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

Main Article Content

Cassandra M Vanderwall Jens Eickhoff R Randall Clark Aaron L Carrel

Abstract

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.

Keywords: : Body Mass Index Z-score, Dual Energy X-Ray Absorptiometry, Body Composition, COVID-19

Article Details

How to Cite
VANDERWALL, Cassandra M et al. Body composition, fitness, and eating behaviors deteriorate during the COVID-19 pandemic in at-risk pediatric patients. Medical Research Archives, [S.l.], v. 9, n. 8, aug. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2540>. Date accessed: 29 mar. 2024. doi: https://doi.org/10.18103/mra.v9i8.2540.
Section
Research Articles

References

1. World Health Organization. Novel Coronavirus (2019-nCoV) situation report– 51. [cited 2021 May 12] Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10
2. Holmes ME & Spring KE. A Brief Review of the Physical activity, Stress, and Metabolic Syndrome Relationship in Youth: Consideration of Socioeconomic Position as a Chronic Stressor. Medical Research Archives [Internet]. 2018 [cited 2021 May 12];6(4):1-18. Available from http://journals.ke-i.org/index.php/mra.
3. Calcaterra V, Vandoni M, Carnevale Pellino V, Cena H. Special Attention to Diet and Physical Activity in Children and Adolescents With Obesity During the Coronavirus Disease-2019 Pandemic. Front. Pediatr [Internet]. 2020 [cited 2021 May 12];8:407. Available from https://doi.org/10.3389/fped.2020.00407
4. Carrel AL, Clark RR, Peterson S, Eickhoff J, Allen DB. School-based fitness changes are lost during the summer vacation. Arch Pediatric Adolsc Med [Internet]. 2007 [cited 2021 June]; 161(6): 561-4. Https://doi.org/10.1001/archpedi.161.6.561
5. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, & Bassett MT. Structural racism, and health inequities in the USA: Evidence and interventions. Lancet [Internet] 2017 [cited 2021 May 12]389;10077:1453–1463. Available from https://doi.org/10.1016/S0140-6736(17)30569-X.
6. Bowleg L. We're not all in this together: On COVID-19, intersectionality, and structural inequality. American Journal of Public Health [Internet] 2020 [cited 2021 May 12];110(7):917. Available from https://doi.org/10.2105/AJPH.2020.305766
7. Fegert JM, Vitiello B, Plener PL, & Clemens V. Challenges and burden of the coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: A narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child and Adolescent Psychiatry and Mental Health [Internet] 2020 [cited 2021 May 12]; 14:20. Available from https://doi.org/10.1186/s13034-020-00329-3.
8. Small L & Aplasca A. Child Obesity and Mental Health: A Complex Interaction. Child Adolesc Psychiatr Clin N Am [Internet] 2016 [cited 2021 June]; 252(2):269-282. Available from httos://doi.org/10.1016/j.chc.2015.11.008.
9. Zametkin AJ, Zoon CK, Klein HW, Munson S. Psychiatric aspects of child and adolescent obesity: A review of the past 10 years. J AM Acad Child Adolesc Psychiatry [Internet] 2004 [cited 2021 May 12];43:134-150.
10. Miller AL, Riley H, Domoff SE, Gearhardt AN, Sturza J, Kaciroti N, Lumeng JC. Weight Status Moderates Stress-Eating in the Absence of Hunger Associations in Children. Appetite [Internet] 2019 [cited 2021 June]; 136:184–192. Available from https://doi.org/10.1016/j.appet.2019.02.005
11. Nogueira-de-Almeida CA, Del Ciampo LA, Ferraz IS, Del Ciampo IRI, Contini AA, Ued FV. COVID-19 and obesity in childhood and adolescence: a clinical review. J Pediatr (Rio J) [Internet] 2020 [cited 2021 May 12];96(5):546-558. Available from https://doi.org/10.1016/j.jped.2020.07.001
12. Godzune KA, Bennet WL, Cooper LA, Bleich SN. Patients who feel judged about their weight have lower trust in their primary care providers. Patient Educ Couns [Internet] 2014 [cited 2021 June];97(1):128-31. Available from https://doi.org/10.1016/j.pec.2014.06.019.
13. Puhl RM & King KM. Weight discrimination and bullying. Best Pract Res Clin Endocrinol Metab [Internet] 2013 [cited 2021 June]; 27(2):117-27. Available from https://doi.org/0.1016/j.beem.2012.12.002.
14. Tomiyama AJ, Carr D, Granberg EM, Major B, Robinson E, Sutin AR, & Brewis A. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMJ Medicine [Internet] 2018 [cited 2021 May 12];16:123. Available from https://doi.org/10.1186/s12916-018-1116-5.
15. Clark RR, Sullivan JC, Bartok C, Schoeller DA. Multi-component cross-validation of minimum weight predictions for college wrestlers. Med. Sci. Sports Exerc [Internet] 2003 [cited 2021 June];35(2):342-347.
16. Clark RR, Bartok C, Sullivan JC, Schoeller DA Minimum weight predictions cross-validated using a four-compartment model. Med Sci Sport Exerc [Internet] 2004 [cited 2021 June]; 36(4): 639-647.
17. Clark RR, Sullivan JC, Bartok C, Carrel AL. DXA provides a valid minimum weight in wrestlers. Med. Sci. Sports Exerc. [Internet] 2007 [cited 2021 June];39 (11): 2069–2075.
18. Dencker M, Karlsson M, Wollmer P, Andersen L, Thorsson O. Body Fat, Abdominal Fat and Body Fat Distribution Related to Clustering of Risk Factors for Cvd in Children. Pediatrics [Internet] 2018 [cited 2021 June 23];141 (1 MeetingAbstract) 212: https://doi.org/10.1542/peds.141.1_MeetingAbstract.212
19. Goran MI & Gower BA. Relation between visceral fat and disease risk in children and adolescents. Am J Clin Nutr [Internet] 1999;70(suppl):149S–56S.
20. Suliga E. Visceral adipose tissue in children and adolescents: a review. Nutrition Research Reviews [Internet] 2009;22:137–147. https://doi.org/10.1017/S0954422409990096
21. Digitale E. Youth at both ends of weight spectrum challenged by global pandemic. Stanford Medicine [Internet] 2021 [cited 2021 June 23]. Available from https://med.stanford.edu/news/all-news/2021/03/pandemic-worsens-weight-woes-among-young-people.html