Trend Impact Analysis (TIA) of community-based futures study for pediatric obesity in Iran.

BACKGROUND: Childhood obesity has been regarded as one of the main healthcare challenges in the last century, leading to critical health problems and reduced life expectancy. Many factors can play a role in its development or prevention. Using the Trend Impact Analysis (TIA), this study aimed to conduct a community-based futures study for pediatric obesity in Iran. METHODS: We obtained the prevalence of overweight and obesity from the database of the Ministry of Health and Medical Education. Moreover, we reviewed 21 documents, texts, and comments from three key stakeholders in Iran and prepared a list of key experts, who were stakeholders in the field of obesity prevention of childhood in different organizations. Then, we collected the expert opinions by Delphi method. Data analysis was performed using the Excel and R software. RESULTS: Fourteen experts participated in the first stage and nine experts in the second stage. We identified two positive drivers, including the prevalence of coronavirus disease 2019 (COVID-19) and the widespread expansion of online educational programs. Meanwhile, we identified five negative drivers as follows: (1) controlling and limiting obesogenic environments in the community, school, and family; (2) running annual compulsory anthropometry programs for students of all educational levels in health centers; (3) integrating nutrition education interventions in the curricula of all educational levels; (4) taxation of unhealthy and fast foods; and (5) preparing safe and appropriate sports environments for children and adolescents (on the streets, schools, parks, and sports clubs). Without considering the drivers, the prevalence of overweight and obesity is predicted to reach 29.10% in 2031. However, it is expected that the negative drivers can increase the prevalence trend from 23.40% in 2018 to 19.57% in 2031, the positive drivers to 32.61%, and the combination of all drivers to 23.07%. CONCLUSION: It seems that measures such as the effective communication of policy makers, basic evaluation of the programs and policies related to the prevention of childhood obesity, and localization of the programs of international organizations for the prevention of obesity can greatly control the prevalence of childhood obesity.

Epidemiological correlates of overweight and obesity in the Northern Cape Province, South Africa.

Background: In the past several decades, obesity has become a major public health issue worldwide, associated with increased rates of chronic disease and death. Like many developing nations, South Africa is experiencing rapid increases in BMI, and as a result, evidence-based preventive strategies are needed to reduce the increasing burden of overweight and obesity. This study aimed to determine the prevalence and predictors of overweight and obesity among a multi-ethnic cohort from the rural Northern Cape of South Africa. Methods: These data were collected as part of a tuberculosis (TB) case-control study, with 395 healthy control participants included in the final analysis. Overweight and obesity were defined according to WHO classification. Multivariate linear models of BMI were generated using sex, age, education level, smoking, alcohol consumption, and diabetes as predictor variables. We also used multivariable logistic regression analysis to assess the relationship of these factors with overweight and obesity. Results: The average BMI in our study cohort was 25.2. The prevalence of overweight was 18.0% and the prevalence of obesity was 25.0%. We find that female sex, being older, having more years of formal education, having diabetes, and being in a rural area are all positively associated with BMI in our dataset. Women (OR = 5.6, 95% CI [3.3-9.8]), rural individuals (OR = 3.3, 95% CI [1.9-6.0]), older individuals (OR = 1.02, 95% CI [1-1.04]), and those with more years of education (OR = 1.2, 95% CI [1.09-1.32]) were all more likely to be overweight or obese. Alternatively, being a smoker is negatively associated with BMI and decreases one's odds of being overweight or obese (OR = 0.28, 95% CI [0.16-0.46]). Conclusions: We observed a high prevalence of overweight and obesity in this study. The odds of being overweight and obese were higher in women, those living in rural areas, and those with more education, and increases with age. Community-based interventions to control obesity in this region should pay special attention to these groups.

The levels of BMI and patterns of obesity and overweight during the COVID-19 pandemic: Experience from the Iran STEPs 2021 survey.

Background: Obesity and its increasing burden have become an urgent health problem all over the world. Benefiting from a national representative sample, the present study aimed to estimate the distribution of body mass index (BMI) levels and its association with metabolic and lifestyle risk factors in an Iranian adult population by sex, age, and geographical distribution. Methods: This study involves a national survey of noncommunicable disease risk factor surveillance (STEPs) in Iran. Through systematic random sampling, in compliance with safety considerations during the COVID-19 pandemic, of the 28,520 adults who gave voluntary consent and included in the study, 27,874 participants completed the questionnaires (step 1), 27,745 individuals were anthropometrically measured (step 2), and 18,119 individuals completed laboratory evaluation (step 3). Anthropometric measurements followed based on standard protocols and by using calibrated instruments. Results: In 2021, the national prevalence of normal weight, obesity, and overweight/obesity in ≥18-year-old Iranian adults was estimated at 33.61% (95% CI: 32.99-34.23), 24.96% (24.39-25.53), and 63.02% (62.39-63.65), respectively. Compared to women, Iranian men had a lower mean BMI [25.54 (24.95-26.13 vs. 27.6 (27.07-28.12) kg/m2] (p < 0.001). There was also a significant difference in the national prevalence rate of overweight/obesity [women: 66% (61-71), men: 53% (46-60) (p < 0.001)]. The prevalence of obesity was significantly higher in participants suffering from metabolic and lifestyle risk factors. The study of the geographical extent of obesity and overweight shows that compared to national levels, the highest prevalence of being underweight was seen in the southeastern provinces. On the other hand, the highest prevalence of obesity belonged to the northeastern and central provinces. The highest provincial prevalence of obesity was almost 2.5-fold higher than the lowest provincial prevalence. Conclusion: The study reveals a significant difference between the prevalence of obesity in male and female participants and between different regions of the country. These findings will help policymakers, clinicians, and researchers to more accurately estimate the obesity/overweight problem and to implement more effective interventional programs to promote strategies of prevention and control of weight gain.

Child health and development in the course of the COVID-19 pandemic: are there social inequalities?

COVID-19 pandemic lockdowns and closures have influenced all children's health and development (HAD). We aimed to examine whether this differs by social circumstances. We hypothesised that socially disadvantaged children experienced more pronounced deterioration in their HAD compared with better-off children. In our trend study, we included five cohorts of school enrolment medical screening (school entrance 2018-2022) in the city of Dusseldorf, Germany. To compensate for selection bias due to the limited number of examinations in pandemic months, we chose the first 800 examinations of each cohort. We computed predicted prevalences of overweight, coordination and language problems as indicators of HAD. Neighbourhood deprivation, single-parent families and non-German nationality were used as indicators of social disadvantage. All groups of children experienced a deterioration in their HAD. Its magnitude is comparable between children with different social circumstances. For instance, between 2018 and 2021, prevalence of overweight increased from 19.2 to 24.2% in children from deprived neighbourhoods, and from 8.1 to 16.5% in children from well-off neighbourhoods. Prevalence of language problems (prepositions) increased from 49.9 to 72.1% among non-German children, and from 14.4 to 39.1% among German children.   Conclusion: Results only partly confirmed our hypothesis. However, since the pre-pandemic prevalences of HAD problems among disadvantaged children were already higher, further deterioration - regardless of its magnitude - has led to their particularly poor situation. For those children, overweight and language development should be priorities of prevention. Generally, important settings for child HAD such as kindergartens or leisure facilities should remain open in future pandemics. What is known: • The COVID-19 pandemic has had a negative impact on general child health and development. • Before the pandemic, social inequalities in child health and development were a common phenomenon. What is new: • Children in all social groups experienced a deterioration in their health and development over the course of the pandemic. • Over the course of the pandemic, children from deprived neighbourhoods have demonstrated a particularly high prevalence of overweight. Language problems are particularly prevalent among non-German children.

Increased incidence of overweight and obesity among preschool Swedish children during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has had wide effects on child health globally. Increased prevalence of childhood obesity has been observed by a number of countries during the pandemic. The absence of a formal societal lockdown during the pandemic, made Sweden stand out compared to other countries. This study aims to examine changes in BMI among preschool children in Sweden before and during COVID-19 pandemic. METHODS: Retrospective population-based cross-sectional study, with longitudinal follow-up for a portion of the children. The study included 25 049 children from three Swedish regions, with growth measures at 3- (n = 16 237), 4- (n = 14 437) and 5-years of age (n = 11 711). Care Need Index was used as a socioeconomic parameter at health centre level. RESULTS: There was an increase in BMI in children aged three (P = 0.028) and four (P<0.001) during the COVID-19 pandemic. Obesity in 3-year-old girls increased from 2.8% to 3.9%. Four-year-olds increased in obesity, and overweight (girls) and the prevalence of underweight decreased in boys. No change in BMI was observed in 5-year-olds. Children in areas of low socioeconomic status had higher risk of obesity. CONCLUSIONS: Overweight and obesity increased among 3- and 4-year-old children in Sweden, findings that were accentuated in children attending child health centres in areas with lower socioeconomic status. The COVID-19 pandemic is likely to have affected health behaviours negatively in Swedish preschool children. Our results expose the need for extended efforts directed to prevent childhood obesity, especially targeting lower socioeconomic areas.

Television Viewing Time, Overweight, Obesity, and Severe COVID-19: A Brief Report From UK Biobank.

BACKGROUND: Overweight and obesity are well-established risk factors for COVID-19 severity; however, less is known about the role of sedentary behaviors such as television (TV) viewing. The purpose of this brief report was to determine whether lower TV viewing time may mitigate the risk of severe COVID-19 in individuals with excess weight. METHODS: We analyzed 329,751 UK Biobank participants to investigate the independent and combined associations of BMI and self-reported TV viewing time with odds of severe COVID-19 (inpatient COVID-19 or COVID-19 death). RESULTS: Between March 16 and December 8, 2020, there were 1648 instances of severe COVID-19. Per 1-unit (hours per day) increase in TV viewing time, the odds of severe COVID-19 increased by 5% (adjusted odds ratio = 1.05, 95% confidence interval = 1.02-1.08). Compared with normal-weight individuals with low (≤1 h/d) TV viewing time, the odds ratios for overweight individuals with low and high (≥4 h/d) TV viewing time were 1.17 (0.89-1.55) and 1.66 (1.31-2.11), respectively. For individuals with obesity, the respective ORs for low and high TV viewing time were 2.18 (1.61-2.95) and 2.14 (1.69-2.73). CONCLUSION: Higher TV viewing time was associated with higher odds of severe COVID-19 independent of BMI and moderate to vigorous physical activity. Additionally, low TV viewing time may partly attenuate the elevated odds associated with overweight, but not obesity.

Analysis of Association between Adolescents' Food Habits and Body Mass Change in a Population-Based Sample: Diet and Activity of Youth during COVID-19 (DAY-19) Study.

The COVID-19 pandemic may have contributed to food habit changes, including some negative ones that may increase the risk of overweight and obesity. The aim of the study was to analyze the association between adolescents' food habits, body mass change, as well as physical activity level in a population-based sample within the Diet and Activity of Youth during COVID-19 (DAY-19) Study. The DAY-19 Study was conducted in a cohort of 1333 students (aged 10-16 years) recruited in schools after stratified random quota sampling of primary schools (sampling counties within voivodeships and schools within counties) in June 2020. The food habits were assessed for the period of the COVID-19 pandemic and the period before the COVID-19 pandemic while using Adolescent Food Habits Checklist (AFHC). The body mass changes were assessed based on body weight and height for the period of the COVID-19 pandemic and the period before the COVID-19 pandemic while using Polish growth reference values. The physical activity changes were assessed based on the subjective assessment of adolescents. It was stated that for female adolescents declaring body mass gain during the COVID-19 pandemic the highest AFHC purchase scores (healthy purchase habits) (p < 0.0001) were accompanied by the lowest AFHC consumption score (unhealthy consumption habits) (p < 0.0001), as well as for female adolescents declaring physical activity decrease during the COVID-19 pandemic the highest AFHC purchase scores (healthy purchase habits) were observed (p = 0.0333). It was stated that for male adolescents declaring physical activity increased during the COVID-19 pandemic, the highest AFHC consumption scores (healthy consumption habits) were observed (p = 0.0003). In the case of a majority of participants, the general food habits were unchanged, which was observed mainly for food habits associated with food preparation. More food habits changes associated with the COVID-19 pandemic resulting in body mass changes were observed in females than in male adolescents. Body mass gain during the COVID-19 pandemic in adolescents may have resulted from unhealthy consumption habits, accompanied by decreased physical activity, in spite of the fact that this sub-group presented healthy purchase habits, which was observed especially for female adolescents.

COVID-19, Non-Communicable Diseases, and Behavioral Factors in the Peruvian Population ≥ 15 Years: An Ecological Study during the First and Second Year of the COVID-19 Pandemic.

A range of health-related and behavioral risk factors are associated with COVID-19 incidence and mortality. In the present study, we assess the association between incidence, mortality, and case fatality rate due to COVID-19 and the prevalence of hypertension, obesity, overweight, tobacco and alcohol use in the Peruvian population aged ≥15 years during the first and second year of the COVID-19 pandemic. In this ecological study, we used the prevalence rates of hypertension, overweight, obesity, tobacco, and alcohol use obtained from the Encuesta Demográfica y de Salud Familiar (ENDES) 2020 and 2021. We estimated the crude incidence and mortality rates (per 100,000 habitants) and case fatality rate (%) of COVID-19 in 25 Peruvian regions using data from the Peruvian Ministry of Health that were accurate as of 31 December 2021. Spearman correlation and lineal regression analysis was applied to assess the correlations between the study variables as well as multivariable regression analysis adjusted by confounding factors affecting the incidence and mortality rate and case fatality rate of COVID-19. In 2020, adjusted by confounding factors, the prevalence rate of obesity (ß = 0.582; p = 0.037) was found to be associated with the COVID-19 mortality rate (per 100,000 habitants). There was also an association between obesity and the COVID-19 case fatality rate (ß = 0.993; p = 0.014). In 2021, the prevalence of obesity was also found to be associated with the COVID-19 mortality rate (ß = 0.713; p = 0.028); however, adjusted by confounding factors, including COVID-19 vaccination coverage rates, no association was found between the obesity prevalence and the COVID-19 mortality rate (ß = 0.031; p = 0.895). In summary, Peruvian regions with higher obesity prevalence rates had higher COVID-19 mortality and case fatality rates during the first year of the COVID-19 pandemic. However, adjusted by the COVID-19 vaccination coverage, no association between the obesity prevalence rate and the COVID-19 mortality rate was found during the second year of the COVID-19 pandemic.

The effects of consuming a Mediterranean style diet on associated COVID-19 severity biomarkers in obese/overweight adults: A systematic review.

Background: COVID-19 severity is strongly associated with high Body Mass Index (BMI) (≥25kg/m2) amongst adults and elevated inflammatory markers have enabled prediction of disease progression. The composition of a Mediterranean diet provides favourable outcomes on weight reduction and inflammatory markers. Aim: This systematic review aimed to investigate the effects of consuming a Mediterranean diet on BMI and inflammatory markers of obese/overweight adults (≥18 years) at risk of developing severe COVID-19 outcomes. Methods: PubMed Central, Cochrane Library and MEDLINE databases were searched to identify randomised controlled trials published between January 2010 to August 2021 evaluating the impact of Mediterranean diet on BMI and inflammatory markers in overweight/obese adults. The review followed the PRISMA checklist, used Cochrane Collaboration search strategies, and is PROSPERO registered (CRD42021277070). Two authors independently screened and evaluated studies for methodological quality. Papers were extracted and included based eligibility, despite risk of bias scores. Results: Of 65 extracted records, six studies met the eligibility criteria and were included. Reductions in BMI, TNF-α, IL-6 and hs-CRP were reported amongst most findings, the majority of which were significant. Conclusion: The main findings indicate a hypocaloric, fibre dense Mediterranean diet is a short-term (<4 months) mitigation strategy to significantly reduce BMI and inflammatory markers amongst overweight/obese adults at risk of developing severe COVID-19 outcomes. Further research is now needed to examine the role of Mediterranean diet in COVID-19 prevalence, severity, morbidity and mortality.

Hunger and its associated factors in the western Brazilian Amazon: a population-based study.

BACKGROUND: Hunger affects millions of people worldwide. In the current pandemic scenario of coronavirus Brazil has experienced an epidemic peak of hunger, amplifying existing prepandemic vulnerabilities, mainly in the North Region of the country. The aim of the present study was to investigate the prevalence of food insecurity and its associated factors in homes with children under 5 years of age in an urban area of a municipality of the western Brazilian Amazon. METHODS: A household survey was conducted with a probabilistic sample of 557 children and their families. Food insecurity (FI) was determined using the Brazilian Food Insecurity Scale. Associations between variables were analyzed based on the prevalence ratio (PR) and respective 95% confidence intervals (CI) calculated through multiple Poisson regression analysis. Variables with a P value < 0.05 after adjustments were considered significantly associated with the outcome. RESULTS: A prevalence of 76.5% (CI 1.36-2.67) food insecurity was found among the families in the study; 42.9% had moderate (CI 1.31-2.83) and severe (CI 1.10-1.83) food insecurity. Moderate and severe FI was associated with low family income (P = 0.00), participation in governmental income transfer programs (P = 0.01), and heads of household with less than 7 years of schooling (P = 0.02). Moreover, substantial frequencies of height deficit and being overweight were found among the children. CONCLUSIONS: The high prevalence of hunger and food insecurity and its associated factors reflects the context of geographic isolation and social exclusion in which these families live, suggesting that a substantial portion of the population under 5 years of age had experienced episodes of hunger in the 90 days prior to the survey. The prevalence of height deficit and being overweight among the children reveals a scenario of epidemiological/nutritional polarization, requiring the formulation of specific public policies for this population.

Overweight and obesity are not associated with worse clinical outcomes in COVID-19 patients treated with fixed-dose 6 mg dexamethasone.

OBJECTIVE: A fixed 6 mg dexamethasone dose for 10 days is the standard treatment for all hospitalised COVID-19 patients who require supplemental oxygen. Yet, the pharmacokinetic properties of dexamethasone can lead to diminishing systemic dexamethasone exposure with increasing body mass index (BMI). The present study examines whether this translates to overweight and obesity being associated with worse clinical outcomes, defined as ICU admission or in hospital death, in COVID-19 patients treated with fixed-dose dexamethasone. METHODS: We conducted a single centre retrospective cohort study in COVID-19 patients who were admitted to a non-ICU ward and were treated with dexamethasone (6 mg once daily for a maximum of ten days) between June 2020 and January 2021. Univariable and multivariable logistic regression analyses were conducted to assess the association between BMI-categories and an unfavourable clinical course (ICU admission and/or in hospital death). Analyses were adjusted for age, comorbidities, inflammatory status, and oxygen requirement at admission. For reference, similar analyses were repeated in a cohort of patients hospitalised before dexamethasone was introduced (March 2020 through May 2020). RESULTS: In patients treated with dexamethasone (n = 385) an unfavourable clinical course was most prevalent in patients with normal weight (BMI < 25) compared to patients with overweight (BMI 25-30) and patients with obesity (BMI ≥ 30) with percentages of 33, 26 and 21% respectively. In multivariable analyses, there was no association between BMI-category and an unfavourable clinical course (respectively with aORs of 0.81 (0.43-1.53) and 0.61 (0.30-1.27) with normal weight as reference). In the reference cohort (n = 249) the opposite was observed with an unfavourable clinical course being most prevalent in patients with overweight (39% vs 28%; aOR 2.17 (0.99-4.76)). In both cohorts, CRP level at admission was higher and lymphocyte count was lower in patients with normal weight compared to patients with obesity. CONCLUSIONS: Overweight and obesity are not associated with an unfavourable clinical course in COVID-19 patients admitted to a non-ICU ward and treated with 6 mg dexamethasone once daily.

The bad rainbow of COVID-19 time: effects on glucose metabolism in children and adolescents with obesity and overweight.

BACKGROUND: COVID-19 restriction measurements have enhanced the obesity status in the pediatric population which might further contribute to obesity-related glucose-insulin metabolism alterations. Therefore, we retrospectively compared anthropometric and OGTT data on children with obesity during the 13 years before and during the COVID-19 pandemic. SUBJECTS/METHODS: Data from 741 children with obesity and overweight were retrieved and clustered into seven groups starting from year 2008-2009 until 2020-2021. Differences in anthropometric measurements and glucose/insulin metabolism were evaluated between the different groups. RESULTS: Children with overweight and obesity in the COVID-19 restriction group did not present increased values of SDS-Body Mass Index (BMI). Significantly higher values for Waist Circumference (WC), SDS-WC, Waist/Height ratio (WHtR), and body mass fat were detected in these children (all P < 0.01). Fasting glycaemia, glucose, and insulin excursions were significantly higher compared to pre- pandemic children (all P < 0.01). Insulin resistance was higher while insulin secretion was lower (all P < 0.01) determining a significantly higher percentage of impaired glucose tolerance in the COVID-19 restriction group (P < 0.002). Furthermore, High-Density Lipoprotein (HDL) cholesterol was significantly lower (P < 0.01) and SDS for systolic and diastolic blood pressure values were significantly higher (P = 0.03 and P = 0.02, respectively). CONCLUSIONS: COVID-19 restriction measurements determined profound alterations in glucose and insulin metabolism in children with obesity and overweight. Urgent strategies are needed in order to reverse COVID-19 restriction measures' effects on glucose and insulin metabolism.

An Examination of the Impact of Social and Cultural Traditions Contributing to Overweight and Obesity Among Black Women.

Black women living in Prince George's (PG) County, Maryland, have high rates of overweight and obesity. Obesity significantly impacts Black women, leading to poor physical and mental health, decreased social well-being, and a financial strain on the healthcare system. Despite living in an affluent area and having middle to high incomes and high education levels, Black women living in PG County have difficulty managing their weight. This study explores how social and cultural factors and social networks impact the weight of Black women living in PG County, Maryland. A qualitative case study design guided by social cognitive theory was employed to conduct semi-structured interviews and focus groups with 15 women. Key social and cultural factors (income, family network, peer network, and living in PG County) influenced participants' attitudes and behaviors toward their weight and strategies to manage their weight. Additionally, participants expressed that Black culture is more accepting of larger and curvier body types, and this reinforces a positive body image and less desire to achieve an ideal BMI. Participants also expressed that COVID-19 impacted their weight management strategies. This study adds to the literature by better explaining some of the underlying factors that influence decision-making around weight management among Black women who live in PG County, Maryland.

Modified body mass index z-scores in children in New York City during the COVID-19 pandemic.

OBJECTIVES: Determine whether the negative impact of the COVID-19 pandemic on weight gain trajectories among children attending well-child visits in New York City persisted after the public health restrictions were reduced. STUDY DESIGN: Multicenter retrospective chart review study of 7150 children aged 3-19 years seen for well-child care between 1 January 2018 and 4 December 2021 in the NYC Health and Hospitals system. Primary outcome was the difference in annual change of modified body mass index z-score (mBMIz) between the pre-pandemic and early- and late-pandemic periods. The mBMIz allows for tracking of a greater range of BMI values than the traditional BMI z-score. The secondary outcome was odds of overweight, obesity, or severe obesity. Multivariable analyses were conducted with each outcome as the dependent variable, and year, age category, sex, race/ethnicity, insurance status, NYC borough, and baseline weight category as independent variables. RESULTS: The difference in annual mBMIz change for pre-pandemic to early-pandemic = 0.18 (95% confidence interval [CI]: 0.15, 0.20) and for pre-pandemic to late-pandemic = 0.04 (95% CI: 0.01, 0.06). There was a statistically significant interaction between period and baseline weight category. Those with severe obesity at baseline had the greatest mBMIz increase during both pandemic periods and those with underweight at baseline had the lowest mBMIz increase during both pandemic periods. CONCLUSION: In NYC, the worsening mBMIz trajectories for children associated with COVID-19 restrictions did not reverse by 2021. Decisions about continuing restrictions, such as school closures, should carefully weigh the negative health impact of these policies.

Trends in body mass index changes among Korean adolescents between 2005-2020, including the COVID-19 pandemic period: a national representative survey of one million adolescents.

OBJECTIVE: The impact of the coronavirus disease 2019 (COVID-19) pandemic on weight gain in children and adolescents remains unknown. We aimed to identify an estimated 15-year trend in mean body mass index (BMI) changes and prevalence of obesity and overweight among Korean adolescents from 2005 to 2020, including the period of the COVID-19 pandemic. PATIENTS AND METHODS: We analyzed data taken from a nationwide survey (Korea Youth Risk Behavior Survey), between 2005 and 2020. Representative samples of one million Korean adolescents aged 13-18 years (n=1,057,885) were examined. The 15-year trends in mean BMI and proportion of obesity or overweight, and the changes due to the COVID-19 pandemic were analyzed. RESULTS: The data of 1,057,885 Korean adolescents were analyzed (mean age: 14.98 years; females, 48.4%). The estimated weighted mean BMI was 20.5 kg/m2 [95% confidence interval (CI), 20.4-20.5] from 2005 to 2008 and 21.5 kg/m2 (95% CI, 21.4-21.6) in 2020 (during the COVID-19 pandemic). Although the 15-year trend of mean BMI gradually increased, the change in mean BMI before and during the pandemic significantly lessened (ßdiff, -0.027; 95% CI, -0.028 to -0.026). The 15-year (2005-2020) trend changes in the prevalence of obesity and overweight were similar (obesity prevalence from 2005-2008, 3.2%; 95% CI, 3.1-3.3 vs. obesity prevalence in 2020, 8.6%; 95% CI, 8.2-9.0; ßdiff, -0.309; 95% CI, -0.330 to -0.288). CONCLUSIONS: The 15-year trend of overall mean BMI and obesity and overweight prevalence demonstrated a significant increase; however, its slope decreased during the pandemic. These landmark results suggest the need for the development of precise strategies to prevent pediatric obesity and overweight during the COVID-19 pandemic.

Nationwide Trends of Pediatric Obesity and BMI z-Score From 2017-2021 in China: Comparable Findings From Real-World Mobile- and Hospital-Based Data.

Introduction: Lifestyle changes including COVID-19 lockdown cause weight gain and may change obesity trends; however, timely changes are largely unknown and monitoring measures are usually lack. This first large-scale study aimed to analyze the real-world national trends of obesity prevalence of Chinese children in the past five years, and the impact of COVID-19 pandemic on pediatric obesity development through both mobile- and hospital-based data. Methods: This study included children aged 3 to 19 years old all over China from January 2017 to April 2021. Hospital-measured and parent-reported cases from XIGAO database were analyzed. Body mass index (BMI) z-score calculation and obesity status evaluation were made according to Chinese standards. We evaluated obesity/overweight prevalence over the past five years and the changes of BMI z-score during COVID-19 lockdown. Results: A total of 656396 children from 31 provinces were involved, including 447481 hospital-measured cases and 208915 parent-reported cases. The obesity and overweight prevalence were 8.05% (95%CI 7.76%-8.39%) and 10.06% (95%CI 10.79%-11.55%), comparable to those of China National Nutrition Surveys during 2015-2019. Northern China had the highest obesity prevalence. Parent-reported data had higher obesity/overweight prevalence than hospital-measured data (18.3% [95%CI 17.7%-18.9%] vs. 21.7% [95%CI 20.7%-23.0%]). The trend of obesity prevalence remained stable with slight decrease, but COVID-19 lockdown caused a significant increase of 1.86% in 2020. Both mobile- and hospital-based data showed weight gain in the first half of 2020. High BMI z-score increase were found among primary and junior middle school children, and children in northeast area during lockdown. Conclusion: Weight gain during COVID-19 among Chinese children had regional differences and mainly affect primary and junior middle school children, thus warrants targeted interventions. The mobile growth assessment based on parent-reported data was a feasible, efficient and timely way for obesity monitoring among Chinese children, especially during epidemic.

Changes in body mass index in children and adolescents in Israel during the COVID-19 pandemic.

BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic has health, social, and economic implications. Our primary objective was to evaluate changes in body mass index (BMI) from the pre-pandemic to COVID-19 pandemic period among a large pediatric population in Israel. METHODS: This retrospective cohort study is based on data from Clalit Health Services, the largest health maintenance organization in Israel. The data accessed included sociodemographic, anthropometric, and clinical parameters of persons aged 2-20 years with at least one BMI measurement during 2017-2019 (pre-pandemic period) and one between April 1, 2020 and December 31, 2020 (pandemic period). RESULTS: The cohort comprised 36,837 individuals (50.8% females); median age 11.2 years, 83.6% were Jewish and 10.3% of Arab ethnicity. BMI-SDS increased in both sexes (p < 0.001), in both ethnicities (p < 0.001), in all socioeconomic position clusters (p < 0.001), in children aged 2-18 years (P < 0.001), and in children with underweight or normal-weight in the pre-pandemic period (p < 0.001). For 21,610 individuals (35.6%), BMI-SDS increased ≥0.25 SD. The increase in BMI-SDS was greater in children aged 2-6 compared to 6.1-18 years; BMI-SDS decreased among those aged 18.1-20 years (P < 0.001). The increase in BMI-SDS was greater among those with underweight than normal weight; BMI-SDS decreased among those with overweight and obesity (P < 0.001). During the pandemic, overweight or obesity presented in 11.2% of those with normal weight in the pre-pandemic period; and obesity presented in 21.4% of those with overweight in the pre-pandemic period. CONCLUSIONS: The COVID-19 pandemic correlated with overall weight gain among children and adolescents, with the most substantial weight gain in children aged 2-6 years. Notably, the most significant increase in BMI-SDS was observed in children with underweight; BMI-SDS decreased in children with overweight and obesity. Policies should be established during the pandemic that focus on increasing physical activity, reducing sedentary time, and promoting healthy diets.

Successful telehealth transformation of a pediatric outpatient obesity teaching program due to the COVID-19 pandemic - the "Video KiCK" program.

OBJECTIVES: To investigate if digital approaches can ameliorate the known consequences of social-distancing restrictions in the context of the global COVID-19 pandemic for adolescent participants originally registered for a face-to-face outpatient weight regulation program and whether video-based multiprofessional outpatient obesity therapy is successful for a group of adolescents with preexisting obesity. METHODS: The certified KiCK outpatient training program for children and adolescents with overweight and obesity was remodeled as a consequence of the lockdown traditional face-to-face program to a completely digital and video-based format on short notice. The virtual approach was compared with the results of the conventional program regarding metabolic parameters, body mass index standard deviation score (BMI SDS), well-being, and physical fitness. RESULTS: Sixty-nine of 77 enrolled participants for KiCK (age 8 to 17 years, BMI z score >2.0) were able and willing to participate virtually. After the first lockdown significant improvements of BMI SDS (mean 0.18; p=0.02), homeostasis model assessment (HOMA) index (mean 1.4; p=0.016), triglycerides (mean 0.18 mmol/dL; p=0.021), 6 minute-walk-test (mean 97.0 m; p=0.030, and well-being according to the World Health Organization 5 (WHO-5) questionnaire (mean 2.5; p=0.002) were found after the virtual intervention, which was comparable to the results observed previously in matched pairs data from the program during the pre-COVID period. After the end of the second lockdown weight SDS, BMI SDS, HOMA INDEX, and cholesterol were also measured reduced compared to baseline parameters measured before program initiation. Walking distance in the 6 MWT and improvement in general well-being in the WHO-5 questionnaire also persisted. CONCLUSIONS: These results indicate good acceptance and efficacy of the video-intervention for youth with overweight and obesity during the lockdown, supporting the use of virtual modules in future programs after the pandemic.

Explaining the complex impact of the Covid-19 pandemic on children with overweight and obesity: a comparative ecological analysis of parents' perceptions in three countries.

BACKGROUND: The Covid-19 pandemic has changed children's eating and physical activity behaviours. These changes have been positive for some households and negative for others, revealing health inequalities that have ramifications for childhood obesity. This study investigates the pandemic's impact on families of children aged 2-6 years with overweight or obesity. METHODS: Drawing on interviews conducted as part of a randomised controlled trial (RCT) for childhood obesity, thematic analysis was used to examine how parents of pre-schoolers perceived changes in their eating, screentime and physical activity behaviours between the first and second waves of Covid-19. Parents (n = 70, representing 68 families) were interviewed twice during a period of 6 months in three countries with markedly different pandemic policies - Sweden, Romania, and Spain. The analysis is informed by Bronfenbrenner's ecological systems theory, which embeds home- and school-based influences within societal and policy contexts. RESULTS: The findings show that, although all participants were recruited from an RCT for families of children with excess weight, they reported different responses to the pandemic's second wave, with some children engaging in healthier eating and physical activity, and others engaging in comfort eating and a more sedentary lifestyle. Differences in children's obesity-related behaviours were closely related to differences in parents' practices, which were, in turn, linked to their emotional and social wellbeing. Notably, across all sites, parents' feeding and physical activity facilitation practices, as well as their emotional and social wellbeing, were embedded in household resilience. In resilient households, where parents had secure housing and employment, they were better able to adapt to the challenges posed by the pandemic, whereas parents who experienced household insecurity found it more difficult to cope. CONCLUSIONS: As the Covid-19 pandemic is turning into a long-term public health challenge, studies that address household resilience are crucial for developing effective prevention and treatment responses to childhood obesity.