Influences of the COVID-19 Pandemic on Obesity and Weight-Related Behaviors among Chinese Children: A Multi-Center Longitudinal Study

Abstract

COVID-19-related lockdown measures have been affecting children’s weight status and weight-related behaviors, which are often associated with an increase in childhood obesity. However, large-scale longitudinal studies are lacking. Our study aimed to analyze changes in obesity and weight-related behaviors in Chinese children before and during the COVID-19 pandemic and provide references for addressing the high prevalence of childhood obesity. A prospective multi-center longitudinal survey was conducted among Chinese children (n = 5963), collecting data on weight status, COVID-19-related measures, and lifestyle behaviors. Changes were assessed using t-tests and χ2 tests for paired samples, or the Wilcoxon signed-rank test, according to the type and distribution of data. The Generalized Estimating Equations model was used to explore influential factors of obesity. The prevalence of overweight and obesity increased from 9.2% and 8.6% before the pandemic to 10.5% and 10.6% during the pandemic (p < 0.001), respectively. Daily physical activity, sleep duration, and sugar-sweetened beverage consumption decreased while screen time increased. The results of the generalized estimating equations showed that ethnic minority, older age, less daily physical activity, reduced sleep duration, and longer screen time were positively associated with obesity. There is an intensifying trend of obesity in children in the context of the COVID-19 pandemic, to which altered weight-related behaviors might have contributed largely. Maintaining a healthy lifestyle, especially in social crises, should be highlighted to ease the burden of childhood obesity.

Physical Changes of Preschool Children during COVID-19 School Closures in Fujian, China

“…Canadian scholars have found that the COVID-19 pandemic may reduce the health impact of weight management programs for children and adolescents, especially for boys, leading to increased weight and BMI [ 11 ]. A multicenter study in China found that the trend in childhood obesity was intensifying in the context of the COVID-19 pandemic, and that altered weight-related behaviors such as less daily physical activity, reduced sleep duration, and longer screen time due to lockdown measures may have largely contributed to this trend [ 12 ]. The main influencing factors of obesity include genetic, individual, social, and environmental factors [ 13 ].…”

Effect of the COVID-19 pandemic on obesity and its risk factors: a systematic review

“…Quality was assessed using the modified Newcastle–Ottawa Scale [ 19 ]. Out of included forty studies, 16 were classified as good quality [ 26 , 27 , 33 – 38 , 45 , 46 , 48 , 49 , 54 , 58 , 59 ] while twenty-four were also classified as satisfied [ 21 – 25 , 28 – 31 , 39 – 44 , 47 , 50 – 53 , 55 – 57 , 60 ]. Twenty-four articles were done on the adult population [ 22 , 23 , 25 , 26 , 28 – 30 , 36 , 38 , 42 – 44 , 46 , 48 – 50 , 55 , 57 – 59 ], five articles were done only adolescents [ 31 , 39 , 41 , 47 , 60 ], three research articles were also done on children [ 34 , 53 , 54 ], and finally, eight articles were done on both children and adolescents [ 21 , 24 , 27 , 33 , 37 , 45 , 52 , 56 ] as shown in Table 1 .…”

“…The most common determinants identified were physical inactivity [ 21 – 23 , 27 , 30 , 31 , 34 , 37 , 40 , 43 , 44 , 46 , 48 , 52 , 56 , 57 , 60 ], increasing sedentary [ 21 , 25 , 26 , 28 , 29 , 37 ], and eating unhealthy foods [ 25 , 36 , 38 , 43 , 46 , 50 , 57 ]. In addition, the age of participants, feeling hungry, overeating, eating low-quality or unbalanced diet, sweet beverages, snacks, excess salty foods, drinking soda, binge eating, and less water consumption, we have one additional paper on household food insecurity, gender, ethnic minority, educational status, fear of COVID-19, anxiety, stress, and low mood during the pandemic, Internet or social media addiction, long screening time, long sitting hours, and substance abuse were found to be associated with COVID-19 lockdown on obesity.…”

The Role of Molecular and Hormonal Factors in Obesity and the Effects of Physical Activity in Children

“…Leptin, mainly synthesized in adipocytes, exerts multiple functions. One key function is as one of the key modulators in regulating food intake and energy metabolism, by provoking energy expenditure and suppressing food intake via the hypothalamus [ 36 ]. During weight maintenance, the most significant determinant of circulating leptin concentrations is body fat mass and, indirectly, BMI [ 37 ].…”

“…This results in restricted mobility and a more sedentary lifestyle, which contributes to weight gain and diminishes the overall function of the body [ 34 ]. Children and adolescents, who are at the beginning of their physical, intellectual, and emotional development, have been particularly affected by the COVID-19 pandemic [ 35 , 36 ]. In Europe, approximately 20% of children aged 2–19 years are overweight or obese, which has negative health consequences in adulthood [ 37 ].…”