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. 2021 Jul 16:38:101026.
doi: 10.1016/j.eclinm.2021.101026. eCollection 2021 Aug.

Pediatric BMI changes during COVID-19 pandemic: An electronic health record-based retrospective cohort study

Corinne G Brooks  1 , Jessica R Spencer  1   2 , J Michael Sprafka  1   3 , Kimberly A Roehl  1 , Junjie Ma  1 , Ajit A Londhe  1 , Fang He  1 , Alvan Cheng  1 , Carolyn A Brown  1 , John Page  1
Affiliations

Pediatric BMI changes during COVID-19 pandemic: An electronic health record-based retrospective cohort study

Corinne G Brooks et al. EClinicalMedicine. .

Abstract

Background: Beginning March 2020, the COVID-19 pandemic has disrupted different aspects of life. The impact on children's rate of weight gain has not been analysed.

Methods: In this retrospective cohort study, we used United States (US) Electronic Health Record (EHR) data from Optum® to calculate the age- and sex- adjusted change in BMI (∆BMIadj) in individual 6-to-17-year-old children between two well child checks (WCCs). The mean of individual ∆BMIadj during 2017-2020 was calculated by month. For September-December WCCs, the mean of individual ∆BMIadj (overall and by subgroup) was reported for 2020 and 2017-2019, and the impact of 2020 vs 2017-2019 was tested by multivariable linear regression.

Findings: The mean [95% Confidence Interval - CI] ∆BMIadj in September-December of 2020 was 0·62 [0·59,0·64] kg/m2, compared to 0·31 [0·29, 0·32] kg/m2 in previous years. The increase was most prominent in children with pre-existing obesity (1·16 [1·07,1·24] kg/m2 in 2020 versus 0·56 [0·52,0·61] kg/m2 in previous years), Hispanic children (0·93 [0·84,1·02] kg/m2 in 2020 versus 0·41 [0·36,0·46] kg/m2 in previous years), and children who lack commercial insurance (0·88 [0·81,0·95] kg/m2 in 2020 compared to 0·43 [0·39,0·47] kg/m2 in previous years). ∆BMIadj accelerated most in ages 8-12 and least in ages 15-17.

Interpretation: Children's rate of unhealthy weight gain increased notably during the COVID-19 pandemic across demographic groups, and most prominently in children already vulnerable to unhealthy weight gain. This data can inform policy decisions critical to child development and health as the pandemic continues to unfold.

Funding: Amgen, Inc.

Keywords: COVID-19; Obesity; Overweight; Pediatrics; Public health; Vulnerable populations.

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Conflict of interest statement

AC is an employee of Amgen, Inc; AL, JM, CAB, JHP, KAR, FH and CGB are employees at Amgen, Inc and declare stock option in Amgen, Inc; AL declares stock in Johnson and Johnson as well; JMS is a consultant of Amgen, Inc, reports consulting fees at Amgen, Inc and is a formal employee of Amgen, Inc; JRS is a contract employee at Amgen, Inc through SimulStat and declares stock option at Amgen, Inc.

Figures

Fig. 1
Fig. 1
Count of all well check checks documented in Optum® COVID-19 EHR by month and year. Dotted line represents the expected number in February-December 2020 extrapolated from the observed number in January 2020 (before pandemic shutdowns) using the ratios observed in February-December of 2017–2019 to January 2017–2019.
Fig. 2
Fig. 2
Mean of individual ΔBMIadj values during WCCs divided by age group. Mean is represented at a given month relative to the individual's previous WCC (9-to-15 months previous) stratified by age group, with shaded 95% CIs.
Fig. 3.
Fig. 3.
Age- and Sex-adjusted BMI change, years 2017-2019 vs 2020 (September-December WCCs). (a) mean of individual ΔBMIadj values during WCC of September-December 2017–2019 (blue) or September-December 2020 (red), overall and by subgroups, with bars representing 95% CIs; (b) regression coefficients and CIs of binary independent variable year=2020, from multivariable linear regression of ΔBMIadj on independent variables year=2020 and covariates age, prior WCC BMI category, prior WCC insurance status, race, and sex (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.).
See this image and copyright information in PMC

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