Specialized Care Gaps During COVID-19 Lockdowns Tied to Pediatric Weight Gain

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The COVID-19 pandemic resulted in significant weight gain among children and adolescents with prior obesity who had their outpatient follow-up interrupted.

During the early months of the pandemic, many countries around the world implemented quarantine measures. Although they were designed to keep the population safe, they also significantly impacted the lifestyle and physical and mental health of individuals. For children and adolescents, the closure of educational institutions meant canceling physical education classes and team sports as well as eliminating other previously necessary activities, such as walking to school — all of which reduced the time of physical activity and increased sedentary behavior.

“Such changes made it possible to experience a feeling of frustration, boredom, and, above all, anxiety, which would act as a risk factor for the worsening of the childhood obesity pandemic due to eating behaviors that arise in response to new stressors,” wrote the team of investigators from the State University of Campinas, Brazil. “Maintaining a healthy routine has become an arduous task in this context. Thus, the COVID-19 pandemic, which in itself is a major global public health challenge, may aggravate childhood obesity, which affects around 158 million children and adolescents worldwide.”

The observational study evaluated the effects of social contingency measures during the COVID-19 pandemic and disruptions to outpatient follow-up on weight gain among children and adolescents with a prior diagnosis of obesity using electronic medical records of pediatric patients treated at a specialized outpatient clinic between 2019 and 2023.

Investigators assessed changes in weight, height, body mass index (BMI), laboratory tests and any associated comorbidities using the Statistical Package for the Social Sciences (SPSS) at baseline and the first postpandemic visit. Laboratory data included total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides and fasting glucose.

In total, investigators analyzed the electronic medical records of 73 pediatric patients. Most (58.9%) were male, the mean age was 10.24 years, and the median BMI was 28.10 kg/m2. The most common comorbidities included asthma, allergic rhinitis, allergic conjunctivitis, depression and anxiety, dyslipidemia, diabetes mellitus, systemic arterial hypertension and hepatic steatosis.

During the COVID-19 pandemic, pediatric patients experienced a significant median weight gain of approximately 17.66%, corresponding with a median increase of 14 kilograms. Male and female participants showed similar weight increases, with a 21.38% gain for male subjects and a 21.45% gain for female subjects. In Brazil specifically, the percentage of children and adolescents with overweight grew by 6.1% and 17.2%, respectively, during this time.

During the pandemic, children and adolescents experienced increases in total cholesterol, LDL ("bad cholesterol") and triglycerides, along with a decrease in HDL ("good cholesterol"), while blood glucose levels stayed the same. Before the pandemic, common conditions in pediatric patients included asthma, high blood pressure and fatty liver disease (in boys) or anxiety (in girls). Post pandemic, asthma remained the most common condition in both sexes, though rates slightly decreased, while high blood pressure remained a key concern.

Investigators noted using electronic medical records as a data source may have limited the study due to a lack of uniformity in clinical records, which made it harder to include more cases in the analysis. This may have also impacted the generalization of findings.

“On the contrary, the study showed the relationship between social isolation and the worsening of obesity and comorbidities in children and adolescents previously diagnosed with obesity,” investigators concluded. “These results underscore concern about the future consequences of this unhealthy weight gain in childhood, both in the short and long term.”