Body composition, fitness, and eating behaviors deteriorate during the COVID-19 pandemic in at-risk pediatric patients

The COVID-19 pandemic has significantly altered children's daily routines. The health impacts of our obesogenic environment are exacerbated by COVID-19. Many clinicians have concerns that the lack of structured activity, increased stress and altered eating behaviors would lead to increases in adiposity in children. The present study examined changes in body composition as a result of the COVID-19 pandemic in pediatric patients in larger bodies and demonstrates significant increases in total body fat, percent body fat (%fat), and BMI z-score, as well as markers of insulin resistance. In this retrospective, longitudinal study, body composition was measured by dual energy x-ray absorptiometry (DXA) within a multidisciplinary pediatric fitness clinic at an academic medical center. Visit dates were categorized into Pre-COVID-19 (before 4/1/2020) and Peri-COVID-19 (on or after 4/1/2020). Linear mixed effects modeling was conducted to evaluate changes in clinical and laboratory outcomes from Pre- to Peri-COVID-19. Baseline assessment was obtained from 650 patients with higher BMI scores (52% male) with a mean (SD) age of 12.3 (3.2) years. The adjusted mean BMI z-score (BMIz) was significantly higher in the Peri-COVID-19 sample when compared to the Pre-COVID-19 samples (2.31 vs. 2.25, P < 0.0001) which can be attributed to greater total fat mass (TFM) of 93.0 (90.0-96.4) lbs. (P = 0.007) and %FAT of 40.2% (39.2-41.2) as compared to the Pre-COVID-19 patients. The COVID-19 pandemic influenced social determinants and lifestyle factors. Most notable changes observed were negative changes in physical activity and screen time. The need for social isolation in a pandemic has resulted in worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. The COVID-19 pandemic exerts disproportionate burden on children and families, magnifying their vulnerability to changes in body composition and chronic disease risk.