Weight-related behaviors when children are in school versus on summer breaks: does income matter?

The impact of the COVID-19 pandemic on childhood obesity rates, by Health Board area, in Wales, UK

BACKGROUND

The aim of this study was to examine the possible impact of the coronavirus pandemic on rates of children living with obesity and severe obesity, by Health Board area in Wales.

METHODS

The pre-pandemic data consisted of all children included in the Wales Childhood Measurement Programme (2014/15-2018/19). The 2021/22 Child Measurement Programme data were used as the post-pandemic data set. Body mass index for obesity and severe obesity were calculated as 95th and 99.6th centiles, respectively.

RESULTS

Of the 163 277 children measured pre-pandemic (2014/15 to 2018/19), the overall prevalence of children with obesity and severe obesity were 12.1 and 3.2%, respectively. In the post-pandemic year (2021/22), obesity increased to 15.5% and severe obesity increased to 4.8%, with clear deprivation differentials (noting one of the seven Health Boards was unable to submit data post-pandemic). Two Health Boards had significantly higher rates of obesity post-pandemic compared to pre-pandemic. Increased levels of severe obesity were observed in all Health Boards with available data.

CONCLUSION

The post-pandemic rise in obesity and severe obesity in young children living in Wales demonstrates a need for more work on the prevention of obesity and severe obesity, targeting the early years and areas of socio-economic disadvantage.

Effect of COVID-19 Pandemic Lockdowns on Body Mass Index of Primary School Children from Different Socioeconomic Backgrounds

BACKGROUND

Childhood obesity is associated with various health outcomes. Restrictive measures to contain the spread of the Coronavirus Disease 2019 (COVID-19) pandemic, like lockdowns and school closures, affected children's daily structure, physical activity, dietary habits, and sleep quality, possibly exacerbating risk factors for childhood obesity and higher body mass index (BMI) in children. Poor socioeconomic conditions may have led to relatively higher risk for elevated BMI levels following pandemic measures. In this study, the impact of measures related to the COVID-19 pandemic on the BMI of third graders was investigated regarding children's socioeconomic background (SEB).

METHODS

Data from 41,728 children (8.84 ± 0.56 years, 20,431 female) were collected in the context of a cohort study. Children were tested either before the pandemic (preCOVID: Sept2017-March2020, n = 26,314), or following the first (postLDI: Aug2020-Dec2020, n = 6657) or second lockdown in Germany (postLDII: Aug2021-Jan2022, n = 8757). SEB was based on the official school type classification of the state of Berlin. Outcome was BMI standard deviation scores (SDS).

RESULTS

Significant effects of Time and SEB revealed elevated BMIs in postLDI (M = 0.23, p = 0.011) and postLDII (M = 0.22, p = 0.011) compared to preCOVID (M = 0.17) cohorts and higher BMIs for children with lower SEB (b = - 0.13, p < 0.001). A significant Time × SEB interaction indicated that the effect of SEB on children's BMI increased in response to lockdowns, especially in postLDII (b = - 0.05, p = 0.006). Results suggest that the COVID-19-related measures lead to increased BMI in children, and that children of lower SEB were at particular risk for higher BMIs following lockdowns.

CONCLUSIONS

These findings highlight the dependency of children's BMI on societal circumstances. Over the course of two lockdowns in Germany, children have experienced BMI increments, particularly in low socioeconomic areas. Authorities are called into action to counteract increasing rates of childhood weight by promoting physical activity of children and establishing related post-pandemic offers.

Primary School-Aged Children's Physical Activity Level, Eating Habit, and Sleeping Pattern Changes During the COVID-19 Pandemic in Indonesia

Background and objective This study aims to explore the effect of physical distancing on physical activity, eating habits, and sleeping patterns among Indonesian primary schoolchildren during the COVID-19 pandemic. Methodology This cross-sectional study was conducted from October to December 2020, involving 489 primary schoolchildren. Parents/caregivers were queried about changes in their children's physical activity (utilizing the Physical Activity Questionnaire for Older Children - PAQ-C), eating habits (via a questionnaire modified from Southeast Asian Nutrition Surveys - SEANUTS), and sleeping patterns (assessed using the Children's Sleep Habits Questionnaire - CSHQ) both before and during the pandemic. Various sociodemographic characteristics and income status were also obtained. Paired univariate and multivariate analyses were conducted where applicable. Results In comparison to the period before the pandemic, both the PAQ-C score and active proportion significantly decreased during the pandemic (P = 0.000). Children consumed more snacks (322, 65.8%) but less canned and processed foods (180, 36.8%, and 128, 26.2%, respectively). Sleep duration and sufficiency increased significantly, with a CSHQ score mean of 48.62 ± 9.88 (P = 0.000, P = 0.004), and sleep disturbance was observed in 391 (79.96%) subjects. Conclusions Children were physically less active during the COVID-19 pandemic. They also experienced variable changes in eating habits based on parental employment, family income and expenses, and the presence of governmental support. While more children had longer sleep duration and more achieved the recommended sleep time, sleep disturbance happened in most subjects.

Barriers in the Management of Obesity in Mexican Children and Adolescents through the COVID-19 Lockdown-Lessons Learned and Perspectives for the Future

The COVID-19 lockdown caused health system issues, including the need for long-term care for patients with conditions like childhood obesity. We wanted to know how the lockdown had changed our patients' health and which variables had greater influence in preventing and managing overweight and obesity in kids and teens during and after the lockdown.

METHODS

Our study comprised two phases. The initial descriptive cross-sectional phase included surveys of children who are overweight or obese and their parents/guardians from the Pediatric Obesity Clinic at the Child Welfare Unit (UBI, acronym in Spanish) in the Hospital General de México "Dr. Eduardo Liceaga" (n = 129). The participants were studied to explore changes in lifestyle, physical activity, sleep patterns, eating behaviors, food consumption, anxiety, and depression. In the second phase, the biochemical, body composition, and anthropometric parameters of 29 pre-COVID-19 patients were compared before and after the lockdown.

RESULTS

The survey showed more moderate anxiety and depression, alterations in sleep, physical inactivity, and an increase in the consumption of animal products, fruits, cereals, tubers, sugary drinks, and ultra-processed food. In the study's comparative phase, we observed a substantial increase in BMI z-score (p = 0.01), waist circumference (p < 0.001), fat mass (p < 0.001), percentage of adiposity (p = 0.002), and basal glucose (p = 0.047) and a drop in lean mass (p = 0.008).

CONCLUSIONS

The pandemic led to a loss of routines and socioeconomic changes that made it difficult to address weight and obesity in young people. The results show that managing obesity in our patients involves considering both lifestyle and the social environment. This encourages us to consider a comprehensive and personalized approach.

Children's activity and diet behaviours in the summer holidays versus school year

BACKGROUND

Evidence shows children gain more weight during the summer holidays versus the school year.

OBJECTIVES

To examine within-child differences in activity and diet behaviours during the summer holidays versus the school year.

METHODS

Children (mean age 9.4 years; 37% male) wore accelerometers (GENEActiv; n = 133), reported activities (Multimedia Activity Recall for Children and Adolescents; n = 133) and parents reported child diet (n = 133) at five timepoints over 2 years capturing school and summer holiday values. Mixed-effects models were used to compare school and summer holiday behaviours.

RESULTS

Children spent less time in moderate- to vigorous-physical activity (-12 min/day; p = 0.001) and sleep (-12 min/day; p < 0.001) and more time sedentary (+27 min/day; p < 0.001) during summer holidays versus the school year. Screentime (+70 min/day; p < 0.001), domestic/social activities (+43 min/day; p = <0.001), self-care (+24 min/day; p < 0.001), passive transport (+22 min/day; p = 0.001) and quiet time (+16 min/day; p = 0.012) were higher during the summer holidays, compensating for less time in school-related activities (-164 min/day; p < 0.001). Diet quality was lower (-4 points; p < 0.001) and children consumed fewer serves of fruit (-0.4 serves; p < 0.001) during the summer holidays versus the school year.

CONCLUSIONS

Children are displaying poorer activity and diet behaviours during the summer holidays, which may contribute to accelerated weight gain over the holiday period.

Effects of a Summer Physical Activity Program on Fitness and Cognitive Function among Children from Low Socioeconomic Households

During the summer months, school aged children experience a loss in academic gains made over the course of the school year, as well as engage in poorer health behaviors such as decreased physical activity and poor diet that can lead to excess weight gain. This study aimed to assess changes in body composition, fitness, and cognitive abilities in children from low-income households after a summer physical activity program and explored whether time spent in moderate to vigorous physical activity (MVPA) was related to these changes. Participant's (N = 77) body composition, aerobic fitness (i.e., PACER), and cognitive function (i.e., modified flanker task) were measured during week 1 and week 3. MVPA was collected via hip accelerometer worn during program hours. Paired t-tests and regression analyses were conducted to determine changes between week 1 and 3, whether participation was related to changes in fitness, adiposity, and cognitive function. T-tests revealed significant changes in PACER score (10.71 ± 7.72 to 13.301 ± 10.68; p < 0.001) and incongruent accuracy on the flanker task (65.94% ± 23.83 to 69.00% ± 21.89; p < 0.006), however no significant change in BMI-for-age percentile or body fat percentage was detected. Additionally, regression analyses revealed no significant relationship between change in MVPA or attendance, and changes in PACER, flanker task performance, BMI, or body fat percentage. Children that participated in a summer physical activity program targeted toward children affected by poverty exhibited significant improvements in cardiorespiratory fitness and cognitive abilities, and no changes in body composition.

Examination of parent-reported differences in children's daily screen use, sleep, and sleep hygiene behaviors during the school year and summer and their association with BMI

OBJECTIVE

The current study examined school-summer differences in children's sleep patterns and sleep hygiene. Cross-sectional relationships with children's sleep, sleep hygiene, and weight status were explored during the school year and summer.

METHODS

Children (5-8 years) and their parents (n = 197 dyads) were recruited from 4 schools in southeastern Texas and via Facebook. Parents reported children's school year and summer sleep, sleep hygiene, and screen media use. Children's body mass index (BMI) was objectively assessed at the beginning and end of the summer. Associations between children's sleep hygiene and screen media use, sleep duration, and weight status were explored.

RESULTS

Children's sleep midpoint was earlier during the school year (1:54 AM ± 0.03) than in the summer (2:06 AM ± 0.03; t = 4.07, p < .0001). During summer, children increased their screen media use by 38 minutes (t = 2.32, p = .023) and decreased their caffeine intake from 7.43 to 7.0 (with scores ranging from 3 to 15; t = 2.83, p = .006). Greater sleep-inhibiting (β = 0.40, p = .011) and fewer sleep-promoting (β = -0.28, p = .049) behaviors during the school year were associated with having a higher BMI. There were no associations among sleep patterns, sleep hygiene and BMI during summer.

CONCLUSIONS

More positive school year sleep hygiene behaviors were supportive of having a healthier weight status. Changes in these behaviors during the summer did not portend worse weight outcomes. Supporting families in the establishment of sleep-promoting behaviors, particularly during the school year may help address the child obesity epidemic.

Feasibility and preliminary efficacy of structured programming and a parent intervention to mitigate accelerated summer BMI gain: a pilot study

BACKGROUND

This study assessed the initial feasibility and preliminary efficacy of providing children a free summer day camp and a parent intervention to improve self-regulation and mitigate accelerated summer BMI gain.

METHODS

This pilot 2x2 factorial randomized control trial used a mixed-methods design to evaluate providing children a free summer day camp (SCV), a parent intervention (PI), and the combination of these two strategies (SCV+PI) to mitigate accelerated summer body mass index (BMI) gain. Progression criteria for feasibility and efficacy were assessed to determine if a full-scale trial was warranted. Feasibility criteria included recruitment capability (≥80 participants recruited) retention (≥70% participants retained), compliance (≥80% of participants attending the summer program with children attending ≥60% of program days, and ≥80% of participants completing goal setting calls with ≥60% of weeks syncing their child's Fitbit), and treatment fidelity (≥80% of summer program days delivered for ≥9 h/day, and ≥80% of participant texts delivered). Efficacy criteria were assessed via achieving a clinically meaningful impact on zBMI (i.e., ≥0.15). Changes in BMI were estimated using intent-to-treat and post hoc dose-response analyses via multilevel mixed-effects regressions.

RESULTS

For recruitment, capability and retention progression criteria were met with a total of 89 families participating and 24 participants randomized to the PI group, 21 randomized to the SCV group, 23 randomized to the SCV+PI group, and 21 randomized to the control. However, fidelity and compliance progression criteria were not achieved due to COVID-19 and lack of transportation. Progression criteria for efficacy was also not achieved as intent-to-treat analyses did not show changes in BMI gain that were clinically meaningful. Post hoc dose-response analyses showed that for each day (0 to 29) of summer programming children attended they gained -0.009 (95CI= -0.018, -0.001) less in BMI z score.

CONCLUSIONS

Engagement in both the SCV and PI was not ideal due to COVID-19 and lack of transportation. Providing children with structured summer programming to mitigate accelerated summer BMI gain may be an effective strategy. However, because feasibility and efficacy progression criteria were not met, a larger trial is not warranted until further pilot work is completed to ensure children attend the programming.

TRIAL REGISTRATION

The trial reported herein was prospectively registered at ClinicalTrials.gov. Trial #: NCT04608188.

Interventions to promote healthy lifestyle behaviors in children and adolescents in summer day camps: a scoping review

BACKGROUND

Children and adolescents have suboptimal physical activity and eating habits during summer breaks. Unlike the school setting, there is little evidence on interventions to promote healthy lifestyle behaviors in Summer Day Camps (SDCs).

METHODS

The aim of this scoping review was to examine physical activity, healthy eating, and sedentary behavior interventions in the SDCs. A systematic search on four platforms (EBSCOhost, MEDLINE, EMBASE, and Web of Science) was performed in May 2021 and was updated in June 2022. Studies related to promoting healthy behaviors, physical activity, sedentary behaviors and/or healthy eating among campers aged 6 to 16 in Summer Day Camps were retained. The protocol and writing of the scoping review were done according to the guidelines of the "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR)".

RESULTS

Most interventions had a positive effect on the behavioral determinants or the behaviors themselves (i.e., physical activity, sedentary behaviors, or healthy eating). Involving counsellors and parents, setting camp goals, gardening, and education are all relevant strategies in promoting healthy lifestyle behaviors in SDCs.

CONCLUSIONS

Since only one intervention directly targeted sedentary behaviors, it should strongly be considered for inclusion in future studies. In addition, more long-term and experimental studies are needed to establish cause-and-effect relationships between healthy behavior interventions in SDCs and behaviors of children and young adolescents.

Disparities in weight changes during the COVID-19 pandemic-related lockdown in youths

OBJECTIVE

This study evaluates whether changes in weight among school-aged youth in California due to the COVID-19 lockdown vary by social constructs of race/ethnicity and associated social factors.

METHODS

Including 160,472 youth aged 5 to 17 years enrolled at Kaiser Permanente Southern California, mixed effects models stratified by age group were fitted to estimate changes in distance from the median BMI-for-age from March 2020 to January 2021 (lockdown) compared with the same period before the pandemic.

RESULTS

Excess pandemic weight gain was higher among Black and Hispanic youth aged 5 to 17 years than among White and Asian youth; this difference was most pronounced in those aged 5 to 11 years. In youth aged 5 to 11 years, the distance from the median BMI-for-age increased by 1.72 kg/m2 (95% CI: 1.61-1.84) in Hispanic and 1.70 kg/m2 (95% CI: 1.47-1.94) in Black youth during the lockdown compared with 1.16 kg/m2 (95% CI: 1.02-1.29) in non-Hispanic White youth. The excess weight gain was also higher in youth with fewer neighborhood parks and those with state-subsidized health insurance.

CONCLUSIONS

The COVID-19 pandemic lockdown led to a gain of excess body weight, particularly for Black and Hispanic youth; this weight gain varied by social factors associated with race and ethnicity.

Interpersonal and Environmental Protective Factors and Their Associations With Children's Weight Status

Both external structure (ie, participating in extracurricular activities) and family factors (ie, parental emotional support) have separately been linked with children's physical health and well-being, however, their combined effects are less well known. The current study examined the longitudinal associations between participating in structured out-of-school activities and parent reports of warmth/emotional support with children's weight status (ie, zBMI) over time. Utilizing longitudinal data from the United States-based Early Childhood Longitudinal Study, Kindergarten Class of 2010 to 2011 (ECLS-K:2011), we employed a confirmatory factor analysis (CFA) and a latent variable cross-lagged path analysis to examine if emotional supportiveness and participation in structured activities predicted lower zBMI over the course of 1 year. The final sample included 18 135 participants. Mean age of the participants was 8.12 years (±0.38 years), and 51% of children were male. Mean zBMI was 0.54 (±1.12). Structure at baseline predicted increased zBMI in year 2 (β = .03, P = .02) but did not predict parent emotional supportiveness at year 2 (β = -.05, P = .09). Parent emotional supportiveness at baseline predicted greater zBMI at year 2 (β = .02, P = <.01) but did not predict structure at year 2 (β = .02, P = .39). zBMI at baseline did not predict structure (β = .02, P = .25) or parent emotional supportiveness at year 2 (β = -.01, P = .55). Our findings were inconsistent with our hypothesis with regard to directionality. Continued refinement about the role of internal structure (ie, family, and parenting practices) may inform public health prevention strategies to support the well-being of children and families.

Prolonged body weight gain, lifestyle changes and health-related quality of life in children during the COVID-19 pandemic lockdown: A follow-up study

BACKGROUND

Further investigation is needed to define the impact of long-term pandemic lockdown in children.

OBJECTIVES

To examine changes in body mass index z-score (zBMI), lifestyle, Health-Related Quality of Life and proportion of overweight or obesity (OW/OB) in 6- to 9-year-old children in Argentina.

METHODS

Observational study with baseline measurements prior to lockdown and follow-up after eight months of strict restrictive measures (November 2020, first visit, n = 144) and after ten months of partial reopening (September 2021, second visit, n = 108). Anthropometric changes from baseline to first visit in lockdown group (LG) were compared with a historical control group (HCG, n = 134). Follow-up visits included anthropometric measures, lifestyle questionnaire and Pediatric Quality of Life Inventory.

RESULTS

Change in zBMI was higher in LG [median, IQR: 0.46 (-0.00; 0.83)] vs HCG [median, IQR: 0.02 (-0.31; 0.27)]; p < 0.001, particularly in children with pre-existing OW/OB. In LG, zBMI was higher at first and second visit vs baseline (p < 0.001) and in second visit vs first visit for boys (p = 0.037) but not for girls. The proportion of children with OW/OB increased from baseline (43.5%) to first (56.5%) and second visit (58.3%) (p = 0.029). Unlike girls, the proportion of boys with OW/OB increased from baseline to first and second visit (p = 0.045). Change in zBMI was higher in children with less healthy habits (p < 0.001).

CONCLUSIONS

Weight gain continued to increase in boys when lockdown measurements were eased, although sedentary behaviors decreased and quality of life improved, indicating that the effects of pandemic lockdown could be difficult to reverse.

Psychopathology in virtual education for primary school students in the COVID-19 pandemic: A qualitative analysis

BACKGROUND

COVID-19 virus continues to be an international concern, challenging psychological resilience in all areas, especially virtual education, making the psychopathology and problems more evident.

MATERIALS AND METHODS

The present study is a qualitative study of conventional content analysis, in which 24 participants (14 parents, 5 teachers, and 5 principals) were selected by purposive sampling from primary schools in Zahedan. Data collection tools included semi-structured interviews with open-ended questions. Interviews continued until reaching data saturation. The transcripts of the interviews were coded according to Graneheim and Lundman's 5-step approach, and then, the codes were classified according to the specified axes. For accuracy and exactness of information, the researchers used the criteria of validity, verifiability, reliability, and transferability.

RESULTS

The results of this study include two categories, "e-learning infrastructure" and "psychopathology," indicating the importance of creating, using, and strengthening cyberspace infrastructure for the use of education in primary schools during COVID-19 pandemic.

CONCLUSION

The results indicated that identifying these cases and attempting to eliminate them can reduce psychopathology and improve the quality of virtual education for students. Moreover, this can help principals and educational planners have new insights so that they can focus on solving psychological problems in e-learning and provide their supportive planning.

Impact of COVID-19 on Well-Being and Physical Activity in Ugandan Children With and Without HIV

BACKGROUND

The present study aims to understand the socioeconomic and physical activity impact of the COVID-19 pandemic on children living with perinatally acquired HIV (PHIV) and without HIV (HIV-) in Kampala (Uganda).

METHODS

The authors included children aged 10-18 years who filled out questionnaires at baseline (2017-2018, prepandemic) and 2 years later (March 2020-January 2021, pandemic) in an observational cohort study at Joint Clinical Research Centre (Kampala). Physical activity energy expenditure was calculated using a youth compendium from the National Collaborative on Childhood Obesity Research. Descriptive and standard test statistics including Kruskal-Wallis were used.

RESULTS

One hundred and ninety-eight children from Kampala Uganda were included prepandemic (101 PHIV and 97 HIV-); 131 (71 PHIV and 60 HIV-) had information collected during the pandemic. At baseline, median and interquartile range age was 13 years (11; 15), and 52% were females. During the pandemic, overall weekly physical activity increased by a median of 854 minutes (interquartile range: 270-1890), and energy expenditures increased by 16% in both PHIV and in HIV- (P < .001 for groups overall prepandemic vs pandemic).

CONCLUSIONS

The authors found in this Ugandan cohort of children that children engaged in more physical activity. Further research is warranted to understand the long-term effects of the pandemic on children's well-being.

Changes in Physical Health-Related Indexes of Chinese College Students before and after COVID-19 Lockdown

The outbreak of the COVID-19 pandemic has caused negative impacts on people's lifestyles, as well as considerable indirect social impacts, which has even overshadowed the direct impact of virus infection itself. This study is aimed at examining the changes in physical health-related indexes of Chinese college students before and after the COVID-19 lockdown. The data of this study are from the National Physical Health Testing Program, covering 43 college students (male: 22) from a class of a Chinese university. Paired t-tests were performed on the physical health test data separately collected in November 2019 before the COVID-19 pandemic and October 2020 after the COVID-19 lockdown was lifted. As shown by the test results, compared to the prelockdown data, college students had an increased body mass index (BMI) (0.43 (SD 0.94) P = 0.004), decreased vital capacity (VC) (-128.98 (SD 310.13) ml P = 0.009), and lowered performance in the 800/1000 m endurance (-6.21 (SD 8.81) points P < 0.001) and standing long jump tests (-2.44 (SD 7.37) points P = 0.036) after the lockdown, and the differences in these regards all were significant. In addition, for the students in the overweight/obese group, their pre- and postlockdown physical fitness test results were found to have no statistically significant difference (P > 0.05), but the students in the control group showed a significantly increased BMI, as well as significantly decreased vital capacity and performance in the 800/1000 m endurance and standing long jump tests (P < 0.05). The findings of this study are expected to help government departments and policymakers better understand the impacts of school closures and online learning on the physical health of adolescents, while providing a basis for the formulation of measures that are aimed at reversing adolescents' physical health decline.

The effects of the covid-19 pandemic on puberty: a cross-sectional, multicenter study from Turkey

BACKGROUNDS

During the Coronavirus-19 disease (Covid-19) pandemic it was observed that the number of girls presenting with early puberty had increased. The aim of this study was to carry out a retrospective evaluation of the characteristics of girls who had been referred for evaluation of precocious puberty in five different pediatric endocrinology units, before and during the pandemic.

METHODS

The study participants comprised 359 girls who were assigned into 2 groups a pre-pandemic group (n:214) and a pandemic group (n:145). Those participants (n:99) who had medical records in the follow-up period were classified into 3 subgroups according to the time of presentation and follow-up visits (group-1: first admission and follow-up visit before the pandemic, group-2: first admission before the pandemic, the follow-up visit during the pandemic, group-3: first admission and follow-up visit during the pandemic).

RESULTS

The age at presentation and age at pubertal onset were both significantly lower in the pandemic group than those in the pre-pandemic group(8.1 vs 8.6, p: < 0.001,7.7 vs 7.9,p:0.013, respectively). There was no significant difference between the body mass index standard deviation scores (BMI-SDS) values of the groups (0.57 vs 0.51, p:0.430). The initiation rate of pubertal suppression therapy at the time of presentation was significantly higher in the pandemic group compared to that of the pre-pandemic group (7.7%vs 27.5%), and in groups-2 & 3 compared to group-1, during follow-up (20%&44%vs 8%).

CONCLUSION

Our research showed that the onset of puberty occurred earlier in the pandemic period compared to the previous year, and the need for pubertal suppression therapy increased during the pandemic.

Children and Adolescents Dietary Habits and Lifestyle Changes during COVID-19 Lockdown in Italy

Background: We evaluated the changes in lifestyle during the COVID-19 pandemic lockdown in a sample of children and adolescents in order to assess any increase in risk factors for the onset of cardiovascular diseases in later ages. Methods: We conducted a cross-sectional study involving 965 parents who completed an online survey about dietary habits and lifestyle during the first lockdown in Italy (from 9 March 2020 to 18 May 2020) and compared their findings with the period before the pandemic. The inclusion criteria were parents (or caregivers) with Italian residency and with children aged between 5 and 18 years. Results: We identified 563 adolescents and 402 children. The mean age was 12.28 years (SD 3.754). The pandemic was associated with an increase in the consumption of high-calorie snack foods. The total amount of food in homes during lockdown compared with before the pandemic increased 50%. Relating to the parent-perceived child weight status, more parents reported obesity in their children after lockdown (+0.6% in the 5–11 age group and +0.2% in the 12–18 age group). We reported a reduction of physical activity, an increase of sedentary lifestyle and sleep habits changes. Conclusion: The COVID-19 pandemic was associated with changes in the lifestyles of children and adolescents; this could cause an increase in the incidence of obesity and of cardiovascular and metabolic diseases in adulthood.

Maintaining School Foodservice Operations in Ohio during COVID-19: “This [Was] Not the Time to Sit Back and Watch”

The COVID-19-related lockdowns led to school closures across the United States, cutting off critical resources for nutritious food. Foodservice employees emerged as frontline workers; understanding their experiences is critical to generate innovations for program operations and viability. The purpose of this cross-sectional study was to characterize COVID-19-related foodservice adaptations for summer and school year meal provision. Public school district foodservice administrators across Ohio were surveyed in December 2020. Questions related to meal provision before, during, and after COVID-19-related school closures. Results indicate the majority of districts continued providing meals upon their closure in Spring 2020 (n = 182, 87.1%); fewer did so in Summer (n = 88, 42.1%) and Fall (n = 32, 15.3%). In Spring and Summer, most districts that offered meals functioned as ‘open sites’ (67.0% and 87.5%, respectively), not limiting food receipt to district-affiliated students. Most districts employed a pick-up system for food distribution (76–84% across seasons), though some used a combination of approaches or changed their approach within-season. Qualitatively, districts reported both “successes” (e.g., supporting students) and “challenges” (e.g., supply chain). Despite being ill-prepared, districts responded quickly and flexibly to demands of the pandemic. This analysis provides insight for future practice (e.g., establishing community partnerships) and policy (e.g., bolstering local food systems).

The impact of COVID-19 in children and adolescents with obesity in Brazil

Objective

The primary goal of the study was to evaluate weight gain in children and adolescents with obesity during the COVID-19 pandemic period, and compare it with the period before the pandemic.

Methods

The sample comprised 68 children with obesity aged between 7 and 18 years, 30 (44.1%) boys and 38 (55.9%) girls, who were attended at the pediatric endocrinology clinic of the Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brazil. Weight gain in the sample in the pre-lockdown period (December 2, 2018 to March 11, 2020) was compared with that in the lockdown period (March 11, 2020 to February 21, 2021).

Results

Approximately one year before the start of the pandemic period, the mean (SD) chronological age was 10.1 years old (± 2.4), and an average weight gain of 4.4 kg (± 4.8) was observed during the pre-lockdown period described. One year after the start of the pandemic, mean (SD) chronological age was 11.8 years old (± 2.4), and an average weight gain of 8.5 kg (± 7.6) was observed in the lockdown period described. When we compared the weight gain in the two periods, it was higher in the pandemic period, both in girls and boys (p = 0.013 and 0.035, respectively).

Conclusion

The results of the study show that the period of social isolation adopted to mitigate the COVID-19 pandemic was associated with increased weight gain in the studied population, probably due to a reduction in physical activities and an increase in energy consumption.

The effect of school year and summer break in health-related cardiorespiratory fitness: A 2-year longitudinal analysis

This study aimed to assess the trends of health-related cardiorespiratory fitness (CRF) during two school years with a 3-month summer break in children and adolescents. A 2-year longitudinal study, including 440 6th to 8th graders (218 boys), mean age 12.3 years, was conducted. The Progressive Aerobic Cardiovascular Endurance Run (PACER) was used to assess CRF. Physical activity was measured using accelerometers. Repeated measures linear models were used to analyses differences and trends in VO2peak and health-related CRF. Overall differences between time-point VO2peak were significant for both boys (p<0.001) and girls (p=0.003). Pairwise comparisons showed that VO2peak improved from the beginning to the end of the same school year for boys (school-year 1: 1.53 ml/kg/min, 95%CI=0.98, 2.09; school-year 2: 1.81 ml/kg/min, 95%CI=1.28, 2.34) and girls (school-year 1: 0.85 ml/kg/min, 95%CI=0.43, 1.27; school-year 2: 1.05 ml/kg/min, 95%CI=0.73, 1.36), while, differences in CRF during summer break were not significant. However, significance was only maintained for girls when performing monthly adjusted analysis. Improvements in CRF were observed during school year and remained unchanged during summer break. These findings provide relevant information for the health education community, suggesting the need for additional efforts to counteract the summer break effects on CRF, especially for girls.

Bidirectional relationships of physical activity and gross motor skills before and after summer break: Application of a cross-lagged panel model

BACKGROUND

Gross motor skills are postulated to have a bidirectional relationship with physical activity (PA); however, no study has tested this relationship before and after a summer break. The purpose of this study was to examine the bidirectional relationships between school PA and gross motor skills in children before and after a summer break.

METHODS

Participants were a sample of 440 children recruited from 3 low-income schools (age = 8.9 ± 1.2 years, mean ± SD). PA was assessed as average school-day step counts using Yamax DigiWalker pedometers (Yamasa Tokei Keiki, Tokyo, Japan) worn for 5 consecutive school days. Gross motor skills were assessed using the Test for Gross Motor Development, 3rd edition. Data were collected at 2 timepoints: at the end of spring semester (T1) and at the beginning of the subsequent fall semester (T2). An age- and body mass index-adjusted cross-lagged model was employed to relate T1 school step counts with T2 gross motor skills and T1 gross motor skills with T2 school step counts.

RESULTS

T1 gross motor skills significantly predicted T2 school step counts (β = 0.24, 95 % confidence interval (95%CI): 0.08-0.40, p = 0.003); however, T1 school step counts did not predict T2 gross motor skills (β = 0.04, 95%CI: -0.06 to 0.14, p = 0.445). The model explained 35.4% and 15.9% of the variances of T2 gross motor skills and T2 school step counts, respectively. Additional analyses indicated that these relationships were driven primarily by ball skills.

CONCLUSION

The relationship between gross motor skills and school PA was not bidirectional; however, higher gross motor skills, specifically ball skills, predicted higher school PA after a 3-month summer break.

What did COVID-19 Change? The Impact of COVID-19 on Korean Parents' and Children's Daily Lives and Stress

The COVID-19 outbreak has not only posed a threat to physical health but has also changed our daily lives. This study explored how the COVID-19 pandemic affected Korean parents' and children's daily lives and stress levels. Parents' childcare time, children's screen time, the time spent for social interactions and learning, and parents' and children's stress levels before and after the pandemic were compared. The main caregivers' childcare time increased significantly during the pandemic (4.00 h/day). For children, the time spent for screen time (1.76 h) and online interactions (0.95 h) increased significantly, whereas face-to-face interaction time (4.17 h) and time spent learning (2.16 h) decreased significantly. In addition, parents' and children's stress levels increased significantly during the pandemic. Other descriptive information is provided and discussed. Our results indicate that Korean parents and children experienced significant disruption to their daily lives and increased stress during the pandemic.

The effects of the home-based exercise during COVID-19 school closure on the physical fitness of preschool children in China

BACKGROUND

Social distancing and school closures during the COVID-19 pandemic reduced the physical activities of the preschool children living in China. However, the effects of home-based exercise on the physical fitness of Chinese preschool children during COVID-19 school closures are still unknown. This study aimed to investigate the effects of home-based exercise on the physical fitness of Chinese preschool children during COVID-19 school closure.

METHODS

In this retrospective analysis, data from 1,608 Chinese preschool children (aged 3-5.5 years) in a second-tier city of Guangdong Province of China (Zhongshan city) were extracted from three successive National Physical Fitness Measurement (NPFM) from 2019 to 2021. NPFM consists of weight, height, and six subtests of physical fitness including 10-m shuttle run test (SRT), standing long jump (SLJ), balance beam walking (BBW), sit-and-reach (SR), tennis throwing (TT), and double-leg timed hop (DTH) tests. The change differences or change ratios of all the items in NPFM between any two successive years from 2019 to 2021 were compared. The exercise profiles about home-based and outdoor exercise before, during, and after COVID-19 school closure were obtained from 185 preschool children via retrospective telephone survey.

RESULTS

Between 2019 and 2021, 1,608 preschool children were included in this study. We observed larger changes in SLJ, SR, TT, and DTH tests during school closure than after school closure. But the children showed lower reduction rates in the completion time of SRT and BBW. During school closure, higher change ratios in SLJ and TT were observed in the children primarily participating in home-based exercise than those primarily participating in outdoor exercise. However, no statistical differences were observed in the changes in SRT and BBW between home-based and outdoor training groups.

CONCLUSION

The home-based exercise program might be an alternative approach to improve the physical fitness of preschool children during COVID-19 school closure, but could not be beneficial to speed-agility and balance functions. A specific guideline geared toward a home-based exercise program during the COVID-19 outbreak is highly needed.

Seasonal variation in added sugar or sugar sweetened beverage intake in Alaska native communities: an exploratory study

Excess added sugar intake contributes to tooth decay risk in Alaska Native communities. The goal of this exploratory study was to determine if there is seasonal variation in total added sugar intake or in the leading sources of added sugars in a Yup'ik population. Data were collected in spring and winter from 2008-2010 using self-reported intake data measured by 24-hour recall and by hair biomarker (carbon and nitrogen stable isotope). Seventy Yup'ik participants ages 14-70 years were recruited from two communities and data were collected twice from a subset of 38 participants. Self-reported added sugar intake (g/day), biomarker-predicted added sugar intake (g/day), and leading sources of added sugar were calculated. Seasonal variation was evaluated using a paired sample t-test. Total added sugar intake was 93.6 g/day and did not significantly differ by season. Sodas and other sugar-sweetened beverages (e.g. Tang, Kool-Aid) were the leading sources and added sugar from these sources did not significantly differ by season (p=.54 and p=.89, respectively). No seasonal variation in added sugar intake was detected by either self-report or biomarker. Dietary interventions that reduce intake of added sugars have the potential to reduce tooth decay in Yup'ik communities.

Differences in ​the proportion of children meeting behavior guidelines ​between summer ​and school by socioeconomic status and race

OBJECTIVE

Children who fail to meet activity, sleep, and screen-time guidelines are at increased risk for obesity. Further, children who are Black are more likely to have obesity when compared to children who are White, and children from low-income households are at increased risk for obesity when compared to children from higher-income households. The objective of this study was to evaluate the proportion of days meeting obesogenic behavior guidelines during the school year compared to summer vacation by race and free/reduced priced lunch (FRPL) eligibility.

METHODS

Mixed-effects linear and logistic regressions estimated the proportion of days participants met activity, sleep, and screen-time guidelines during summer and school by race and FRPL eligibility within an observational cohort sample.

RESULTS

Children (n = 268, grades = K - 4, 44.1%FRPL, 59.0% Black) attending three schools participated. Children's activity, sleep, and screen-time were collected during an average of 23 school days and 16 days during summer vacation. During school, both children who were White and eligible for FRPL met activity, sleep, and screen-time guidelines on a greater proportion of days when compared to their Black and non-eligible counterparts. Significant differences in changes from school to summer in the proportion of days children met activity (-6.2%, 95CI = -10.1%, -2.3%; OR = 0.7, 95CI = 0.6, 0.9) and sleep (7.6%, 95CI = 2.9%, 12.4%; OR = 2.1, 95CI = 1.4, 3.0) guidelines between children who were Black and White were observed. Differences in changes in activity (-8.5%, 95CI = -4.9%, -12.1%; OR = 1.5, 95CI = 1.3, 1.8) were observed between children eligible versus uneligible for FRPL.

CONCLUSIONS

Summer vacation may be an important time for targeting activity and screen-time of children who are Black and/or eligible for FRPL.

A digitally enhanced home-based physical activity intervention for high-risk middle school youth during COVID-19

COVID-19 significantly impacted physical activity among high-risk youth. Camp from Home, a digitally enhanced home-based intervention, was developed to address physical activity disparities among middle school youth during COVID-19. Camp from Home enrolled 62 youth in 54 families from five schools in Philadelphia during the summer of 2020. The 6-week intervention comprised of (1) three home deliveries of "activity kits" including exercise equipment and activity booklets, (2) asynchronous sport and exercise videos posted to a private YouTube channel, and (3) supportive text-messages from health coaches. YouTube analytics and self-report surveys completed by parents and youth at baseline and at the end of programming were used to assess engagement, acceptability, and preliminary efficacy. Youth participants were 12.4 (1.2) years, 38.7% female and 90.3% Black/African American. At follow-up, 41 parents (75.9%) and 34 youth (54.8%) completed measures. Youth self-reported increases in self-efficacy (ΔM(sd) = 0.4(1.0), p = .03) and physical activity (ΔM(sd) = 4.2(7.9), p = .004), despite suboptimal engagement in digital program components. Overall, participants highly rated the program. Activity kits and text-messages from health coaches were rated as most helpful. Most parents (95.1%) and youth (83.8%) expressed interested in participating again in the future. A 6-week digitally enhanced, home-based physical activity intervention was acceptable and feasible among parents and youth during the summer of 2020, with youth reporting improvements in self-efficacy and physical activity. Summer programs are critical for reducing disparities in physical activity and hold potential for addressing key barriers for high-risk youth even outside the context of COVID-19.

Excess weight gain in the paediatric bleeding disorders population: Impact of the COVID-19 Pandemic

Introduction

The COVID‐19 pandemic has resulted in lifestyle changes for children. The aim of this study was to evaluate the impact of the pandemic on weight/BMI in children with severe bleeding disorders.

Methods

We conducted a retrospective review of patients age 3–18 years with severe bleeding disorders on prophylactic therapy treated at SickKids Hospital (Toronto, Canada) between February 01, 2018 and March 31, 2021. We evaluated the following pre‐ and post‐COVID variables: weight (kg), weight percentile, BMI (kg/m²), BMI percentile, HJHS score, and prophylactic dosing (units/kg).

Results

One hundred and four patients were included in the final analysis. Diagnoses were as follows:  haemophilia A (n = 92; 70.8%), haemophilia B (n = 17; 13.1%), type 3 von Willebrand disease (n = 11; 8.5%), the remainder were diagnosed with rare factor deficiencies.  Median interval time from pre‐COVID measurements to latest follow‐up was 12.4 months (IQR 10.32–14.52 months) during which there was a statistically significant increase in median weight percentile +5.75 centiles (from 63^rdcentile to 68.75^thcentile). There was a statistically significant increase in mean BMI of +1.03 kg/m²(P = < .001) while median BMI percentile increased +8.82 centiles (from 53.9^thcentile to 62.72^ndcentile) and mean BMI percentile increased 3.42 centiles (from 57.5 centile to 60.9 centile). The group that gained the most weight centiles, BMI and BMI centiles were 5–14 years old.

Conclusion

There was a trend to weight gain over the study period. More long‐term data is required to evaluate the impact of this increase in weight and BMI on children with bleeding disorders.

Impact of a year-round school calendar on children's BMI and fitness: Final outcomes from a natural experiment

BACKGROUND

Structure may mitigate children's accelerated summer BMI gain and cardiorespiratory-fitness (CRF) loss.

OBJECTIVES

Examine BMI and CRF change during school and summer for year-round and traditional calendar school children.

METHODS

Three schools (N = 2279, 1 year-round) participated in this natural experiment. Children's BMI z-score (zBMI) and CRF (PACER laps) were measured from 2017 to 2019 each May/August. Mixed effects regression estimated monthly zBMI and CRF change during school/summer. Secondary analyses examined differences by weight status and race. Spline regression models estimated zBMI and CRF growth from kindergarten-sixth grade.

RESULTS

Compared to traditional school, children attending a year-round school gained more zBMI (difference = 0.015; 95CI = 0.002, 0.028) during school, and less zBMI (difference = -0.029; 95CI = -0.041, -0.018), and more CRF (difference = 0.834; 95CI = 0.575, 1.093) monthly during summer. Differences by weight status and race were observed during summer and school. Growth models demonstrated that the magnitude of overall zBMI and CRF change from kindergarten-sixth grade was similar for year-round or traditional school children.

CONCLUSIONS

Contrary to traditional school children zBMI increased during the traditional 9-month school calendar and zBMI decreased during the traditional summer vacation for year-round school children. Structured summer programming may mitigate accelerated summer BMI gain and CRF loss especially for overweight or obese, and/or Black children.

Food environments and the COVID-19 pandemic in Brazil: analysis of changes observed in 2020

Evidence of changes caused by the COVID-19 pandemic in food security and nutrition conditions, as well as in different food environments, has called researchers’ attention to substantial changes taking place in individuals’ dietary habits. The aim of this study is to present and address changes that have already happened in food environments, during the first COVID-19 pandemic year, in a middle-income country. Multiple changes were observed and had direct impact on the population, among them, worsened health and nutrition indicators and advanced dietary inequalities, as well as on its food profile in different life cycles, if one takes into consideration aspects such as food availability, financial access and dietary quality.

Weight-Related Behaviors of Children with Obesity during the COVID-19 Pandemic

Background: During the coronavirus disease 2019 (COVID-19) pandemic, children and families have had to adapt their daily lives. The purpose of this study was to describe changes in the weight-related behaviors of children with obesity after the onset of the COVID-19 pandemic. Methods: Semistructured interviews (n = 51) were conducted from April to June 2020 with parents of children with obesity. Families were participants in a randomized trial testing a clinic-community pediatric obesity treatment model. During interviews, families described their experience during the COVID-19 pandemic, with a particular emphasis on children's diet, physical activity, sleep, and screen time behaviors. Rapid qualitative analysis methods were used to identify themes around changes in children's weight-related behaviors. Results: The mean child age was 9.7 (±2.8) years and the majority of children were Black (46%) or Hispanic (39%) and from low-income families (62%). Most parent participants were mothers (88%). There were differences in the perceived physical activity level of children, with some parents attributing increases in activity or maintenance of activity level to increased outdoor time, whereas others reported a decline due to lack of outdoor time, school, and structured activities. Key dietary changes included increased snacking and more meals prepared and consumed at home. There was a shift in sleep schedules with children going to bed and waking up later and an increase in leisure-based screen time. Parents played a role in promoting activity and managing children's screen time. Conclusions: The COVID-19 pandemic has created unique lifestyle challenges and opportunities for lifestyle modification. Clinical Trials ID: NCT03339440.

Body Mass Index, Practice of Physical Activity and Lifestyle of Students During COVID-19 Lockdown

PURPOSE

Several factors influence the student's physical activity and lifestyle. The coronavirus disease (COVID-19) lockdown has restricted student's activity and altered their routine lifestyle. This prospective cohort study aimed to determine the significant changes in body mass index (BMI), physical activity, and lifestyle of the students including diet, sleep, and mental health before and during COVID-19 lockdown.

METHODS

The study participants were 628 students studying bachelor's degree programs, between 18 and 30 years of age, both genders from the university of Al-Ahsa, Saudi Arabia. The lockdown began on 23 March and ended on 21 June 2020 in Saudi Arabia. The students were interviewed before (March 2020) and during (June 2020) lockdown. The structured tool included baseline information of the students, anthropometric data, global physical activity questionnaire (GPAQ), dietary recall, Pittsburgh sleep quality index (PSQI), and perceived stress scale (PSP). Chi-square tests were used to associate the baseline information with BMI changes during the lockdown.

RESULTS

BMI of the students showed that 32% increased their weight, 22% lost their weight and 46% maintained the same weight during COVID-19 lockdown. The physical activity significantly decreased and sedentary time increased (p = 0.0001). Regarding the lifestyle components, fast and fried food consumption decreased, and calorie intake increased significantly (p = 0.001). Stress level (p = 0.001) significantly decreased, and sleep level (p = 0.001) increased during lockdown. The variables associated with weight changes were the level of students (p < 0.05) and time spent on social media per day (p < 0.0001).

CONCLUSION

Though half of the students maintained the same BMI during the lockdown, students who increased BMI were associated with physical activity and lifestyle. Hence, health awareness on weight maintenance, active physical activities, and a healthy lifestyle must be created among the students, which help in creating and implementing policies in the future.

Effects of COVID-19 home confinement on eating behavior: A review

Coronavirus disease is a global pandemic that has led to radical changes in lifestyle habits, including dietary habits. Therefore, the objective of the present review is to evaluate the effect of quarantine on dietary habits when enforcing a lockdown. Some databases were used, including Web of Science, Science Direct, Google Scholar, and PubMed. Ten studies conducted between March and May 2020 were included. There is an increase in the number of meals and snacks during home confinement as well as unhealthy food such as fast food, sweets and chocolate, sugar-added drinks, and processed meat, while fruit and vegetable consumption was reduced. Very few studies reported that participants had increased fruit and vegetable intake. In conclusion, collateral effects of this pandemic include an environment that is not favorable to healthy dietary habits, which could have a lasting impact on health. The long-term health effects are unknown and worth investigating.

The Impact of COVID-19 School Closure on Child and Adolescent Health: A Rapid Systematic Review

School closures during pandemics raise important concerns for children and adolescents. Our aim is synthesizing available data on the impact of school closure during the coronavirus disease 2019 (COVID-19) pandemic on child and adolescent health globally. We conducted a rapid systematic review by searching PubMed, Embase, and Google Scholar for any study published between January and September 2020. We included a total of ten primary studies. COVID-19-related school closure was associated with a significant decline in the number of hospital admissions and pediatric emergency department visits. However, a number of children and adolescents lost access to school-based healthcare services, special services for children with disabilities, and nutrition programs. A greater risk of widening educational disparities due to lack of support and resources for remote learning were also reported among poorer families and children with disabilities. School closure also contributed to increased anxiety and loneliness in young people and child stress, sadness, frustration, indiscipline, and hyperactivity. The longer the duration of school closure and reduction of daily physical activity, the higher was the predicted increase of Body Mass Index and childhood obesity prevalence. There is a need to identify children and adolescents at higher risk of learning and mental health impairments and support them during school closures.

Seasonal Variability in Weight Gain Among American Indian, Black, White, and Hispanic Children: A 3.5-Year Study

INTRODUCTION

Several studies have reported that children gain more weight during the summer season. Despite high obesity rates, little research has included American Indian/Alaskan Native children, and few studies have been longitudinal. This observational study examines seasonal weight variability over 3.5 years among ethnically diverse children, including 2,184 American Indian/Alaskan Native children.

METHODS

Children's height and weight were measured before and after the summer from 2012-2015 and analyzed in 2019-2020, including children with ≥2 consecutive measurements (N=7,890, mean age=8.4 [SD=2.8] years). Mixed-effects models tested whether the percentage of the 95th BMI percentile and BMI differed by season (summer versus the rest of the year) and ethnicity.

RESULTS

American Indian/Alaskan Native (23.7%), Hispanic (19.8%), and Black (17.8%) children had significantly higher baseline obesity rates than White children (7.1%). The percentage of the 95th BMI percentile significantly increased during the summer compared with the percentage during the rest of the year, with the strongest effects for children who were obese (b=2.69, 95% CI=1.35, 4.03, p<0.001) or overweight (b=1.47, 95% CI=0.56, 2.35, p<0.01). In BMI units, summer BMI increase was 0.50 kg/m² higher (obese model) and 0.27 kg/m² higher (overweight) than that of the rest of the year. Seasonal effects were significantly less pronounced for American Indian/Alaskan Native children than for White children.

CONCLUSIONS

Children gained significantly more weight during the summer season, with the strongest effects for children who were obese. American Indian/Alaskan Native children had less seasonal variability than White children, but higher overall obesity rates. These data underscore summer as a critical time for obesity prevention among children who are overweight/obese but suggest that seasonal patterns may vary for American Indian/Alaskan Native children.

Impact of COVID-19 on School-Aged Male and Female Health-Related Fitness Markers

PURPOSE

The purpose of this study was to examine the impact of the Coronavirus disease 2019 on male and female anthropometric variables and physical performance.

METHODS

This study utilized a mixed (time [PRE vs POST], gender [male vs female]) methods design to examine changes in the body mass index and physical fitness performance measures prior to and following closures. Data were collected from 264 third through eighth graders. This sample consisted of 131 males and 133 females. The data was collected through anthropometric (body mass index) and physical performance measures and was analyzed with separate 2 × 2 mixed-factorial analyses of variance (time [PRE, POST] × gender [male, female]).

RESULTS

The findings indicated both males and females exhibited mean increases in the body mass index (+10.6%; 18.8-20.8 kg·m-2, P < .001, partial η2 = .627) and decreases in push-ups (-35.6%; 7.3-4.7 repetitions, P < .001, partial η2 = .371), sit-ups (-19.4%; 22.7-18.3 repetitions, P < .001, partial η2 = .420), and the Progressive Aerobic Cardiovascular Endurance Run test (-26.7%; 31.4-22.4 laps, P < .001, partial η2 = .644) scores from PRE to POST.

CONCLUSION

The results of this study demonstrate that both males and females exhibited significant anthropometric and physical performance losses during the Coronavirus disease 2019 shutdown.

Lifestyle Changes and Determinants of Children's and Adolescents' Body Weight Increase during the First COVID-19 Lockdown in Greece: The COV-EAT Study

Previous studies showed that the coronavirus disease 2019 (COVID-19) lockdown imposed changes in adults’ lifestyle behaviors; however, there is limited information regarding the effects on youth. The COV-EAT study aimed to report changes in children’s and adolescents’ lifestyle habits during the first COVID-19 lockdown and explore potential associations between changes of participants’ lifestyle behaviors and body weight. An online survey among 397 children/adolescents and their parents across 63 municipalities in Greece was conducted in April–May 2020. Parents self-reported changes of their children’s lifestyle habits and body weight, as well as sociodemographic data of their family. The present study shows that during the lockdown, children’s/adolescents’ sleep duration and screen time increased, while their physical activity decreased. Their consumption of fruits and fresh fruit juices, vegetables, dairy products, pasta, sweets, total snacks, and breakfast increased, while fast-food consumption decreased. Body weight increased in 35% of children/adolescents. A multiple regression analysis showed that the body weight increase was associated with increased consumption of breakfast, salty snacks, and total snacks and with decreased physical activity. The COV-EAT study revealed changes in children’s and adolescents’ lifestyle behaviors during the first COVID-19 lockdown in Greece. Effective strategies are needed to prevent excessive body weight gain in future COVID-19 lockdowns.

Impact of COVID-19 Lockdown on Body Weight, Eating Habits, and Physical Activity of Jordanian Children and Adolescents

OBJECTIVE

The lockdown for the COVID-19 pandemic affects lifestyle patterns globally and impacts children and adolescents. This study aims to assess the effect of the lockdown on body weight, eating habits, and physical activity of Jordanian youth (children and adolescents).

METHODS

A cross-sectional study was conducted on a sample of 477 Jordanian children and adolescents aged 6-17 y. The study tool was a structured validated questionnaire. It comprised 4 parts, including a general description of the study purpose, sociodemographic and anthropometric data, physical activity data, and food intake pattern. Questions were reported before and during lockdown. Changes in outcomes over the 2 study time points were evaluated.

RESULTS

After the lockdown period, the mean body weight and body mass index for age Z-scores (BAZ) showed a significant increase (P < 0.001) compared with before the lockdown period. More than 50% of the subjects reported that they spent more than 3 h in front of the screen during the lockdown. The percent of subjects who watched TV for more than 3h was increased. Moreover, physical inactivity was increased significantly during the lockdown. All food groups consumption was significantly increased during the lockdown compared to before the lockdown.

CONCLUSIONS

COVID-19 lockdown period was characterized by an increase in the use of screen-based devices, lower physical activity, uncontrolled food intake, and weight gain.

The Impact of the Coronavirus Disease-2019 Pandemic on Childhood Obesity and Vitamin D Status

BACKGROUND

The risk of weight gain as a consequence of school closure in children during the coronavirus disease-2019 (COVID-19) pandemic has been recognized. This study was performed to investigate changes in anthropometric and metabolic parameters in children following a 6-month period of social distancing and school closure due to the pandemic.

METHODS

This retrospective cohort study was conducted in school-aged children that were on routine follow-up at the Growth Clinic of Seoul St. Mary's Hospital. Changes in body mass index (BMI) standard deviation scores (z-scores), lipid profiles, and vitamin D levels were investigated. The 1-year period prior to school closure was defined as "pre-COVID-19 period," and the subsequent 6-month period as "COVID-19 period."

RESULTS

Overall, 226 children between 4 to 14 years old without comorbidities were assessed. On average, their BMI z-scores increased by 0.219 (95% confidence interval [CI], 0.167-0.271; P < 0.001) in the COVID-19 period compared to the pre-COVID-19 period, and the proportion of overweight or obesity increased from 23.9% in the pre-COVID-19 period to 31.4% in the COVID-19 period. The number of days after school closure (P = 0.004) and being in the normoweight category in the pre-COVID-19 period (P = 0.017) were factors associated with an increased BMI in the COVID-19 period. The mean triglyceride (105.8 mg/dL vs. 88.6 mg/dL, P < 0.001) and low-density lipoprotein-cholesterol (100.2 mg/dL vs. 94.0 mg/dL, P = 0.002) levels were higher, whereas the calcidiol level (18.9 mg/dL vs. 23.8 mg/dL, P < 0.001) was lower in the COVID-19 period compared to the pre-COVID-19 period.

CONCLUSION

Within 6 months, increased childhood obesity and vitamin D deficiencies were observed. The duration of school closure was significantly associated with an increased BMI and being normoweight does not exclude the risks for gaining weight.

The intersection of COVID-19, school, and headaches: Problems and solutions

OBJECTIVE

To equip clinicians with recommendations specific to concerns related to the novel coronavirus disease 2019 (COVID-19), which impact the physical, emotional, and social health of youth with headache disorders.

BACKGROUND

COVID-19 has affected societies on a global scale including children and youth with chronic headache disorders. Many concerns are predicted to arise in the 2020-2021 school year, whether classes are conducted in-person or virtually.

METHODS

Clinical impressions were combined with a review of the literature, although limited due to the recent nature of this issue.

RESULTS

We describe recommendations to support caregivers and youth as they face changes expected with the return to school in the fall of 2020.

CONCLUSION

Although there are significant concerns for caregivers and youth with migraine given the context of changes related to the pandemic, there are many recommendations that can help minimize exacerbations of the physical, emotional, and social health of youth with chronic migraine.

Feeding Students During COVID-19-Related School Closures: A Nationwide Assessment of Initial Responses

OBJECTIVE

To conduct a nationwide assessment of child nutrition administrative agencies' responses to meal service provision during coronavirus disease 2019-related school closures.

DESIGN

Systematic coding of government websites (February-May 2020) regarding school meal provision in all 50 US states and the District of Columbia, 5 US territories, and the US Department of Interior Bureau of Indian Education.

PARTICIPANTS

All US jurisdictions (N = 57).

VARIABLES MEASURED

Seven coding criteria were established to assess the strengths and weaknesses of jurisdictions' responses derived from emergency declarations, school closure announcements, and government websites on emergency school meals.

ANALYSIS

Descriptive analyses.

RESULTS

Most jurisdictions mentioned school meal provisions in school closure announcements (76.4%), provided easily interpretable information and/or maps about meal sites (57.9%), and included detailed information about school meal provisions in their coronavirus disease 2019 landing webpages (n = 26, 51%). Fewer provided updated and comprehensive implementation guidance (39.3%), referenced school closures in emergency declarations (37.5%), had clear communication/outreach to families (21.4%), or partnered with antihunger organizations (11.6%).

CONCLUSIONS AND IMPLICATIONS

Understanding initial jurisdictions' approaches are critical to current and future emergency planning during school closures and reopening to help address food insecurity better, limit disease transmission, and prevent health disparities, particularly among at-risk populations.

The effect of the coronavirus (COVID-19) pandemic on health-related quality of life in children

INTRODUCTION

The study was conducted to examine the effect of the COVID-19 pandemic on health-related quality of life in children.

MATERIALS AND METHODS

The study was conducted with 597 children aged 7-13 and their parents using the online data collection tool via social media. Socio-demographic form and Generic Health-related Quality of Life Questionnaire for Children (Kid-KINDL) were used to collect the data. SPSS 23.0 program, descriptive statistics, Mann-Whitney U test and Kruskal-Wallis variance analysis were used to evaluate the data.

RESULTS

During the pandemic, 41.5% of the parents stated that their child gained weight, tendency to sleep of 34.2% and tendency to use the Internet of 69.3% increased. The average self-reported quality of life score of the children was found to be 73.91 ± 8.44. The self-esteem sub-dimension score of the children whose tendency to sleep increased during the pandemic (p < 0.05); and the physical well-being (p < 0.001), emotional well-being (p < 0.001), self-esteem (p < 0.001), family (p < 0.01), school (p < 0.05) sub-dimensions and total (p < 0.05) score averages of the children whose tendency to use the Internet were found to be lower. The emotional well-being, family and friends sub-dimensions as well as total average scores of the children of the parents who feel fear/anxiety about coronavirus becoming a pandemic and who stated that lockdown negatively affected their mental health were found to be lower (p < 0.05).

CONCLUSION

Although self-reported quality of life scores of children were generally good, parents reported that their children gained weight, tendency to sleep and internet use increased during the pandemic.

The impact of summer vacation on children's obesogenic behaviors and body mass index: a natural experiment

BACKGROUND

Children's BMI gain accelerates during summer. The Structured Days Hypothesis posits that the lack of the school day during summer vacation negatively impacts children's obesogenic behaviors (i.e., physical activity, screen time, diet, sleep). This natural experiment examined the impact of summer vacation on children's obesogenic behaviors and body mass index (BMI).

METHODS

Elementary-aged children (n = 285, 5-12 years, 48.7% male, 57.4% African American) attending a year-round (n = 97) and two match-paired traditional schools (n = 188) in the United States participated in this study. Rather than taking a long break from school during the summer like traditional schools, year-round schools take shorter and more frequent breaks from school. This difference in school calendars allowed for obesogenic behaviors to be collected during three conditions: Condition 1) all children attend school, Condition 2) year-round children attend school while traditional children were on summer vacation, and Condition 3) summer vacation for all children. Changes in BMI z-score were collected for the corresponding school years and summers. Multi-level mixed effects regressions estimated obesogenic behaviors and monthly zBMI changes. It was hypothesized that children would experience unhealthy changes in obesogenic behaviors when entering summer vacation because the absence of the school day (i.e., Condition 1 vs. 2 for traditional school children and 2 vs. 3 for year-round school children).

RESULTS

From Condition 1 to 2 traditional school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 24.2, 95CI = 10.2, 38.2), screen time minutes (∆ = 33.7, 95CI = 17.2, 50.3), sleep midpoint time (∆ = 73:43, 95CI = 65:33, 81:53), and sleep efficiency percentage (-∆ = 0.7, 95CI = -1.1, - 0.3) when compared to year-round school children. Alternatively, from Condition 2 to 3 year-round school children experienced greater unhealthy changes in daily minutes sedentary (∆ = 54.5, 95CI = 38.0, 70.9), light physical activity minutes (∆ = - 42.2, 95CI = -56.2, - 28.3) MVPA minutes (∆ = - 11.4, 95CI = -3.7, - 19.1), screen time minutes (∆ = 46.5, 95CI = 30.0, 63.0), and sleep midpoint time (∆ = 95:54, 95CI = 85:26, 106:22) when compared to traditional school children. Monthly zBMI gain accelerated during summer for traditional (∆ = 0.033 95CI = 0.019, 0.047) but not year-round school children (∆ = 0.004, 95CI = -0.014, 0.023).

CONCLUSIONS

This study suggests that the lack of the school day during summer vacation negatively impacts sedentary behaviors, sleep timing, and screen time. Changes in sedentary behaviors, screen time, and sleep midpoint may contribute to accelerated summer BMI gain. Providing structured programming during summer vacation may positively impact these behaviors, and in turn, mitigate accelerated summer BMI gain.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03397940 . Registered January 12th 2018.

Food Insecurity, the Home Food Environment, and Parent Feeding Practices in the Era of COVID-19

OBJECTIVE

This study aimed to describe changes in families' home food environment and parent feeding practices, from before to during the coronavirus disease 2019 (COVID-19) pandemic, and examine whether changes differed by food security status.

METHODS

Parents (N = 584) in the US completed a single online survey, reporting on food security, home food availability, and feeding practices both retrospectively (considering before COVID-19) and currently (during COVID-19). χ² and univariate regressions examined associations by food security status.

RESULTS

The percent of families reporting very low food security increased by 20% from before to during COVID-19 (P < 0.01). About one-third of families increased the amount of high-calorie snack foods, desserts/sweets, and fresh foods in their home; 47% increased nonperishable processed foods. Concern about child overweight increased during COVID-19, with a greater increase for food-insecure versus food-secure parents (P < 0.01). Use of restriction, pressure to eat, and monitoring increased, with a greater increase in pressure to eat for parents with food insecurity compared with food-secure parents (P < 0.05).

CONCLUSIONS

During COVID-19, increases in very low food security and changes in the home food environment and parent feeding practices were observed. Results highlight the need to address negative impacts of COVID-19 on children's obesity risk, particularly among those facing health disparities.

Effects of COVID-19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study

OBJECTIVE

The aim of this study was to test the hypothesis that youths with obesity, when removed from structured school activities and confined to their homes during the coronavirus disease 2019 pandemic, will display unfavorable trends in lifestyle behaviors.

METHODS

The sample included 41 children and adolescents with obesity participating in a longitudinal observational study located in Verona, Italy. Lifestyle information including diet, activity, and sleep behaviors was collected at baseline and 3 weeks into the national lockdown during which home confinement was mandatory. Changes in outcomes over the two study time points were evaluated for significance using paired t tests.

RESULTS

There were no changes in reported vegetable intake; fruit intake increased (P = 0.055) during the lockdown. By contrast, potato chip, red meat, and sugary drink intakes increased significantly during the lockdown (P value range, 0.005 to < 0.001). Time spent in sports activities decreased by 2.30 (SD 4.60) h/wk (P = 0.003), and sleep time increased by 0.65 (SD 1.29) h/d (P = 0.003). Screen time increased by 4.85 (SD 2.40) h/d (P < 0.001).

CONCLUSIONS

Recognizing these adverse collateral effects of the coronavirus disease 2019 pandemic lockdown is critical in avoiding depreciation of weight control efforts among youths afflicted with excess adiposity. Depending on duration, these untoward lockdown effects may have a lasting impact on a child's or adolescent's adult adiposity level.

Qualitative Research in Phoenix, AZ, Exploring Support for Public-Private Partnerships to Expand the Reach of the Fresh Fruit and Vegetable Program

BACKGROUND

Fruit and vegetable (F/V) consumption among school-aged children falls short of current recommendations. The development of public-private partnerships (PPPs) has been suggested as an effective approach to address a number of public health concerns, including inadequate F/V consumption. The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) provides F/V as snacks at least twice per week in low-income elementary schools. In addition to increasing F/V consumption behaviors at school, children participating in the FFVP make more requests for F/V in grocery stores and at home, suggesting the impact of the program extends beyond school settings.

OBJECTIVE

This study explored the potential for establishing successful PPPs between schools and food retailers to promote the sales of F/V in low-income communities.

DESIGN

Semi-structured interviews and focus groups were conducted with participants from 4 groups of stakeholders.

PARTICIPANTS/SETTING

Grocery store and produce managers from 10 grocery stores, FFVP personnel from 5 school districts and 12 schools, and parents of children attending 3 different FFVP-participating schools, all in the Phoenix, AZ, metropolitan area participated in interviews and focus groups.

STATISTICAL ANALYSES PERFORMED

Data were analyzed using a directed content analysis approach to examine benefits, barriers, and strategies for developing a PPP.

RESULTS

Key perceived benefits of creating a PPP included the potential to increase store sales, to enhance public relations with the community, and to extend the impact of the FFVP to settings outside of schools. Barriers included offering expensive produce through the FFVP and the potential lack of communication among partners. Strategies for developing a PPP included using seasonal produce and having clear instructions for teachers and staff. Parents reported their children requesting more F/V as a result of FFVP participation.

CONCLUSIONS

Stakeholders support forming PPPs. Partnerships between FFVP schools and retailers can be mutually beneficial and have a positive impact on children and their families.

The impact of summer programming on the obesogenic behaviors of children: behavioral outcomes from a quasi-experimental pilot trial

BACKGROUND

Children from low-income families experience accelerated BMI gain and learning loss during summer. Healthy Summer Learners (HSL) addresses accelerated BMI gain and academic learning loss during summer by providing academic- and health-focused programming. This manuscript reports the effects of HSL on underlying obesogenic behaviors (i.e., physical activity, screen time, sleep, diet) that lead to accelerated summer BMI gain, a necessary first step to informing a future randomized controlled trial of HSL.

METHODS

In the summer of 2018 and 2019 using a quasi-experimental study design, 180 children (90 per summer, 7.9 years [SD = 1.0], 94% non-Hispanic Black, 40% male) at two schools (i.e., one per summer) who were struggling academically (25-75% on a standardized reading test) were provided a free, school-based 6-week health- and academic-focused summer program (i.e., HSL, n = 60), a 4- to 6-week academic-focused summer program (i.e., 21st Century Summer Learning program (21C), n = 60), or no summer program (n = 60). Children wore the Fitbit Charge 2™ over a 10-week period during the summers (June-Aug) of 2018-2019. Differences within (within child days attend vs. not attend) and between (differences between groups attend vs. not attend) were evaluated using mixed effects linear regression.

RESULTS

Regression estimates indicated that, on days attending, HSL children experienced a greater reduction in sedentary minutes (- 58.6 [95% CI = - 92.7, - 24.4]) and a greater increase in moderate-to-vigorous physical activity (MVPA) (36.2 [95% CI = 25.1, 47.3]) and steps (2799.2 [95% CI = 2114.2, 3484.2]) compared to 21C children. However, both HSL and 21C children were more active (i.e., greater MVPA, total steps) and less sedentary (i.e., less sedentary minutes and total screen time) and displayed better sleeping patterns (i.e., earlier and less variability in sleep onset and offset) on days they attended than children in the control.

CONCLUSIONS

HSL produced greater changes in physical activity than 21C. However, attendance at either HSL or 21C leads to more healthy obesogenic behaviors. Based on the behavioral data in this pilot study, a larger trial may be warranted. These results must be considered along with the pending primary outcomes (i.e., academics and BMI z-score) of the HSL pilot to determine if a full-scale trial is warranted.

TRIAL REGISTRATION

NIH-NCT03321071. Registered 25 October 2017.

Nutritional problems in childhood and adolescence: a narrative review of identified disparities

To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.