], and Polish studies [12] [27] also showed that the number of daily consumed meals increased among the majority of the respondents during the lockdown. The deviation in eating habits in Lebanon was not only limited to “increasing” meal quantity and “gaining” weight, which could also be related to how each individual cope with stress, a factor that usually increases the number of meals consumed daily [31], but is not always the case.

In this study, consumption of home-grown fruits and vegetables did not change before and during the pandemic. Although many Lebanese residents moved to their villages to spend their stay-at-home time away from the city, it was assumed that home-grown produce consumption would increase, but this was not the case. This could be explained by the fact that Lebanese residents who moved to more rural areas remained functional in their work or studies. So, despite the fact that they had the chance to grow more fresh produce; they lacked the time for it.

The pandemic caused positive changes in the Lebanese population’s eating habits. Fast food consumption declined, as shown in this study, similar to data from Poland [12], yet contradicts what was seen in a similar research done in Qatar, where frequent consumption of fast food increased [20]. Moreover, meat consumption significantly declined throughout the lockdown in Lebanon, compared to before it, and home-made meals increased significantly. This is beneficial for individual as well as environmental health [32] [33]. The increase in home-made meals is similar to data results from Spain [34], in New Zealand, where respondents reported an increase in home cooking and baking from scratch [35], and in Saudi Arabia, where 85.6% of the respondents reported eating home-cooked meals on a daily basis during COVID-19 as compared to 35.6% before the lockdown [25].

Another positive outcome is the decline in the consumption of unhealthy snacks like chocolate, chips, crackers, cakes, etc. This is also comparable to data obtained from New Zealand [35], yet contradicts data from Spain that instead showed an increase in the consumption of unhealthy snacks such as salty snacks, cookies, bakery products, and chocolate. [36].

On the other hand, there were several negative effects regarding eating habits, one of which was binge eating out of control; also witnessed in a similar study conducted in Italy [37]. Another negative impact shown in this study is the increase in frequent snacking (including late-night snacks) that increased during the quarantine compared to before it, mainly among females. This might be related to increased levels of stress accompanied by quarantine and the lockdown, which is consistent with several global studies that shed light on emotional eating during the lockdown [37]. The increase in snacking was also observed in the UK, a similar study confirms [10].

When it comes to lifestyle changes; UK studies showed inconsistent data. One study showed an increase in smoking during the lockdown, explained by the fact that people resorted to smoking to kill time and because of stress and boredom [38], Meanwhile, another study showed that the increase in smoking was statistically insignificant; and interestingly, it showed that smoking cessation and quit attempts increased during the pandemic compared to before it [39]. In New Zealand, around half the respondents of one study, who usually smoke on a daily basis, reported increasing their smoking consumption, with an average increase of 6 cigarettes per day, due to feelings of loneliness and boredom [40]. In Lebanon, although 64.3% reported no changes in smoking habits, 13.2% reported smoking more during the quarantine, which is similar to most global data. These results were mostly significant in lower-income families. This can be explained by the fact that those with the least income were the most stressed because of the pandemic coinciding with the financial crisis, causing them to resort to smoking.

Concerning caffeine consumption, even though around half the respondents reported no change in caffeine consumption, 25.7% reported increasing their caffeine intake during the lockdown. The increase in caffeine consumption was mostly reported, unfortunately, in young adults aged 18 to 25; this is contradictory to a study conducted in the USA that showed that young adults aged 18-35 years had a decline in their caffeine intake compared to older adults [41]. Likewise, a same increase in caffeine consumption was observed in Lebanese healthcare professionals, unmarried individuals, or those with the least income. The concern is that caffeine consumption, when excessive, is associated with an increased risk in cardiovascular disease [42].  Similar to the case of smoking, populations that were probably stressed the most resorted to increasing their caffeine consumption; this may be explained by the increase in overwhelmed healthcare workers, as well as the population with the least income.

A life aspect that was significantly affected by COVID-19 pandemic is engagement in physical activity. Other studies showed that shutting down gyms and limiting ‘non-essential’ travel may result in a decline in overall physical activity [43]. In a study conducted in the UAE, 38.5% of respondents did not engage in physical activity during lockdown [9]. In India, people who exercised more than 3 times a week went down radically from 42% of total participants before the lockdown, to 22% of participants during the lockdown [44]. In Spain, the number of participants that exercise decreased significantly, as well as the time spent exercising [34]. The same applies to China, where around 60% of adults had no engagement in proper physical activity [45]. These results are consistent with results from this Lebanese study, where those who did not engage in sports before the COVID-19 pandemic did not use this as an opportunity to start; on the contrary, those who were physically active had a decrease in terms of days exercised weekly. Respondents who do not exercise at all increased from 31.4% before the lockdown to 40.6% during lockdown. Both males and females had a decline in mean hours of exercise, however, females were more likely to skip exercising than males with 45% of them engaging in no physical activity whatsoever compared to 36% of all males. On the other hand, males grasped the opportunity to exercise on most days significantly more than females. This shows that males were more dedicated to exercise compared to females. This might be due to the fact that females were busy with their children, family, house and/or work, during the total lockdown sparing no time to invest in sports. This is also shown in the correlation between marital status and physical activity; where significantly more married individuals had no physical activity at all compared to singles. When it comes to age, adults aged 26 to 35 were the largest group to report not exercising at all, which can be due to the heavy workload “from home” and getting accustomed to a new norm which left them too busy to exercise. However, luckily, the age group that significantly exercised the most was the eldest group, aging above 56. This data is similar to a recent study conducted in Belgium where individuals above 55 were the most age group to engage in frequent physical activity [46].

Finally, the increase in screen time during the lockdown was consistent with Chinese [45] [47], German [48] and several global studies. In Lebanon, this study showed that those who spent 6 or more hours per day on their computer to work or study increased from 16.7% before to 40.4% during the pandemic. Those who didn’t use the computer for work and study declined from 21% before the pandemic to 8% during the pandemic. Even mean hours for daily screen time increased significantly. Single individuals spent more time working and/or studying on-screen compared to married individuals, which hints that single people had more time on their hands to use their computers. Moreover, the least educated demographic was the least to use screens, which is expected. At last, half of those in the health-related field were spending more than 6 hours on their computers. Thus, healthcare professionals may have found themselves spending a lot of time on screen to stay up-to-date with all the new medical knowledge. Increased digital screen time during the pandemic is no surprise, since the lockdown obliged the whole world to “work-“and “study-from-home”. We expect that daily screen time will maintain pandemic highs into the “new normal”. The problem is that prolonged hours in front of screens has been proven to lead to several risks, of which are myopia [49], depression [50], extensive feelings of sleepiness [51], and an overall decline in mental, general health [52], and overall wellbeing [53].

Health authorities and policy makers in Lebanon have conducted awareness campaigns regarding several aspects related to COVID-19. First, multiple campaigns were designed to educate people on the prevention of virus transmission, mainly by explaining what measures are recommended to contain the virus and limit its spread. Furthermore, health authorities have shed light on what to do in case of infection; all measures concerning isolation and what to do during the infection phase were clearly communicated to the public. Finally, health policy makers also held campaigns on vaccinations for COVID-19, where they educated people on the importance of getting vaccinated to prevent infection and build immunity, which in turn reduces the community spread.

In light of this study, we recommend that health policy makers take into consideration the dietary and lifestyle changes caused by the lockdown measures and pro-actively raise awareness of the health implications caused by the lockdown. We suggest having campaigns that highlight how the increase in weight, food consumption and frequent snacking could lead to obesity. According to the CDC, obesity, as well as a lack of physical activity impose several health risks such as an increased incidence of type 2 diabetes, high blood pressure, high cholesterol and atherosclerosis (where fatty deposits narrow the arteries), which in turn can lead to coronary heart disease and stroke. [2]

Moreover, an increase in smoking causes lung disease by damaging the airways and the small air sacs (alveoli) found in the lungs. Lung diseases caused by smoking include COPD –Chronic obstructive pulmonary disease-, which includes emphysema and chronic bronchitis. Cigarette smoking causes most cases of lung cancer. Health policy makers should highlight these risks to the public in order to prevent the dangerous effects of smoking. When it comes to caffeine consumption, we suggest that people should be aware that a high caffeine intake can cause insomnia, restlessness, nervousness, stomach irritation, nausea, an increased heart rate and respiration.

This study has several limitations. One limitation is the simultaneous crises that struck the Lebanese population. The pandemic coincided with a major financial crisis and a significant devaluation in the local currency. This led to an increase in emotional stress that could impact the eating habits and lifestyle of the population. Thus, the results of this study may be multi-factorial. Another limitation to this study is the online nature of the questionnaire. Having been distributed via social media, this may lead to a bias in responses by social media users with internet connections within the researchers' immediate and expanded social networks. Therefore, there could be sections of populations that were not reached because they have no internet access.

The strengths of this study are mainly its number of participants and their diversity, and it being the first of its kind in Lebanon. Having a sample with a large number (n=1749) gives a more representative figure of the whole population. Also, the demographic characteristics of the sample show that the participants were diverse in age, gender, financial status, field of study, education level, and marital status. Finally, this is the first study in Lebanon to assess the impact of the confinement measures on eating behaviors and lifestyle changes in the country.