Body composition, fitness, and eating behaviors deteriorate during the COVID-19 pandemic in at-risk pediatric patients

Abstract

The COVID-19 pandemic has significantly altered children's daily routines. The health impacts of our obesogenic environment are exacerbated by COVID-19. Many clinicians have concerns that the lack of structured activity, increased stress and altered eating behaviors would lead to increases in adiposity in children. The present study examined changes in body composition as a result of the COVID-19 pandemic in pediatric patients in larger bodies and demonstrates significant increases in total body fat, percent body fat (%fat), and BMI z-score, as well as markers of insulin resistance. In this retrospective, longitudinal study, body composition was measured by dual energy x-ray absorptiometry (DXA) within a multidisciplinary pediatric fitness clinic at an academic medical center. Visit dates were categorized into Pre-COVID-19 (before 4/1/2020) and Peri-COVID-19 (on or after 4/1/2020). Linear mixed effects modeling was conducted to evaluate changes in clinical and laboratory outcomes from Pre- to Peri-COVID-19. Baseline assessment was obtained from 650 patients with higher BMI scores (52% male) with a mean (SD) age of 12.3 (3.2) years. The adjusted mean BMI z-score (BMIz) was significantly higher in the Peri-COVID-19 sample when compared to the Pre-COVID-19 samples (2.31 vs. 2.25, P < 0.0001) which can be attributed to greater total fat mass (TFM) of 93.0 (90.0-96.4) lbs. (P = 0.007) and %FAT of 40.2% (39.2-41.2) as compared to the Pre-COVID-19 patients. The COVID-19 pandemic influenced social determinants and lifestyle factors. Most notable changes observed were negative changes in physical activity and screen time. The need for social isolation in a pandemic has resulted in worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. The COVID-19 pandemic exerts disproportionate burden on children and families, magnifying their vulnerability to changes in body composition and chronic disease risk.

Pre-Pandemic Cardiorespiratory Fitness Levels Predicts Health-Related Quality of Life in Children at Post-Pandemic Covid-19 Social Distancing

“…Comparisons of oxygen uptake and the anaerobic threshold between the pre and post-COVID-19 cohorts indicated that the post-COVID cohort oxygen uptake were significantly lower than in the pre-COVID cohorts (39.1 vs. 44.7, p =0.031) (38). The same was observed in Canadian elementary school-aged children (39). Authors suggest that increases in BMI, overweight, and obesity rates contribute to changes in pre-to post-pandemic health, such as in lower levels of physical fitness and HQoL (40).…”

“…These results are expected hypothetically, considering the complex interpretation including HQoL, fitness, and physical activity presented on the literature, even though, is important to point out that is a scarce kind of analytical longitudinal analysis in children during the years 2019-2022 (1)(2)(3)6,9,12,13,15,22,23,(29)(30)(31).…”

“…Along with the fact that physical activity promotes a positive relation with better HQoL levels during the same period. Besides, the children enrolled in physical education can reach better levels of self-reported physical fitness at end of social distancing (9,13,23).…”

“…Besides, CRF is inversely associated with cardiometabolic risk factors, such as type II diabetes, metabolic syndrome, muscular and bone health decreasing, and cardiovascular diseases (5,7). Thus, understanding how physical fitness and HQoL are associated may help to develop intervention strategies that promote health of children and youth in the post pandemic period, highlighting the school setting as an important target (8)(9)(10)(11)(12)(13).…”

“…However, there are studies hypothesizing this relationship, due to children at pre and during the pandemic presented CRF levels correlated with self-perceived physical fitness (9). Another perspective suggests that self-perceived physical fitness is longitudinally associated with lower BMI levels and higher CRF (13), which could be intermediated by a cyclical relation among CRF, physical activity and HQoL (9,13,(20)(21)(22)(23).…”