Changes in Weight-Related Health Behaviors and Social Determinants of Health among Youth with Overweight/Obesity during the COVID-19 Pandemic

Abstract

Objectives: To assess changes in weight-related health behaviors and social determinants of health (SDoH) among youth with overweight/obesity during the coronavirus disease 2019 (COVID-19) pandemic. Methods: We assessed weight-related health behaviors (physical activity, screen time, sleep, and diet) and SDoH (food insecurity, income/childcare, and caregivers' perceived stress) before vs. during the pandemic with a survey administered August-October 2020 to caregivers of 2-17-year olds and adolescents 13-17 years old with BMI ≥85th percentile seen in clinic within 6 months prepandemic. We analyzed changes in continuous variables using paired t-tests and categorical variables with McNemar's or Fisher's exact tests, and the influence of social determinants on behavior change using multivariable regression models. Results: A total of 129 caregivers and 34 adolescents completed surveys. Compared with prepandemic, caregivers reported youth decreased moderate/vigorous physical activity (-87.4 [205.7] minutes/week, p < 0.001) and increased recreational screen time (2.5 [2.1] hours/day, p < 0.001). Fewer had regular bedtimes (before: 89% and during: 44%, p < 0.001) and more ate most meals with television (before: 16% and during: 36%, p < 0.001). Food insecurity increased from 27% to 43% (p < 0.001), 45% reported reduced household income, and caregivers with moderate/high perceived stress scale scores increased from 43% to 64% (p < 0.001). Moderate/high caregiver stress and food insecurity were associated with greater magnitudes of adverse behavior change. Conclusion: Alarming changes in health behaviors among youth with overweight/obesity, particularly among those with stressed caregivers and food insecurity, may increase prevalence of obesity-related comorbidities and exacerbate health disparities. There is an urgent need to expand access to effective interventions for overweight/obesity that address psychosocial stressors.

Keywords: COVID-19 pandemic; obesity; physical activity; screen time; sleep; social determinants of health.

Figure 1.

Change in caregiver-reported weight-related behaviors during the pandemic stratified by demographic characteristics and SDoH. (a) Change in moderate/vigorous physical activity during the pandemic stratified by demographic characteristics and SDoH. (b) Change in screen time during the pandemic stratified by demographic characteristics and SDoH. (c) Change in sugary beverage intake during the pandemic stratified by demographic characteristics and SDoH. (d) Change in fruit/vegetable intake during the pandemic stratified by demographic characteristics and SDoH. (e) Change in chips/foods with added sugar intake during the pandemic stratified by demographic characteristics and SDoH. (f) Change in sleep duration during the pandemic stratified by demographic characteristics and SDoH. PSS, Perceived Stress Scale; SDoH, social determinants of health.

Figure 1.

Change in caregiver-reported weight-related behaviors during the pandemic stratified by demographic characteristics and SDoH. (a) Change in moderate/vigorous physical activity during the pandemic stratified by demographic characteristics and SDoH. (b) Change in screen time during the pandemic stratified by demographic characteristics and SDoH. (c) Change in sugary beverage intake during the pandemic stratified by demographic characteristics and SDoH. (d) Change in fruit/vegetable intake during the pandemic stratified by demographic characteristics and SDoH. (e) Change in chips/foods with added sugar intake during the pandemic stratified by demographic characteristics and SDoH. (f) Change in sleep duration during the pandemic stratified by demographic characteristics and SDoH. PSS, Perceived Stress Scale; SDoH, social determinants of health.

Figure 1.

Change in caregiver-reported weight-related behaviors during the pandemic stratified by demographic characteristics and SDoH. (a) Change in moderate/vigorous physical activity during the pandemic stratified by demographic characteristics and SDoH. (b) Change in screen time during the pandemic stratified by demographic characteristics and SDoH. (c) Change in sugary beverage intake during the pandemic stratified by demographic characteristics and SDoH. (d) Change in fruit/vegetable intake during the pandemic stratified by demographic characteristics and SDoH. (e) Change in chips/foods with added sugar intake during the pandemic stratified by demographic characteristics and SDoH. (f) Change in sleep duration during the pandemic stratified by demographic characteristics and SDoH. PSS, Perceived Stress Scale; SDoH, social determinants of health.