Obesity Rose Disproportionately Among Low-income Youth During Early COVID-19

The proportion of overweight, obesity, or severe obesity increased from 38% to 45% among 4500 young people seen in a primary care network where most receive public insurance.

During the early months of the COVID-19 pandemic, rates of overweight and obesity increased markedly among children and adolescents from low-income families, according to a new study of more than 4500 young people aged 2 to 17 years seen in a large primary care network in Ohio.

The findings were presented at the 2022 European Congress on Obesity (ECO), held May 4-7 in Maastricht, Netherlands.

The study, led by Ihuoma Eneli, MD, MS, director, Center for Healthy Weight and Nutrition at the Nationwide Children’s Hospital and professor of pediatrics at The Ohio State University in Columbus, is believed to be one of the first to present findings on the impact of the pandemic on weight change in young persons from lower socioeconomic groups, according to a statement from the European Association for the Study of Obesity (EASO).

The months of pandemic-driven lockdown and switch to remote learning, the authors write, are strongly associated with risk factors for obesity, including decreased exercise, altered sleep routines, increased screen time, and poor nutrition choices. In the US where childhood obesity continues to increase and to drive early metabolic morbidity, the school closures and lack of social interaction as well as heightened stress and anxiety created the "perfect storm" for weight gain, said Eneli.

“We know that excess weight gain during childhood is difficult to reverse, and if left unchecked, can have serious health consequences such as type 2 diabetes, as well as higher odds of having obesity as an adult," she continued. "Poverty makes both obesity and its negative health effects more likely, and access to obesity care is disproportionately lower in minority populations. These new data underscore why urgent action is needed to close the gap between the most and least deprived to ensure every child has an equal chance to grow up healthy.”

Eneli and colleagues analyzed electronic medical record data from young people aged 2–17 years who receive outpatient services through a large network of 12 primary care clinics in the Nationwide Children’s Hospital in Ohio. The majority of the more than 100 000 youths seen in the clinic network receive public insurance, like Medicaid.

The final cohort for analysis numbered 4509 young people who had measures of weight and height recorded at least once during clinic visits before the pandemic (January 1 to March 30, 2020 [Q1]) and at least once during early months of the pandemic (June 1 to September 30, 2020 [Q3]). The investigators compared change in weight category between Q1 and Q3 and, after adjusting for visit type and time lapse, used logistic regression to evaluate those weight category changes and age group, sex, and race/ethnicity.

The researchers found that the proportion of youth with overweight, obesity, or severe obesity increased from 38% to 45% and declined by almost 6% in the healthy weight category.

Overall, 23.1% of young people gained at least 5 kg, 4.3% gained ≥10 kg and in 17.8%, BMI rose by ≥2 units. Disturbingly Enili et al report that average (median) weight gain was highest, 5.8 kg, among young people with severe obesity (IQR = 5.2 kg).

Interestingly the researchers found that among youth who were underweight prior to the pandemic, 45.3% moved up to the healthy weight category, gaining a median of 2.1 kg.

Younger and minority youth fare poorly

Additional analyses found that younger children (aged 2–9 years), girls, and ethnic-minority youth were more likely to move to a higher weight category. For example, children aged between 2 and 9 years old were almost twice as likely to move up to a higher weight category (eg, healthy weight to overweight, or obesity to severe obesity) than those aged 14-17 years. Similarly, Hispanic children and teenagers were twice as likely to move up a weight category than their White peers.

In the EASO statement Enili points out that their findings reflect the early months of the pandemic and that individual and social adaptation to pandemic conditions over time may change the trajectory of weight change and that evolution deserves study, she said.

"Along with several negative pandemic-related consequences on child health (eg, increased mental health concerns, food insecurity, deficits in immunization coverage and school performance), addressing the excessive weight gain should be a top priority for families, administrators, or policymakers,” she said. Enili and coauthors conclude in the study abstract: "To reverse this upward trend, integrated multisector interventions that are mutually-reinforcing are urgently needed."

Limitations of the study noted by the authors include its observational design and limit to a single US primary care network. The effect of unmeasured factors, eg, lifestyle behaviors, sleep patterns, also cannot be ruled out.


Reference: Eneli IU, Xu J, Pratt K. Change in weight category among youth early in the COVID-19 pandemic. (P03.11). Obes Facts. 2022;15:1-240.