Changes in body mass index (BMI) in an inner city at risk pediatric population during the COVID 19 pandemic

Background: The prolonged course of the COVID 19 pandemic has numerous social, economic and health consequences. Few studies so far have evaluated the metabolic changes in pediatric populations throughout the pandemic. School provides structure and routine for children and regulates mealtimes, physical activity and sleep schedule, all of which are lifestyle factors that can contribute to obesity if poorly regulated. As per the New Jersey Childhood Obesity Study, 44.2% of children in the city of Newark, are overweight and obese, 25.2% of whom are obese and 18.3% are very obese. The Newark population in 2018 saw 2,069 violent crimes per 100,000 people, approximately twice the national average. As a result of unsafe neighborhoods, most of the physical activity for children in Newark is limited to sports or physical activity organized by institutions, primarily its school system. The switch from in-person to online school during the COVID pandemic along with, increases in screen time due to online classes and homework, as well as increased social activity through video games and virtual outlets can lead to disrupted sleep cycles and increased BMI. The lack of structure and routine in combination with increased screen time, increased snacking and consumption of processed food, as well as limited access to fresh food may have had detrimental metabolic effects particularly on an already high risk urban pediatric population. Objective: To quantify the changes in BMI among overweight and obese children and adolescents before and after the pandemic-associated lockdown. Study Design/Methods: A retrospective chart review for ages 2 to 19 years with BMI > 85th %tile seen in outpatient pediatric clinic of University Hospital located in Newark from March 2019 to April 2021 (n=84) was performed. The executive order to close schools issued on March 16th, 2020 was considered as start date of the pandemic. Visits within 9 months prior to 03/16/20 were counted as pre-pandemic. On January 2, 2021, organized sports were allowed to resume in public schools and this date was used to set the post-pandemic mark. Visits from 1/2/2021 until 4/2021 were counted as post-pandemic. Comparison of pre and post BMI was performed via paired sample t-tests with significance as p<0.05. Average pre and post pandemic BMI was compared between ethnic groups and gender using ANOVA. Results: There was a statistically significant increase in BMI from pre-pandemic visits to post-pandemic (p<0.05) across ages 5-19: ages 5-8 (n=17;average increase = 1.88;p = 0.003);ages 9-13 (n=47;average BMI increase = 2.1;p<0.0001);ages 14-19 (n=14;average BMI increase = 1.54;p =0.01). For ages 2-4 there was an increase in BMI, however it did not reach statistical significance (n=4;BMI increase = 1.69;p =0.051). There was an equal distribution of females (n=40) and males (n=44). There was no significant difference in BMI among male and female subjects pre and post pandemic. The average pre-pandemic BMI in females was 28.29 and in males was 26.74 (p=0.258). Similarly, the average post-pandemic BMI in females was 30.01 and in males was 28.86 (p=0.422). Majority of the subjects were primarily Hispanic (n=45) and African American (n=29). There were 10 subjects classified as other or unknown. There was no statistically significant difference in pre-pandemic BMI between Hispanic (mean = 27.01) and African-American (mean= 28.32) children (p=0.377) but there was a statistically significant difference in post pandemic BMI between Hispanic (mean = 28.34), and African American (mean =31.47) children (p 0.041). Conclusions: We found a statistically significant increase in BMI across all age cohorts in our pediatric population except the 2-4-year age group. The BMI increase was significantly higher among the African American as compared to the Hispanic children. These results may be attributed to the negative effects of school shut-downs and shelter-in-place orders, increased screen times, lack of physical activity and increased consumption of processed foods. The adverse effects of the COVID-19 pandemic on childhood obesity, not only demand maximum efforts to support families and children by appropriate policy changes but also increase awareness among physicians to counsel families and screen for metabolic dysfunction.