Children's rates of BMI change during pre‐pandemic and two COVID‐19 pandemic periods, IQVIA Ambulatory Electronic Medical Record, January 2018 Through November 2021

Abstract

Objective Many U.S. youth experienced accelerated weight gain during the early COVID‐19 pandemic. Using an ambulatory electronic health record dataset, we compared children's rates of BMI change in three periods: prepandemic (January 2018‐February 2020), early pandemic (March‐December 2020), and later pandemic (January‐November 2021). Methods We used mixed‐effects models to examine differences in rates of change in BMI, weight, and obesity prevalence among the three periods. Covariates included time as a continuous variable; a variable indicating in which period each BMI was taken; sex; age; and initial BMI category. Results In a longitudinal cohort of 241,600 children aged 2‐19 years with ≥4 BMIs, the monthly rates of BMI change (kg/m 2 ) were 0.056 (95%CI: 0.056, 0.057) prepandemic, 0.104 (95%CI: 0.102, 0.106) in the early pandemic, and 0.035 (95%CI: 0.033, 0.036) in the later pandemic. The estimated prevalence of obesity in this cohort was 22.5% by November 2021. Conclusions In this large geographically‐diverse cohort of U.S. youth, accelerated rates of BMI change observed during 2020 were largely attenuated in 2021. Positive rates indicate continued weight gain rather than loss, albeit at a slower rate. Childhood obesity prevalence remained high, which raises concern about long‐term consequences of excess weight and underscores the importance of healthy lifestyle interventions. This article is protected by copyright. All rights reserved.

Change in BMI in Children Over the First 30 Months After the Start of the SARS-CoV-2 Pandemic

“…This finding is similar to a recent study conducted with a much larger cohort of patients from the IQVIA’s AEMR database. 14 Although the etiology of the greater increase in BMI early in the pandemic versus later in the pandemic is likely multifactorial, the reintegration of children from the home to the preschool and school environments in the Late Pandemic period could be a possible association. Brazendale et al have postulated the “Structured Days Hypothesis,” suggesting that obesity-related behaviors, including sleep, physical activity, diet, and sedentary behaviors, are positively regulated when children are part of more structured days (similar to school environment) versus unstructured time as during the summer.…”

Changes in Food Consumption, BMI, and Body Composition in Youth in the US during the COVID-19 Pandemic

“…Our hypothesis that youth assessed during the pandemic would gain more weight and adiposity than youth examined before the pandemic was based on literature demonstrating that youth gaining excess weight shortly after the onset of the pandemic [ 16 , 18 , 22 , 23 , 24 , 25 , 26 , 27 ] was in part due to a reduction in their physical activity in the same time period [ 13 , 14 , 19 , 26 , 28 ]. However, more recent data suggest that there was a rapid increase in the rates of obesity at the beginning of the pandemic that slowed later in the pandemic [ 35 ]. Our sample of pandemic data ranged from August 2020 to October 2021, thereby missing the first several months of the pandemic due to COVID-19 safety restrictions.…”

“…The average of the three height measurements and measured weight were used to calculate BMI. BMIz scores were computed according to the CDC standards for age and sex [ 35 ]. Adiposity (percent fat mass) and lean mass (kg) were measured using dual energy X-ray absorptiometry (iDXA system, GE Healthcare, Madison, WI, USA), which is a validated body composition measure in youth [ 36 ].…”

Pediatric overweight and obesity increased in Israel during the COVID-19 period

“…In a study that echoes our findings, a school-based program in Isparta Province, Turkey, showed that improvements in the rates of overweight and obesity that had occurred since 2005 were suddenly reversed, with 2021 numbers being higher than any they had previously observed [ 16 ]. A study relying on a large, common electronic medical record in the USA found that BMI increased very quickly during the early pandemic, but then stabilized or even improved slightly later in the pandemic [ 15 ]. A probabilistic annual national sample from Peru showed that the proportion of children with obesity had increased from 6.4% to 7.8% between 2019 and 2021 [ 11 ].…”