Obesity is a well-established modifiable risk factor for various cardiometabolic disorders, including metabolic syndrome, type 2 diabetes mellitus, stroke, coronary heart disease, heart failure, and nonalcoholic fatty liver disease.^1,2 Lifestyle modification is the cornerstone of treatment for preventing and managing obesity and metabolic syndrome. Comprehensive and structured interventions targeting obesity and metabolic syndrome have demonstrated efficacy in ameliorating cardiometabolic parameters.^3,4 Therefore, population-wide cardiovascular disease (CVD) prevention strategies are needed. Notably, the Seoul Metabolic Syndrome Management Program (the Seoul Program), operated by the Seoul Metropolitan Government represents a community-wide initiative focusing on lifestyle modification interventions for Seoul citizens aged 30 to 64 years with metabolic syndrome. The program has been shown to significantly improve risk factors of CVD associated with the metabolic syndrome.⁵

The emergence of coronavirus disease 2019 (COVID-19), resulting from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evolved into a worldwide pandemic, causing significant public health issues worldwide from 2019 to 2022.⁶ As long-term quarantines and social distancing practices such as avoiding physical contact, school closures, workplace closures, and limiting face-to-face contact were implemented to prevent the spread of COVID, health-related behaviors (i.e., physical activity, diet, weight, smoking, alcohol consumption, and sleeping) had changed in the direction of deteriorating public health for obesity and cardiometabolic disorders during pandemic. Several studies reported detrimental changes in eating patterns, mental health, physical activity, and sleep disruptions during the pandemic.^7-9 A study of Japanese patients with diabetes revealed that decreased physical activity detrimentally impacted glycemic regulation and weight gain.¹⁰ A study evaluating the effects of COVID-19 home confinement on the food habits, lifestyle, and emotional balance of a Spanish population showed that an increase in emotional eating in response to boredom or anxiety during the pandemic resulted in weight gain.¹¹ A recent systematic review of 5,681,813 from 22 countries suggested that physical inactivity, sedentary lifestyle, and poor eating patterns were the most common risk factors for obesity during the COVID-19 pandemic lockdown.¹² Furthermore, the possibility can be assumed that the adverse changes in cardiovascular-related health behaviors observed during the pandemic may persist even after the end of the pandemic and this could potentially contribute to an increased prevalence of CVD. Therefore, interventions and support systems aimed at adopting and sustaining healthy behaviors are imperative, especially during socially isolated periods, such as the COVID-19 pandemic.

In an issue of Journal of Obesity & Metabolic Syndrome, Park et al.¹³ conducted a study investigating the health behavior adherence during the pandemic in adults aged 30 to 64 years who had engaged in a metabolic syndrome management program, the Seoul Program. Interestingly, blood pressure, waist circumference, and blood glucose level significantly improved from baseline to an average 1.1-year follow-up in 116 participants with metabolic syndrome. In addition, the study also reported positive changes in health-related behaviors including physical activity, eating habits, alcohol consumption and smoking, stress management, sleep and rest, and medication compliance and medical examination from baseline to an average 2.4-year of follow-up. The study highlights that a structured metabolic syndrome management program for the public is effective in improving metabolic parameters and health-related behaviors during social isolation.

Long-term, large-scale studies with longitudinal designs are required to evaluate the impact of interventions targeting obesity and metabolic syndrome during social isolation on the development of not only CVD risk factors, but also CVD outcomes. In addition, studies are needed to determine whether the interventions are effective in individuals younger than 30 or older than 65 years. The goal of these efforts is to promote public health through the re-establishment of healthy lifestyle habits and the maintenance of beneficial health adjustments following periods of social isolation.

Junghyun Noh is an editorial board member of this journal; however, she was not involved in the peer reviewer selection, evaluation, or decision process for this article. No other potential conflicts of interest relevant to this article were reported.