ABSTRACT
Introduction: The Covid-19 pandemic drastically modified social life and lifestyle in particular among children and adolescents, promoting sedentary behaviors and unhealthy eating habits. In this scenario, the effectiveness of the outpatient approach for pediatric obesity may decrease. Objective(s): Aims of this study were to assess the rate and the factors associated with outpatient drop-out by comparing two groups of children and adolescents with obesity evaluated at the pediatric endocrinology outpatient clinic before and during the Covid-19 pandemic, respectively, and to evaluate how Covid-19 pandemic influenced the weight status and lifestyle of children and adolescents with obesity. Result(s): One hundred and forty-five children and adolescents with obesity were evaluated, including 80 subjects (mean age 11.6 +/- 2.3 years) evaluated before the Covid-19 pandemic (group A) and 65 subjects (mean age 11.8 +/- 2.7 years) in the period straddling the Covid-19 pandemic (group B). Anamnestic (dietary habits, physical activity, screen time, family history of obesity), socio-cultural (economic status, employment and schooling of parents, household composition, place of living) and clinical (weight, height, BMI, waist circumference) data were analyzed at baseline (T0) and at 12-months (T1) in-person assessment. Glico-lipids biochemical profile was assessed at T0. The drop-out rate did not differ significantly between the two groups. BMI SDS at T0 (OR=2.52;p=0.004), female sex (OR=0.41;p=0.035) and incomplete household (OR=5.74;p=0.033) significantly influenced drop-out in both groups. BMI SDS, not significantly different between the two groups at T0, was significantly higher in group B than group A at T1. Consistently, weight loss between T0 and T1 was significantly greater among group A patients compared to group B (p=0.031). Hours spent in physical activity decreased significantly in group B from T0 to T1 and were significantly lower than group A at T1. Screen time increased significantly in group B from T0 to T1 and were significantly greater than group A subjects at T1. The consumption of sugary drinks and snacks was significantly greater in group B than group A at T1. Hours spent in physical activity (OR=2.27, p=0.038) and group A belonging (OR=0.16, p=0.028) significant influence weight loss. Conclusion(s): Our study documented that the Covid-19 pandemic, although it has not affected the drop-out rate of obese children, negatively influenced lifestyle and reduced the effectiveness of outpatient counseling in childhood obesity treatment.
ABSTRACT
BACKGROUND: The social consequences of COVID-19 pandemic are universally known. In particular, the pediatric population is dealing with a radical lifestyle change. For some risk categories, such as overweight or obese children, the impact of home confinement has been greater than for others. The increased sedentary life, the wrong diet and social distancing have stopped the chance of losing weight. The aims of this study were to analyse the impact of COVID-19 lockdown on the behavior changes in a obese pediatric population and to explore the correlation between the new lifestyle and the level of parental instruction. METHODS: Data show features of 40 obese and overweight pediatric patients of our Clinic in Messina (Italy). We evaluated weight, height, BMI and other biochemical parameters: total cholesterol, HDL, LDL, triglyceride, transaminases, glycemia and insulinemia. After the lockdown, we contacted all patients in order to get some information about diet, physical activity and sedentary lifestyle changes in correlation to the level of their parents' instruction. Additionally, we also evaluated 20 children twice from a clinical and laboratory perspective. RESULTS: The study showed an increase of daily meals during COVID-19 lockdown (3.2 ± 0.4 vs 5 ± 1, P < 0.001). In particular, children whose parents have primary school diploma ate a greater significant number of meals during the lockdown, compared to those who have parents with secondary school diploma (P = 0.0019). In addition, the 95% of patients did low physical activity during the lockdown and the 97.5% spent more time in sedentary activity. Even if BMI's values don't show significant differences, they have increased after the lockdown. We didn't find any correlation between biochemical parameters before and after the lockdown. CONCLUSION: The lockdown has had bad consequences on good style of life's maintenance in overweight and obese children. The absence of a significant correlation between the worsening of biochemical parameters and the lockdown doesn't allow to exclude any long-term consequences. It's safe to assume that, if the hours spent in sedentary activity and the number of meals don't diminish, there will probably repercussion on the biochemical parameters.