Background: Societal restrictions during 2020 due to Coronavirus Disease 2019 (COVID-19), such as the closure of schools, childcare centers, and community programs, were implemented to prevent the spread of the disease and to protect the health and well-being of the population. These mitigation efforts, while effective in reducing COVID-19, inadvertently removed youth from structured settings, outside the home, where they spend a majority of their waking hours (e.g., schools, programs, day camps). The pandemic-related mitigation strategies can be viewed as one of the largest natural experiments examining the impact of structured settings outside the home on overweight/obesity (OWOB) and related obesogenic behaviors (i.e., sleep, physical activity, diet, and screen/media time). 

Methods: The purpose of this presentation is to 1) summarize the evidence published to-date on OWOB trends and obesogenic behaviors before and during COVID-19, and 2) provide recommendations and strategies to combat the negative consequences of COVID-19 on childhood obesity.

Results: More than 30 studies representing over 1,000,000 unique children from 13 different countries have reported significant increases in weight related outcomes (e.g., increases in body mass index (BMI), zBMI, %OWOB) during pandemic months compared to months or years prior to the COVID-19 pandemic. There is also a large body of evidence reporting children’s obesogenic behaviors were less favorable during the pandemic, such as lower physical activity levels, dysregulated sleep patterns, and increased dietary consumption and screen/media time.

Conclusions: Evidence from recent large-scale multi-national studies demonstrate that compared to the years prior to 2020, the prevalence of OWOB among children and youth accelerated during the pandemic unlike any other period over the last 3 decades. Although the development of OWOB is multiecological, the common denominator many children faced during the pandemic restriction efforts was the immediate interruption to their ‘typical’ day-to-day structure and routines, as schools and school-like environments closed for public access. The COVID-19 pandemic demonstrated to researchers and public health practitioners the importance of regular access to structured settings outside the home and the association with OWOB and related obesogenic behaviors of children.

Purpose:                Households with a child with a disability experience greater disadvantages in meeting family nutritional needs due to the complexities of income, safety, resources, and stigma in low resource areas. This presentation’s purpose is to describe differences in household dietary diversity (HDDS) in Lusaka, Zambia, between comparable households with a child with a disability compared to those without a child with a disability in the context of the COVID-19 pandemic.

Methods:                Data were collected with surveys in three low-income compounds in Lusaka, Zambia, September 2021. Families with a child with a disability enrolled in Kusamala+, a community-based program to decrease stigma and increase quality of life (n = 444) and convenience sampling of adults living in the same area who do not have a child with a disability (n = 1,027) provided basic demographic information, HDDS, and the extent to which access food changed during the COVID-19 pandemic. Data were collected using REDCap Mobile App and analyzed using Stata v15. Descriptive statistics compared HDDS between families with and without a child with a disability.

Results/Findings:     The primary caregiver among families with children with disabilities were significantly older than community members (39.3 v 37.9 years, t= -1.97,p = 0.05) and more likely to be female (95% v 61.2%, p< 0.001). Mean HDDS for the households with a family with a child with a disability was 4.8 (SD=2.1) compared to 6.1 (SD=2.2) among community members (t=11.1, p<0.001). The child HDDS score for households with children with disabilities was 2.6 (SD=1.4) compared to community member households at 3.7 (SD=1.6) (t = 12.4, p< 0.001). A higher proportion of families with children with disabilities indicated that COVID-19 pandemic has impacted their ability to get food to a great extent (32.0% versus 22.0% community members; Chi²=22.4, p<0.001).

Conclusions:            Families with children with disabilities face multiple barriers to health and livelihood, including lower levels of household dietary diversity. The COVID-19 pandemic has differentially impacted families with children with disabilities compared to community members living in the same low-income areas. National policy must assure equitable distribution of resources for the most vulnerable, and often hidden, community members. 

Purpose: Most of the available evidence on the effects of the COVID-19 pandemic on child movement behaviors is from cross sectional studies using self-report measures. This study aimed to identify change trajectories for objectively-assessed physical activity and sedentary time among an ethnically and socioeconomically diverse sample of school-age children from Central Texas, US, during COVID-19. Additionally, a socio-ecological approach was used to identify factors associated with belonging to change trajectory groups.

Methods: Pre- (Sept. 2019 – Feb. 2020) and during- (Oct. 2020 – March 2021) COVID-19 data were collected for a cohort of school-age children (8 – 11 years) enrolled in the Safe Travel Environment Evaluation in Texas Schools (STREETS) study. Daily time spent in moderate- to vigorous-intensity physical activity (MVPA) and sedentary time were assessed using GT3X-wBT Actigraph accelerometers. Parent surveys were used to assess the socio-ecological characteristics of the children. Latent class linear mixed models were used to identify change trajectories of MVPA and sedentary time. Logistic regression models were used to assess the association between socio-ecological characteristics with physical activity and sedentary time change trajectory groups.

Results: Among children with valid data for both time points (n=157), two trajectory groups were identified for MVPA (‘decreasing’ and ‘maintaining’), with the majority (82.8%) being in the decreasing group. Three trajectory groups were identified for sedentary time (‘decreasing, ‘moderately-increasing, and ‘steeply-increasing’), with most children (77.7%) being in the ‘moderately increasing’ group. Girls had significantly lower odds of being in the ‘maintaining MVPA’ group than boys (OR=0.23, 95% CI=0.08, 0.58). Children living in neighborhoods with high perceived social cohesion had significantly higher odds of being in the ‘maintaining MVPA’ group (OR=1.16, 95% CI= 1.01, 1.36), while those in neighborhoods with low social cohesion had higher odds of being in the ‘decrease sedentary time’ group (OR=0.84, 95% CI=0.72, 0.97).

Conclusions: This study provides objective evidence of declines in physical activity and increases in sedentary time among most school-age children during COVID-19 in a socioeconomically and ethnically diverse US sample, especially among girls. These findings highlight the need to counteract the short-term negative changes in movement behaviors in response to COVID-19 among children.