Age- and weight group-specific weight gain patterns in children and adolescents during the 15 years before and during the COVID-19 pandemic

Abstract

Background/objectives: There is a concern that measures aiming to limit a further spread of COVID-19, e.g., school closures and social distancing, cause an aggravation of the childhood obesity epidemic. Therefore, we compared BMI trends during the 15 years before and during the COVID-19 pandemic.

Subjects/methods: To assess the change in weight dynamics during the first months of COVID-19, we compared the trends of 3-month change in BMI-SDS (ΔBMI-SDS) and the proportions of children showing a high positive (HPC) or high negative (HNC) weight change between 2005 and 2019 and the respective changes from 2019 (pre-pandemic) to 2020 (after the onset of anti-pandemic measures) in more than 150,000 children (9689 during the pandemic period). The period of 3 months corresponds approximately to the first lockdown period in Germany.

Results: During the COVID-19 pandemic, we found a substantial weight gain across all weight and age groups, reflected by an increase in the 3-month change in BMI-SDS (β = 0.05, p < 0.001), an increase in the proportion of children showing HPC (OR = 1.4, p < 0.001), and a decrease in the proportion of children showing HNC (OR = 0.7, p < 0.001). Besides, we found the same trends since 2005 on a low but stable level with a yearly increase of ΔBMI-SDS by β = 0.001 (p < 0.001), the odds of HPC increased by OR_{high_pos} = 1.01 (p < 0.001), and the odds of HNC decreased by OR_{high_neg} = 0.99 (p < 0.001). These rather small effects accumulated to β = 0.02, OR_{high_pos} = 1.14, and OR_{high_pos} = 0.85 over the whole period 2005-2019. Alarmingly, both the long-term and the short-term effects were most pronounced in the obese subgroup.

Conclusions: There are positive dynamics in different measures of weight change, indicating a positive trend in weight gain patterns, especially within the group of children with obesity. These dynamics are likely to be escalated by COVID-19-related measures. Thus, they may lead to a significant further aggravation of the childhood obesity pandemic.

Trial registration: ClinicalTrials.gov NCT03072537.

Fig. 1. Trends in ΔBMI-SDS, HPC, and HNC between 2005 and 2019 modeled via linear additive mixed models by age group.

A Trends in ΔBMI-SDS are shown as lines; points indicate yearly means ± 95% confidence levels. Between 2005 and 2019 (pre-pandemic), the trends were mainly stable, showing only a slight increase. From 2019 (prepandemic)to 2020 (after the onset of anti-pandemic measures), we found a substantial increase, less pronounced in the oldest age group. B The trends in the proportions of children with HPC show the same pattern as we found for ΔBMI-SDS. The patterns were also similar across the age groups but at higher levels for younger children. C Theinverse trends were found for the proportions of children with HNC. There was a small negative trend between 2005 and 2019. Between 2019 (pre-pandemic) and 2020, the proportions of children with HNC decreased substantially. The drop was less pronounced in the oldest age group.

Fig. 2. Trends in ΔBMI-SDS, HPC, and HNC between 2005 and 2019 modeled via linear additive mixed models by weight group.

A Trends in ΔBMI-SDS are shown as lines; points indicate yearly means ± 95% confidence levels. Between 2005 and 2019 (pre-pandemic), the trends were mainly stable, showing only a slight increase. From 2019 (pre-pandemic) to 2020 (after the onset of anti-pandemic measures), we found a substantial increase for all weight groups. B The trends in the proportions of children with HPC show the same pattern as we found for ΔBMI-SDS. However, the increase between 2019 (pre-pandemic) and 2020 was substantially stronger for children already affected by overweight and obesity. C The inverse trends were found for the proportions of children with HNC. There was a small negative trend between 2005 and 2019 for the normal weight and overweight subgroups. The trend was substantially stronger in children with obesity. Between 2019 (pre-pandemic) and 2020, the proportions of children with HNC decreased substantially. Again, the drop was most pronounced in children already affected by overweight or obesity.