Many obesity risk factors have increased during the COVID-19 pandemic, including physical inactivity, poor diet, stress, and poverty. The aim of this systematic review was to evaluate the impact of the COVID-19 pandemic, as well as associated lockdowns or restrictions, on weight change in children and adults. We searched five databases from January 2020 to November 2021. We included only longitudinal studies with measures from before and during the pandemic that evaluated the change in weight, body mass index (BMI) (or BMI z-scores for children), waist circumference, or the prevalence of obesity. Random effects meta-analyses were conducted to obtain pooled estimates of the mean difference in outcomes. Subgroups were evaluated for age groups and diabetes or obesity at baseline. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A total of 74 studies were included (3,213,776 total participants): 31 studies of children, 41 studies of adults, and 2 studies of children and adults. In children, the pooled mean difference was 1.65 kg (95% confidence interval [CI]: 0.40, 2.90; 9 studies) for weight and 0.13 (95% CI 0.10, 0.17; 20 studies) for BMI z-scores, and the prevalence of obesity increased by 2% (95% CI 1%, 3%; 12 studies). In adults, the pooled mean difference was 0.93 kg (95% CI 0.54, 1.33; 27 studies) for weight and 0.38 kg/m 2 (95% CI 0.21, 0.55; 25 studies) for BMI, and the prevalence of obesity increased by 1% (95% CI 0%, 3%; 11 studies). In children and adults, the pooled mean difference for waist circum-

Background The COVID-19 pandemic disrupted access to healthcare services in Canada. Research prior to the pandemic has found that depression and anxiety symptoms were associated with increased unmet healthcare needs. The primary objective of this study was to examine if mental health was associated with perceived access to healthcare during the pandemic Methods A cross-sectional study was conducted using data from 23,972 participants (aged 50-96) in the Canadian Longitudinal Study on Aging COVID-19 Exit Survey (Sept-Dec 2020). We used logistic regression to estimate how the presence of depression and anxiety symptoms, defined using scores of ≥10 on the Center for Epidemiologic Studies Depression Scale and ≥10 on the Generalized Anxiety Disorder Scale, were associated with the odds of reporting: 1) challenges accessing healthcare, 2) not going to a hospital or seeing a doctor when needed, 3) experiencing barriers to COVID-19 testing. Models were adjusted for sex, age, region, urban/rural residence, racial background, immigrant status, income, marital status, work status, chronic conditions, and pre-pandemic unmet needs. Results The presence of depressive (aOR=1.96; 95% CI=1.82, 2.11) and anxiety symptoms (aOR=2.33; 95% CI=2.04, 2.66) compared to the absence of these symptoms were independently associated with higher odds of challenges accessing healthcare. A statistically significant interaction with sex suggested stronger associations in females with anxiety. Symptoms of depression (aOR=2.88; 95% CI=2.58, 3.21) and anxiety (aOR=3.05; 95% CI=2.58, 3.60) were also associated with increased odds of not going to a hospital or seeing a doctor when needed. Lastly, depressive (aOR=1.99; 95% CI=1.71, 2.31) and anxiety symptoms (aOR=2.01; 95% CI=1.58, 2.56) were associated with higher odds of reporting barriers to COVID-19 testing. There was no significantly significant interaction with sex for the latter two outcomes. Conclusion The presence of depression and anxiety symptoms were strongly associated with perceived unmet healthcare needs during the COVID-19 pandemic. Interventions to improve healthcare access for adults with depression and anxiety during the pandemic may be necessary.

Background: The indirect consequences of the COVID-19 pandemic in older adults, such as stress, are unknown. We sought to describe the stressors and perceived consequences of the COVID-19 pandemic on older adults in Canada and to evaluate differences by socioeconomic factors. Methods: We conducted a cross-sectional study using data from the Canadian Longitudinal Study on Aging COVID-19 Exit Questionnaire (September–December 2020). A 12-item checklist was used to assess stressors (e.g., income loss, separation from family) experienced during the pandemic, and a single question was used to measure perceived consequences. We used a generalized linear model with a binomial distribution and log link to estimate prevalence ratios and 95% confidence intervals (CIs) for the association between socioeconomic factors, stressors and perceived consequences. Results: Among the 23 972 older adults (aged 50–96 yr) included in this study, 17 977 (75.5%) reported at least 1 stressor during the pandemic, with 5796 (24.4%) experiencing 3 or more stressors. The consequences of the pandemic were perceived as negative by 23 020 (63.1%) participants. Females were more likely to report most stressors than males, such as separation from family (adjusted prevalence ratio 1.31, 95% CI 1.28–1.35). The perceived consequences of the pandemic varied by region; residents of Quebec were less likely to perceive the consequences of the pandemic as negative (adjusted prevalence ratio 0.87, 95% CI 0.84–0.91) than those of the Atlantic provinces. Interpretation: These findings suggest that older adults across Canada experienced stressors and perceived the pandemic consequences as negative, though stressors and perceptions of consequences varied by socioeconomic factors and geography, highlighting inequalities. Future research will be needed to estimate the impact of stress during the pandemic on future health outcomes.