Explaining the complex impact of the Covid-19 pandemic on children with overweight and obesity: a comparative ecological analysis of parents’ perceptions in three countries

Abstract

Background The Covid-19 pandemic has changed children’s eating and physical activity behaviours. These changes have been positive for some households and negative for others, revealing health inequalities that have ramifications for childhood obesity. This study investigates the pandemic’s impact on families of children aged 2–6 years with overweight or obesity. Methods Drawing on interviews conducted as part of a randomised controlled trial (RCT) for childhood obesity, thematic analysis was used to examine how parents of pre-schoolers perceived changes in their eating, screentime and physical activity behaviours between the first and second waves of Covid-19. Parents (n = 70, representing 68 families) were interviewed twice during a period of 6 months in three countries with markedly different pandemic policies – Sweden, Romania, and Spain. The analysis is informed by Bronfenbrenner’s ecological systems theory, which embeds home- and school-based influences within societal and policy contexts. Results The findings show that, although all participants were recruited from an RCT for families of children with excess weight, they reported different responses to the pandemic’s second wave, with some children engaging in healthier eating and physical activity, and others engaging in comfort eating and a more sedentary lifestyle. Differences in children’s obesity-related behaviours were closely related to differences in parents’ practices, which were, in turn, linked to their emotional and social wellbeing. Notably, across all sites, parents’ feeding and physical activity facilitation practices, as well as their emotional and social wellbeing, were embedded in household resilience. In resilient households, where parents had secure housing and employment, they were better able to adapt to the challenges posed by the pandemic, whereas parents who experienced household insecurity found it more difficult to cope. Conclusions As the Covid-19 pandemic is turning into a long-term public health challenge, studies that address household resilience are crucial for developing effective prevention and treatment responses to childhood obesity.

Impact of the COVID-19 pandemic on children's mental health: A systematic review

“…Using Bronfenbrenner's ecological systems theory (EST) ( 82 , 83 ) as a lens enables us to better understand why the pandemic has had considerable impact on children's mental health. According to the EST, a child develops through the interaction of different systems (i.e., the micro-, meso-, exo-, macro- and chronosystems) from the closest to the broadest ( 84 ). During the pandemic, the children's microsystem has been compromised ( 38 , 85 ) by a number of restrictions, such as the prolonged closure of schools, homeschooling and the absence of social support (peer relationships and extended families).…”

National data showed an increased prevalence of overweight and obesity among four‐year‐old Swedish children during the first year of COVID‐19

“…6 Qualitative studies from North America and Europe stated that the restrictions had influenced food and activity habits. 5,21 The pandemic restrictions have affected the physical and mental health of both children and adults.…”

“…24 These habits were more negatively affected in families that had less resilience and found it more difficult to adapt. 5,7 This implies that inequalities in health increased during the COVID-19 pandemic. The particular increase in obesity over time, and the reported inequalities in health, implies an urgent need for both general and targeted interventions in healthcare, as well as in the entire society.…”

Understanding the corporate political activity of the ultra - processed food industry in East Asia: a Philippines case study

“…We found that the UPF industry is leveraging the COVID - 19 pandemic in the Philippines to counter food and nutrition policy, arguing the need for economic expansion and positioning themselves as a provider of essential food and nutrition services. We argue that the COVID - 19 pandemic instead emphasises the need for food and nutrition policies, to reduce diet - related diseases, many of which are key risk factors for adverse outcomes associated with COVID - 19 [ 55 , 56 ]. We are not the first to report on industry and other coalitions capitalising on such events.…”