Childhood Obesity and Early Body Mass Index Gains Associated with COVID-19 in a Large Rural Health System

Carolyn F McCabe; G Craig Wood; Jennifer Franceschelli-Hosterman; Lisa Bailey-Davis

doi:10.1016/j.acap.2023.12.016

Childhood Obesity and Early Body Mass Index Gains Associated with COVID-19 in a Large Rural Health System

Acad Pediatr. 2024 Jan 6:S1876-2859(23)00481-3. doi: 10.1016/j.acap.2023.12.016. Online ahead of print.

Authors

Carolyn F McCabe¹, G Craig Wood², Jennifer Franceschelli-Hosterman³, Lisa Bailey-Davis⁴

Affiliations

¹ Department of Population Health Sciences (CF McCabe and L Bailey-Davis), Geisinger, Danville, Pa; Center for Obesity and Metabolic Research (CF McCabe, G Craig Wood, J Franceschelli-Hosterman, and L Bailey-Davis), Geisinger, Danville, Pa.
² Center for Obesity and Metabolic Research (CF McCabe, G Craig Wood, J Franceschelli-Hosterman, and L Bailey-Davis), Geisinger, Danville, Pa.
³ Center for Obesity and Metabolic Research (CF McCabe, G Craig Wood, J Franceschelli-Hosterman, and L Bailey-Davis), Geisinger, Danville, Pa; Nutrition and Weight Management (J Franceschelli-Hosterman), Geisinger Medical Center, Danville, Pa.
⁴ Department of Population Health Sciences (CF McCabe and L Bailey-Davis), Geisinger, Danville, Pa; Center for Obesity and Metabolic Research (CF McCabe, G Craig Wood, J Franceschelli-Hosterman, and L Bailey-Davis), Geisinger, Danville, Pa. Electronic address: ldbaileydavis@geisinger.edu.

PMID: 38190886
DOI: 10.1016/j.acap.2023.12.016

Abstract

Objective: To evaluate body mass index (BMI) change among a population of children with a high proportion residing in rural areas across two pandemic time periods.

Methods: Electronic health records were evaluated in a rural health system.

Inclusion criteria: 2-17 years at initial BMI; >2 BMIs during pre-pandemic (January 1, 2018-February 29, 2020); >1 BMI in early pandemic (June 1, 2020-December 31, 2020); and >1 BMI in later pandemic (January 1, 2021-December 31, 2021). Mixed effects linear regression models were used to estimate average monthly rate of change in BMI slope (∆BMI) from pre-pandemic to pandemic and test for effect modification of sex, race/ethnicity, age, BMI, public insurance, and rural address.

Results: Among the 40,627 participants, 50.2% were female, 84.6% were non-Hispanic white, 34.9% used public insurance, and 42.5% resided in rural areas. The pre-pandemic proportion of children with overweight, obesity, and severe obesity was 15.6%, 12.8%, and 6.3%, respectively. The ∆BMI nearly doubled during the early pandemic period compared with the pre-pandemic period (0.102 vs 0.055 kg/m²), however, ∆BMI in the later pandemic was lower (0.040 vs 0.055 kg/m²). ∆BMI remained higher in the later pandemic for all race categories compared to Non-Hispanic white. Children with public insurance had higher ∆BMI compared to those with private insurance that remained higher in the later pandemic (0.051 vs 0.035 kg/m²). There was no significant difference between ∆BMI for rural and urban children during pandemic periods.

Conclusions: Despite the decreased ∆BMI among children in the later pandemic, prevalence of obesity and severe obesity remain high. Efforts must continue to be made to limit excess weight gain during childhood and to assess the impact of forces like structural and social factors in both etiology and prevention.

Keywords: COVID-19; childhood obesity; rural health.