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Abstract

Aims: The COVID-19 pandemic disrupted daily lifestyles worldwide. Its long-term effects on physical activity (PA) and eating behaviors (EB) among Mexican women, who already face barriers to adopting healthy lifestyles, remain unclear. This study aimed to compare PA and EB among adult Mexican women before and after the pandemic. Methods: A cross-sectional study with retrospective data collection was conducted using structured questionnaires. Participants reported their pre- and post-pandemic PA and EB. Results: A total of 104 women, with a mean age of 52.4 ± 9.5 years, participated in the study. Overall, PA levels decreased significantly after the pandemic (P < 0.05), with notable decreases among women without a cancer history, postmenopausal women, homemakers, and those with overweight or obesity. Time spent in overall PA (z = 4.6; r = 0.45) and moderate-to-vigorous PA (z = 5.1; r = 0.50) decreased, while sitting time increased (z = −3.8; r = 0.37) (P < 0.001). In contrast, overall EB did not change significantly; however, employed women and those without a history of cancer reported significant changes in EB after the pandemic (P < 0.05). Conclusions: Despite the end of the pandemic, its effects on PA and EB persist among Mexican women. Targeted, culturally sensitive interventions, along with ongoing monitoring, are essential to reduce long-term health risks in this population.

Keywords

physical activity sedentary behavior eating behavior post-pandemic lifestyle

“Women without a cancer history reported eating unhealthy foods more often, and employed participants experienced more frequent uncontrolled eating.”

Introduction

Lifestyle behaviors are essential factors for physical and mental health. Growing evidence demonstrates that unhealthy habits significantly increase the risk of non-communicable diseases, while healthy behaviors help prevent illness and extend lifespan.¹ Recent studies indicate that individuals who lead a healthy lifestyle have a 63% lower risk of all-cause mortality, including early deaths from cancer and heart disease, and can live an average of 7.1 years longer than those who do not engage in healthy habits.² Similarly, another study shows that women who adopt such habits may live up to 14 years longer, and men up to 12 years longer, than those with unhealthy lifestyles.³

In Mexico, especially in the northwestern region bordering the United States, the burden of non-communicable diseases remains disproportionately high, with rates of diabetes, hypertension, and obesity exceeding both the national average and those of other regions.^4,5 This area is characterized by notable cultural and socioeconomic diversity resulting from the mixing of Mexican and American cultures. Higher rates of overweight, obesity, diabetes, and hypertension are observed among women compared to men; the prevalence of overweight and obesity among women is 75%, vs 69.6% among men, and diabetes affects 11.3% of women compared to 9% of men. These differences are partly due to gender variations in adopting health-promoting behaviors.⁶ National survey data indicate that more women do not meet the World Health Organization’s guidelines for adult physical activity, and diet quality among Mexicans remains low, especially among those in low and medium-socioeconomic groups, which increases their risk for various health issues.

The COVID-19 pandemic has disrupted daily routines and may worsen public health issues due to decreased physical activity, increased sedentary behavior, and changes in dietary habits.⁷ National data show that 68.2% of Mexican adults reported a decline in physical activity, while 27.7% indicated more sedentary time.⁶ Although most adults did not report major dietary shifts, several studies noted increased intake of fast food, red meat, alcohol, and high-calorie foods, often linked to stress, anxiety, and sleep problems.^6-8 Some research, however, has observed healthier habits, including increased consumption of fruits, vegetables, and home-cooked meals.⁹ While existing research reports behavioral changes during the COVID-19 pandemic compared to before the pandemic, there is still limited evidence on whether these changes persist after the pandemic, especially among adult women in Northwest Mexico. Given the region’s high rates of chronic illness and gender-related health disparities, this gap in knowledge hinders the development of targeted and effective public health strategies. Addressing this gap is critical to informing interventions tailored to the specific needs of women in Northwest Mexico. Understanding lifestyle changes after the pandemic will help develop strategies to reduce chronic disease risk and improve health outcomes in this vulnerable group. Therefore, this study aims to examine changes in physical activity and eating behaviors among adult women in Northwest Mexico before and after COVID-19. It specifically investigates how these post-pandemic behaviors differ from pre-pandemic levels in this population.

Materials and Methods

Participants Recruitment and Study Design

A cross-sectional study with retrospective data collection was conducted using structured questionnaires with a differential response format, allowing participants to report their physical activity and eating behaviors separately for both the pre-pandemic and post-pandemic periods. To reduce recall bias, several methodological strategies were employed. Validated retrospective questionnaires with time-specific prompts (e.g., “Thinking back to the months before March 2020…”) were used to help accurately recall behaviors during the 3 months before the pandemic. March 2020 served as the temporal reference point for the pre-pandemic period, and May 2023 was used for the post-pandemic period. Interviewers were trained to use neutral, non-leading language, and data collection was conducted in person to minimize misinterpretation.

A non-probabilistic convenience sample targeted Mexican women aged 25 and older living in Hermosillo, northwest Mexico, who had resided in the city during both periods. To reduce selection bias, recruitment was conducted online through the institution’s website and social media, on local radio, and in person at various locations across Hermosillo, including hospitals, supermarkets, shopping centers, and door-to-door visits. Eligible participants included women with no history of cancer and breast cancer survivors who had completed treatment between 6 months and 5 years prior. Exclusion criteria included current participation in intense physical activity programs or restrictive diets, significant physical limitations, and diagnosed mental disorders such as bipolar disorder or schizophrenia. Data collection took place from June 2023 to April 2024, following the World Health Organization’s declaration ending the COVID-19 public health emergency in May 2023. While this extended period could raise concerns about variability in participants’ reported post-pandemic behaviors, no major public health restrictions, policy changes, or significant economic disruptions related to COVID-19 occurred in Mexico during this time. Social norms and public life had stabilized mainly, and activities like work, schooling, and access to health services had resumed. Therefore, participants’ reports were considered to reflect stable post-pandemic patterns.

All participants provided written informed consent. Ethical approval was granted by the Ethics Committee of the Centro de Investigación en Alimentación y Desarrollo (CIAD) (approval no. CEI/015-2/2022).

Instruments and Variables

Sociodemographic Characteristics

A structured sociodemographic questionnaire was used to collect information on participants’ age, education level, marital status, occupation, and socioeconomic status. Education level was divided into four groups: no education (no formal schooling), basic level (incomplete primary to completed secondary education), middle level (incomplete high school to completed vocational/technical training), and high level (university degree or higher). Socioeconomic status was assessed with a validated tool developed by the Asociación Mexicana de Agencias de Investigación de Mercado y Opinión Pública, which is based on a nationally recognized scoring system. Participants were classified as having low (0-115 points), middle (116-201 points), or high (202 points and above) socioeconomic status, according to the association’s criteria.¹⁰

Physical Activity and Sedentary Behavior

Physical activity levels of the participants were measured using a validated questionnaire, the Godin-Shepherd Leisure-Time Exercise Questionnaire, and interpreted based on its standardized guidelines.¹¹ Participants reported the time spent on light, moderate, and vigorous physical activities during a typical week. They also indicated the daily time spent on sedentary activities such as working at a desk, watching TV, or socializing. Data were collected for both the pre-pandemic period (3 months before March 2020) and the post-pandemic period (after May 2023). The questionnaire was administered in Spanish and included validated items adapted for adult populations. After translating it into Spanish, 3 subject-matter experts reviewed it for clarity, relevance, and appropriate wording before data collection. It was then pilot-tested with five volunteers from the target population to evaluate comprehension and content relevance. All expert feedback and participant responses were systematically recorded and incorporated into the revisions of the questionnaire. To minimize recall bias, participants were instructed to consider a typical week that reflected their usual routine during each period.

Eating Behavior

Eating behaviors were evaluated using the eating behavior section of the Effects of Home Confinement on Multiple Lifestyle Behaviors during the COVID-19 Outbreak (ECLB-COVID-19) questionnaire.¹² Participants reported their behaviors at two time points: “before” and “after” the COVID-19 pandemic. The questionnaire included five items assessing specific eating habits: (1) unhealthy food consumption (e.g., high intake of sugar, fat, salt, and low in fiber/vitamins); (2) binge eating or loss of control while eating; (3) snack eating between meals; (4) alcohol intake; and (5) the number of main meals per day. For each item (except item 5), responses were scored on a 4-point Likert scale: “Never” = 0, “Sometimes” = 1, “Most of the time” = 2, and “Always” = 3, with higher scores (2-3) indicating more frequent engagement in unhealthy behaviors.

For item 5, which assesses the number of main meals per day, the response options and corresponding scores were: “1-2 meals” = 0, “3 meals” = 1, “4 meals” = 2, “5 meals” = 3, and “>5 meals” = 4. Higher scores (2-4) indicate more frequent engagement in potentially unhealthy eating patterns. Explanations and examples were provided to ensure a consistent understanding of each question. Changes in both the scores and frequency categories for each eating behavior indicator were analyzed to assess differences between pre- and post-pandemic periods.

Statistical Analysis

A comprehensive descriptive analysis was conducted for all variables. The normality of the distribution for continuous variables was evaluated using the Kolmogorov-Smirnov test, with P ≥ 0.05 indicating a normal distribution. Continuous variables were summarized by means and standard deviations (SD) or medians and interquartile ranges (IQR), depending on their distribution. Categorical variables were presented as percentages. To compare behavior indicators between pre- and post-pandemic periods, paired t-tests were applied for normally distributed continuous variables, while the Wilcoxon signed-rank test was used for non-normally distributed variables. Effect sizes (r) for Wilcoxon tests were calculated and interpreted as small (r = 0.1), moderate (r = 0.3), or large (r = 0.5).¹³ The McNemar–Bowker test was employed to analyze differences in categorical variables before and after the pandemic. All statistical analyses were performed using SPSS version 30, with significance set at P < 0.05.

Results

Participants Characteristics

In this study, 104 participants completed questionnaires on sociodemographic factors, physical activity, and sedentary behavior, while 100 participants responded to the eating behavior questionnaire. The average age of the entire sample was 52.4 ± 9.5 years, with most being homemakers (51%), married (58.6%), from medium-socioeconomic status (58.7%), and having a medium level of education (35.6%). Among the participants, 42.3% were cancer survivors, 71.2% were postmenopausal, 86.5% were classified as having overweight or obesity, and 94.2% had abdominal obesity (Table 1).

Table 1.

Characteristics of Study Participants.

Variables	Women (n = 104)
Age (years)^a	52.4 ± 9.5
Socioeconomic level: n (%)
○ Low	13 (12.5)
○ Medium	61 (58.7)
○ High	30 (28.8)
Education level: n (%)
○ No education	4 (3.8)
○ Basic level	30 (28.8)
○ Middle level	37 (35.6)
○ High level	33 (31.7)
Occupation: n (%)
○ Homemakers	53 (51)
○ Labor jobs	51 (49)
Marital status: n (%)
○ Single	21 (20.2)
○ Married	61 (58.6)
○ Free union	6 (5.8)
○ Widower	6 (5.8)
○ Divorced	10 (9.6)
Menopause status: n (%)
○ Pre	30 (28.8)
○ Post	74 (71.2)
Pre-existing health conditions: n (%)
○ Cancer survivor	44 (42.3)
○ No cancer antecedents	60 (57.7)
Body Mass Index (BMI) categories: n (%)
○ Normal weight: 18.5 to 24.9	14 (13.5)
○ Overweight/obesity: 25 or higher	90 (86.5)
Waist circumference categories: n (%)
○ Normal:< 80 cm	6 (5.8)
○ Abdominal obesity ≥80 cm	98 (94.2)

^aMean ± Standard Deviation.

Comparison of Physical Activity and Sedentary Behavior Before and After the COVID-19 Pandemic

The time spent on overall physical activity and sitting was analyzed before and after the COVID-19 pandemic, following an assessment of data normality. Since the data did not meet the normality assumption, the Wilcoxon signed-rank test was used to compare the two periods.

Results showed a statistically significant decrease in overall physical activity time following the pandemic, with a moderate effect size (z = 4.6, P < 0.001, r = 0.45). There was also a reduction in time spent on moderate-to-vigorous physical activity, with a large effect size (z = 4.6, P < 0.001, r = 0.50), and an increase in sitting time, with a moderate effect size (z = −3.8, P < 0.001, r = 0.37) (Table 2).

Table 2.

Time Spent in Physical Activity and Sedentary Behaviors Before and After the Pandemic (n = 104).

Variables	Before COVID-19 Pandemic	After COVID-19 Pandemic	Difference	Z Test	Wilcoxon P Value	Wilcoxon Effect Size (r)
Time spent in MVPA (min/week)	10 (287.5)	0 (42.5)	0 (180)	5.1	<0.001	0.5
Time spent doing overall PA (min/week)	210 (478.7)	62 (240)	60 (290)	4.6	<0.001	0.45
Time spent sitting (hours/day)	3 (3)	4 (4)	0.5 (2)	−3.8	<0.001	0.37

Data is expressed in Median and IQR.

MVPA: Moderate and Vigorous Physical Activity.

A post hoc power analysis showed that physical activity outcomes with moderate to large effect sizes (0.37 to 0.50) had high statistical power (>90%).

Additionally, physical activity levels were measured to identify any differences between participants before and after the pandemic using the McNemar–Bowker test. A significant change in physical activity was observed, with inactive participants increasing from 39.4% to 58.6% and active participants decreasing from 41.4% to 26% (P = 0.004) (Table 3). Specifically, 10.6% of participants increased their activity level, 34.6% decreased it, and 54.8% maintained the same level. Overall, there was a noticeable decline in physical activity behaviors. Subgroup analyses showed that significant differences were particularly evident among participants without a cancer history, postmenopausal women, homemakers, and those with overweight or obesity (P < 0.05).

Table 3.

Comparison of Physical Activity Level Before and After the Pandemic (n = 104).

Variables	Before (n = 104)	After (n = 104)	P-Value
Physical activity level: n (%)
Inactive	41 (39.4)	61 (58.6)	0.004
Moderately active	20 (19.2)	16 (15.4)
Active	43 (41.4)	27 (26)

Data is expressed in numbers (percentages).

Comparison of Eating Behaviors Before and After the COVID-19 Pandemic

Differences in eating behaviors between the two periods were evaluated using the Wilcoxon signed-rank test after assessing data normality. Results indicated no statistically significant difference in overall dietary behaviors before and after the pandemic. Although there were trends toward increased unhealthy food consumption (Z = 1.707, P = 0.088, r = 0.17), alcohol intake (Z = 1.084, P = 0.278, r = 0.11), and main meal frequency (Z = 1.025, P = 0.305, r = 0.10), these were not statistically significant. Similarly, no significant differences were observed in uncontrolled eating (Z = −0.809, P = 0.418, r = 0.08) or snacking (Z = −1.344, P = 0.179, r = 0.13). All effect sizes were small, indicating minimal behavioral changes (Table 4). A post hoc power analysis showed that eating behavior outcomes with small effect sizes (0.08 to 0.17) had low statistical power (10 to 30%).

Table 4.

Comparison of Eating Behavior Indicators Scores Before and After the Pandemic (n = 100).

Variables	Before COVID-19 Pandemic	After COVID-19 Pandemic	Difference	Z Test	Wilcoxon P-value	Wilcoxon Effect Size (r)
Have an unhealthy diet/food^a	1 (1)	1 (0)	0 (0)	1.707	0.088	0.17
Eating out of control^a	1 (1)	1 (1)	0 (0)	−0.809	0.418	0.08
Have a snack between meals or a late-night snack^a	1 (1)	1 (1)	0 (1)	−1.344	0.179	0.13
Drink five or more alcoholic drinks at once^a	0 (1)	0 (1)	0 (0)	1.084	0.278	0.11
Number of main meals/day^b	1 (1)	1 (1)	0 (0)	1.025	0.305	0.1

Data is expressed in Median and IQR, P < 0.05: statistically significant.

^aThe scores range from 0 to 3: 0 = never, 1 = sometimes, 2 = most of the time, 3 = always.

^bThe scores range from 0 to 4: 0 = 1-2 meals, 1 = 3 meals, 2 = 4 meals, 3 = 5 meals, 4 = more 5 meals.

To further examine changes across categories, the McNemar–Bowker test was used to compare the proportion of participants in each frequency category for every eating behavior (Table 5). Results showed no significant shifts in category distribution before and after the pandemic. Most participants consistently reported occasional unhealthy food consumption, snacking, and uncontrolled eating frequency, while regularly eating 3 meals per day and abstaining from alcohol.

Table 5.

Distribution of Eating Behavior Responses for the Participants (n = 100).

Answers to Questionnaire		Before the Pandemic (%)	After the Pandemic (%)	P-Value
Have an unhealthy diet/food	Never	8	7	0.76
	Sometimes	64	76
	Most of the time	24	16
	Always	4	1
Eating out of control	Never	38	34	0.45
	Sometimes	49	49
	Most of the time	7	11
	Always	6	6
Have a snack between meals or a late-night snack	Never	22	14	0.07
	Sometimes	47	49
	Most of the time	17	21
	Always	14	16
Drink five or more drinks at once	Never	67	73	0.13
	Sometimes	30	25
	Most of the time	2	1
	Always	1	1
Number of main meals	(1-2)	38	45	0.21
	3	59	52
	4	3	2
	5	0	0
	More than 5	0	1

Data is expressed in numbers (percentages).

Specifically, for unhealthy food intake, 15% of participants moved to a higher frequency category, 22% to a lower one, and 63% stayed in the same category. For uncontrolled eating, 22% increased, 17% decreased, and 61% did not change their frequency. Alcohol intake increased in 6%, decreased in 12%, and remained the same in 82%. Snacking frequency increased in 29%, decreased in 18%, and stayed the same in 53%. Regarding meal frequency, 12% reported an increase, 19% a decrease, and 69% no change.

These results indicate diverse individual responses, with some participants reporting more snacking and uncontrolled eating during the post-pandemic period. Subgroup analyses revealed significant increases in unhealthy food intake among participants without a cancer history and greater uncontrolled eating among those who were employed (P < 0.05).

Discussion

The findings of this study show notable and concerning shifts in physical activity and sedentary habits among Mexican women during the post-pandemic period, while eating behaviors stayed relatively stable compared to before the pandemic. Our results add to the growing evidence documenting the ongoing impact of the COVID-19 pandemic on lifestyle behaviors, especially among vulnerable groups.

The substantial decline in physical activity levels and increase in sitting time we observed demonstrate the ongoing impact of the pandemic on lifestyle even after it ended. This aligns with multiple international studies conducted during the pandemic, as well as a few studies available now that were carried out after the pandemic.^14-19

Our findings show moderate to large effect sizes, indicating that the observed changes in physical activity behavior are not merely statistical but also hold clinical significance. Prolonged sitting time and physical inactivity are linked to an increased risk of several types of cancer and other non-communicable diseases (NCDs), while being active serves as a protective factor against many NCDs.^20-22 We were particularly concerned to find that these negative changes disproportionately affected specific subgroups: women without a cancer history, postmenopausal women, women with overweight or obesity, and homemakers. These groups may face unique barriers to maintaining an active lifestyle. For example, homemakers might lack consistent opportunities for structured exercise, and postmenopausal women may experience age-related physiological and motivational changes that reduce physical activity. The more significant decline in physical activity among women without a cancer history could be due to various factors: health education gaps, less intensive follow-up care, lower perceived health risks, general lack of motivation, or even the influence of the new remote work environment.²³ Interestingly, among cancer survivors, no significant difference in physical activity was observed between the two periods; most remained at the same level. Although no significant change was detected, most cancer survivors reported being physically inactive, which raises serious concerns within this group. Further research is necessary to identify the factors contributing to physical inactivity among women in general and cancer survivors specifically in this region.

The health implications of these findings are significant. Sedentary behavior and insufficient physical activity are both recognized as independent risk factors for a wide range of chronic conditions, including cardiovascular disease, diabetes, obesity, and depression.^24,25 Furthermore, even small increases in sedentary time can negatively impact metabolic health, especially when combined with decreases in moderate-to-vigorous physical activity. Considering that most of our participants were classified as overweight or obese and were postmenopausal, the persistent and observed lifestyle changes are especially concerning and increase the risk of NCDs.²⁵ These findings emphasize the urgent need for public health interventions tailored explicitly for vulnerable women populations in Mexico. Our results extend earlier pandemic-related studies by demonstrating that changes in physical activity and sedentary behaviors have persisted well beyond the acute phase of the COVID-19 pandemic. These ongoing changes support the hypothesis that pandemic-triggered behavior modifications could become long-term or permanent.¹⁴ The mechanisms driving this persistence likely involve numerous factors, including the normalization of remote work, reduced access to recreational facilities, and potential long-term alterations in motivation and habit formation. Future research can thoroughly examine the factors contributing to the continued decrease in physical activity and rise in sedentary time after the pandemic.

The dietary results showed a mixed pattern. While there were no significant overall changes in eating behaviors before and after the pandemic, subgroup analyses revealed notable differences. Women without a cancer history reported eating unhealthy foods more often, and employed participants experienced more frequent uncontrolled eating. These results suggest that the pandemic’s impact on diet was selective, affecting specific subgroups rather than the entire population. This partly contradicts earlier international studies^8,12 but agrees with findings from a previous study in Mexico.⁶

Given that the previous study reported poor diet quality in this population,²⁶ ongoing clinical concerns are justified, even though differences in eating behaviors are not statistically significant and the effect size is small in our study. Furthermore, the lack of improvements in eating habits indicates that unhealthy eating patterns still prevail rather than shifting toward healthier options.

At the population level, eating behaviors remained stable. Most participants reported no change in how often they ate unhealthy foods, consumed alcohol, snacked, or had the same number of meals each day. The majority consistently ate 3 meals daily, occasionally indulged in unhealthy snacks, and did not drink alcohol. These patterns may demonstrate some behavioral resilience. However, the fact that 29% reported more snacking and 22% reported uncontrolled eating indicates that a significant group experienced negative changes in their eating habits. These trends align with previous research linking pandemic-related stress, anxiety, and disrupted routines to increased consumption of energy-dense foods and emotional eating, especially among women.¹² Although these changes are not statistically significant at the population level, if they persist, they could have long-term effects on metabolic health.

The observed subgroup differences highlight the influence of contextual factors on eating behaviors. Women with a history of cancer may show more consistent eating patterns due to previous dietary counseling or long-term lifestyle changes as part of survivorship care, even though no significant dietary improvements were seen in this study. On the other hand, employed women probably face more obstacles to maintaining healthy eating habits, such as limited time, occupational stress, and fewer chances for preparing meals at home. Future research in this region should investigate the specific barriers to adopting and maintaining healthy eating behaviors to develop targeted interventions.

These findings have significant public health implications; the combined impact of physical inactivity and extended sedentary time, even without substantial changes in eating habits, poses a serious health challenge by significantly increasing the risk of obesity and several non-communicable diseases (NCDs), such as type 2 diabetes and cardiovascular disease.^27-29 Despite the World Health Organization’s goal to reduce global physical inactivity by 15% by 2030, current trends indicate that many countries, including Mexico, are heading in the opposite direction.³⁰ This can affect not only the quality of life for the population but also the country’s economy.

The economic burden of lifestyle-related diseases in Mexico is considerable. Poor diet quality, physical inactivity, and obesity-related conditions contribute to rising health care costs and significant productivity losses. These lifestyle factors are key drivers of type 2 diabetes, cardiovascular disease, and other non-communicable diseases, putting considerable pressure on both individuals and the health care system. A recent analysis estimated that the cost of obesity-related diseases is increasing in both developed and developing countries, including Mexico, where it exceeds 2% of GDP when combining direct medical expenses and indirect costs from lost productivity.^31,32 These costs disproportionately affect women, particularly those in low-income households who often lack access to preventive care. At the individual level, unhealthy lifestyle behaviors are associated with higher out-of-pocket expenses, decreased work productivity, and a lower quality of life.³³ These findings highlight the need for multi-sectoral strategies that combine public health interventions with supportive policies, such as workplace wellness programs, subsidies for healthy foods, urban infrastructure encouraging physical activity, and fiscal measures like taxes on sugar-sweetened beverages. Tailored approaches for specific groups, including postmenopausal women, homemakers, working women, and those without regular medical follow-up, could reduce the long-term impact of non-communicable diseases and strengthen population resilience in the post-pandemic era.

Strengths and Limitations

This study has several strengths that improve the validity of its results. Gathering data from the same participants before and after the pandemic enabled within-subject comparisons, lowering interindividual variability and boosting internal validity. The use of validated Spanish-language questionnaires, pilot testing for clarity, and interviewer-administered data collection helped reduce recall bias and social desirability bias. Analyses were also adjusted for important sociodemographic factors, such as age, employment status, and a history of cancer, to minimize potential confounding effects.

However, certain limitations need acknowledgment. The study’s cross-sectional nature and reliance on retrospective self-reports may introduce recall bias and social desirability bias; nonetheless, employing standardized procedures by trained staff, securing participant confidentiality, and encouraging honest responses helped mitigate these concerns. Additionally, the non-probability sampling method limits the extent to which the results can be generalized to the broader population of Mexican women.

The sample size and statistical power also greatly influenced the study’s results. Physical activity outcomes showed moderate to large effect sizes (0.37 to 0.50), offering high statistical power (>90%) and supporting the validity of the significant findings for overall PA, MVPA, and sitting time. In contrast, dietary behaviors had only small effect sizes (0.08 to 0.17), leading to low power (10 to 30%) and increasing the likelihood of Type II error. This difference in power likely explains why key trends in eating behaviors did not reach statistical significance, despite subgroup differences and behavioral variability.

Additional limitations include using only a single post-pandemic time point, which limits the ability to assess long-term or fluctuating behavioral trends, and the lack of data on other influential factors, such as mental health, coexisting non-communicable diseases, household food security, and access to recreational facilities. These factors might have impacted the results by adding unmeasured variability, potentially obscuring or overstating true associations. Future research should involve larger, probability-based longitudinal studies with repeated follow-up assessments and incorporate a broader range of contextual variables to capture sustained lifestyle changes better and enhance external validity, thereby confirming and expanding upon these findings.

Conclusion

This study shows that lifestyle disruptions, such as decreased physical activity and increased sedentary behavior caused by the COVID-19 pandemic, persist among Mexican women after the pandemic, especially in certain vulnerable subgroups. Although eating habits appear more stable at the population level, subgroup analyses reveal concerning trends. These findings highlight the need for targeted, ongoing public health efforts to address the long-term health risks associated with physical inactivity, sedentary behavior, and poor diet after the pandemic.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

The project received ethical approval from the Centro de Investigación en Alimentación y Desarrollo (CIAD) ethics committee under ethical approval number CEI/015-2/2022.

Informed Consent

Participants received an informed consent form, which they signed after a full explanation of the study, and agreed to participate.

ORCID iD

Paul Marcel Nindenshuti

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Eating Behavior and Physical Activity Changes Among Adult Mexican Women After the COVID-19 Pandemic