Author Affiliations
Abstract
Introduction: This systematic review will explore the impact of coronavirus disease (COVID-19) on children in terms of lifestyle changes that could have led to increased obesity, describe effects on health brought about by these changes, and identify interventions undertaken during this period to reduce the negative impact of childhood obesity.
Methods: A systematic review was conducted according to the rules of preferred reporting items for systematic reviews and meta-analysis (PRISMA), obtaining articles for review from several databases. Descriptive studies involving obesity in children during the COVID-19 pandemic period were identified.
Results: Out of 4350 articles identified, 20 were selected for data extraction and analysis. Obesity has been on the rise during the pandemic due to several lifestyle changes such as a decrease in physical activity, an increase in screen time, changes in sleep patterns, and changes in dietary behaviors. The increased risk of obesity is accompanied by mental health problems such as anxiety and stress, and the chances of contracting non-communicable diseases.
Conclusion: The lifestyle modifications assessed across the studies will help to implement future programs to reduce severity and counteract the rise in obesity in children during the COVID-19 pandemic, ensuring a peaceful transition to the new normal.
Keywords
Coronavirus disease, Obesity, Children, Lifestyle changes, Pandemic.
Introduction
The COVID-19 pandemic has had far-reaching health, social, and economic implications. The pandemic introduced a slew of measures aimed at reducing the spread of the disease. Measures such as lockdowns in various countries and the closure of public facilities and amenities like schools, parks, swimming pools, theaters, and shopping malls have impacted the health of children in various ways.
According to Zemrani et al.[1] COVID-19 has indirectly affected the lives of children through “collateral” damage, which manifests as an increase in pediatric obesity. Several factors have been stated to play a crucial part in this rise in obesity among children. With the closures of schools, children lost access to nutritious foods, social interactions, and mandatory physical activity, as well as other social networks and familiar routines.[2] The rise in obesity can lead to consequences for the health of children over the long run. Comprehensive studies listing lifestyle changes and their subsequent effects are limited. This systematic review will explore the impact of COVID-19 on children in terms of lifestyle changes that could have led to increased obesity. Our study will also describe the effects of such lifestyle changes on health and identify interventions undertaken during this period to reduce the negative impact of childhood obesity.
Methodology
Design: The study design used was a systematic review of descriptive studies, following the rules set by the PRISMA.
Search strategy: The first step was to find articles on the topic of interest from several databases using keywords. There were three main databases used: PubMed, Google Scholar and Elsevier’s ScienceDirect. The main keywords used were “obesity”, “COVID-19”, “children” along with variations such as “coronavirus”, “lockdown” and “adolescents” to ensure broad search outputs. These keywords were paired with the relevant logical operators, e.g. AND and OR. The articles of interest were limited to the time period January 2020 – February 2022.
Selection process: The articles selected for review were peer-reviewed articles published in English. Descriptive articles were only used for the purpose of this review.
The inclusion criteria were:
- Articles mentioned the effects of obesity on the health of children during the COVID-19 pandemic.
- Articles mentioned lifestyle changes leading to an increase in obesity in children during the COVID-19 pandemic.
- Articles mentioned the interventions taken to reduce/ counteract increase in childhood obesity during the COVID-19 pandemic.
The exclusion criteria were:
- Articles mentioned children with
For the identification, screening, and eligibility stages, three independent reviewers worked to retrieve the articles from the database. Discrepancies, if any, were resolved through discussion among reviewers.
Risk of bias assessment: The risk of bias will be assessed using the critical appraisal skills programme (CASP) checklist for cohort studies and the Joanna Briggs Institute (JBI) tool for cross-sectional studies.[4]
Results
In the identification phase, 4350 articles were retrieved from the databases. An additional 500 articles were identified from sources other than the main databases used (Multidisciplinary digital publishing institute (MDPI) database, National Center for biotechnology information (NCBI)). After assessing duplicates, 950 articles were removed. In the screening phase, 3900 articles were evaluated using filters such as language, study design, year of publication, and title. 3790 records were removed, and the remaining 110 articles were reviewed for eligibility using the set criteria.
A final output of 20 articles was included for data extraction. Articles were excluded from data extraction due to several reasons such as mixed methods study design, non-specificity of COVID-19 lockdown measures, inclusion of older age groups in the study, and so on. Figure 1 presents a flow diagram of the selection process for articles included in this review. Table 1 presents the evidence collected from the articles. Figure 2 presents a summary of the lifestyle changes that were mentioned in the articles.
Figure 1: Flow diagram
Figure 2: Distribution of lifestyle changes across studies
Physical activity (PA): It was one of the most prominent lifestyle changes affecting children during the COVID-19 pandemic. PA includes sports and non-sports activities like walking, jogging, calisthenics, and so on. Out of 20 articles reviewed, 19 articles mention the association of PA with the lifestyle of children, steering them towards obesity. Participation in PA decreased among children during the pandemic. In 4 studies, physical inactivity, which is no participation in activities of exercise/sports at any time, was found.
Screen time (ST): ST consists of viewing of screens such as televisions or any electronic devices (mobile phones, tablets, laptops, etc). Out of 20 studies, ST was mentioned in 11 studies. An increase in ST was remarked as a lifestyle change, which led to an increase in obesity among children. In all studies, this increase included the usage of online correspondence or distance learning tools. In some studies, consumption of snacks would happen in conjunction with screen viewing, leading to an increased risk of obesity.
Sleep pattern (SP): SP consists of an increase or decrease in the average number of hours of sleep required by children. The average time of sleep differed in each study due to the region’s definitions. However, there was a mixed trend of an increase in the SP or a decrease in SP among the articles, wherein 7 studies showed an increase in SP and 4 studies showed a decrease in SP, respectively. This lifestyle change has also been associated with an increase in obesity and is linked to ST as well.
Dietary changes: Dietary changes are mentioned in 12 studies and differ depending on the country or region in which the study took place. A common trend among these changes included the increased intake of sugary foods and drinks, as well as calorie-dense foods. There was a decrease in the amount of fast food consumed. Other unfavorable changes leading to an increase in obesity are the rise in amounts of red meat, desserts, post-meal snacks, pastas, and so on.
|
Study details |
Target group |
Method |
Lifestyle changes listed |
Result |
Summary of findings |
| Yang S et al.[5] | A total of 10 082 youths
responded to the survey, with 71.7% being females, 4.7% being minority students, 63.2% living in non-urban areas. There were no significant differences in age and ethnic constitution between males and females |
An online questionnaire was
initially distributed among several WeChat and Tencent QQ groups of educators at three education levels (high school, college, and graduate school). At least two educators in each province of China had shared the questionnaire with their surrounding students through WeChat and Tencent QQ groups and/or moments. Those who had completed the questionnaire was also encouraged to forward it to others. |
sports activities
decreased, sleep time increased, and screen time increased significantly. |
The mean body mass index of all
participating in youths has significantly increased (21.8-22.6) and in all education subgroups during COVID-19 lockdown. Increases also occurred in the prevalence of overweight/obesity (21.3%-25.1%, P < .001) and obesity (10.5% to 12.9%, P < .001) in overall youths, especially in high school and undergraduate students. Their activity patterns had also significantly changed, including the decreased frequency of engaged in active transport, moderate−/vigorous-intensity housework, leisure-time moderate−/vigorous-intensity physical activity, and leisure-time walking, and the increased sedentary, sleeping, and screen time. |
This study revealed results from COINLICS that the prevalence of overweight/obesity and obesity has significantly increased in overall youths, specifically in high school and undergraduate students. Also, significant changes during COVID-19 lockdown has been observed in patterns of all PA, sedentary, sleeping, and screen use variables, with more youths increasing them sedentary, sleeping, and screen time relative to their counterparts who had decreased their PA frequency. |
| Maltoni G.[6]
|
Parameters of 51 obese | Nutritional Obesity Physical
activity Observational (cross sectional) |
Lockdown due
to COVID-19 pandemic has forced a decrease in physical activity (PA), an increase in sedentary behavior (SB) and a possibly worsening of fat accumulation in already obese subjects |
Mean weight gain during lockdown
was 2.8 ± 3.7 kg (p < 0.001). Weight increase was higher in males than in females (3.8 ± 3.4 kg vs 1.2 ± 3.7 kg, p = 0.02). The hours dedicated to SB increased (+2.9 ± 2.8 h/day; p < 0.001) while the hours of PA decreased (−1.0 ± 1.6 body mass index (BMI) and waist/height ratio increase were hours devoted to SB during lockdown and differences in mild and moderate PA before and after lockdown. |
Obese adolescents
showed a worsening of obesity during lockdown, with males mainly affected, mainly due to a reduced mild PA and increased hours spent in SB. In conclusion, our study confirms that one of the consequences of lockdown in adolescents with obesity is the worsening of BMI and central obesity, mainly due to the reduced mild PA. It appears unfortunately that the most effective method to contain the circulation of the virus is also a very effective method to increase the BMI not only in adults, therefore starting a vicious circle where the number of patients particularly susceptible to severe forms of Covid become more numerous. |
| adolescents were
compared between two visits: within 2 months before 8 March, start of lockdown, and within 40 days after the end of it. |
|||||
| Adıbelli D et al.[7] | all the parents who have children aged 7–13 and using social media, and their children within the country constituted the study population while 597 participants who were accessible and filled the data collection tools constituted the study sample. | Internet-based cross-sectional study was conducted between March 30 and April 20, 2020, in Turkey.
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-Walli’s variance analysis were used to evaluate the data. |
Tendency to sleep.
Tendency to use internet. Buying high process and calorie food The amount of time spent to screen is increased |
pandemic: 41.5% of 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-dimensional 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, the children of the parents who feel fear/anxiety about coronavirus affected their mental health were found to be lower (p < 0.05). |
This article says about parent reporters about their child changes, quality of life |
| Sol Ventura P et al.[8] | children younger than 17 years who lived in Catalonia during the nationwide implementation of lockdown in Spain. | The survey questionnaire was designed by pediatricians from Hospital HM Nans, HM Hospitals, and approved by the IRB Committee. The questionnaire consisted of three sections adapted from standardized questionnaires that aimed to examine: (i) adherence to mediterranean diet (AMD) after the implementation of lockdown.
(ii) sleeping habits after the implementation of lockdown; and (iii) PA frequency and time spent in front of screens (TV or any other electronic devices) before and after the implementation of lockdown. Information on AMD and sleeping habits was only asked after the implementation of lockdown to reduce recall bias and to avoid extensive questionnarie.
|
Delays in bedtime were frequent, especially among children older than 6 years of age, while inadequate sleeping hours were more frequent among children aged 6–10 years.
No differences between gender were found in AMD or sleeping habits. Boys showed a greater risk of the inadequate frequency of PA and use of TV-ED after lockdown. |
3464 children included, 53.2% showed optimal AMD; 79.2% referred to delayed bedtime; and 16.3% were suspected of sleeping disorders after the implementation of lockdown. Delays in bedtime was more frequent among children older than 6 years, and inadequate sleeping hours among those younger than 11 years. There were no gender differences in AMD or sleeping habits. The odds of inadequate frequency of PA and TV-ED use were greater after lockdown, with a greater risk for TV-ED use. Boys were at greater risk of inadequate PA frequency and TV-ED use. Odds ratio of inadequate PA was greater at older ages. Lockdown could influence changes in children’s habits that could lead to risk factors for
non-communicable diseases. |
This article is about nutrition and diet changes
, lifestyle changes, sleep disorder, risk factor |
| Pietrobelli A et al.[9]
|
41 children and adolescents with obesity participating in a longitudinal observational study located in Verona, Italy.
The 41 participants included 22 males and 19 females with a mean baseline age of 13.0±3.1 (range, 6–18) years |
Lifestyle information including diet, activity, and sleep behaviors were collected at baseline and three 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. |
Changes in diet
Changes in activity Changes in sleep pattern. Time to sport activity decreas . Intake of red meat ,sugary drink,chips increase |
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 (X±SD) by 2.30±4.60 hours/week (p=0.003) and sleep time increased by 0.65±1.29 hours/day (p=0.003). Screen time increased by 4.85±2.40 hours/day (p<0.001). |
This article study the hypothesis of youth obesity in 2019 pandemic.and liestyle behaviours. |
|
Dunton GF et al.[10] |
Parents and legal guardians of U.S. children (ages 5–13) were recruited through convenience sampling
and compared an online survey between April 25–May 16, 2020. |
Measures included an assessment of their child’s previous PA and SB by indicating time spent in 11 common types of PA and 12 common types of SB for children. Parents also reported perceived changes in levels of PA and SB between the pre-COVID-19 (February 2020) and early-COVID-19
(April–May 2020) periods. Additionally, parents reported locations (e.g., home/garage, parks/trails, gyms/fitness centers) where their children had performed PA and their children’s use of remote/streaming services for PA. |
Greater decrease in physical activity. | From parent reports, children (N = 211) (53% female, 13%
Hispanic, Mage = 8.73 [SD = 2.58] years) represented 35 states and the District of Columbia. The most common physical activities during The early-COVID-19 period were free play/unstructured activity (e.g., running around, tag) (90% of children) and going for a walk (55% of children). Children engaged in about 90 min of school-related sitting and over 8 h of leisure-related sitting a day. Parents of older children (ages 9–13) vs. younger children (ages 5–8) perceived greater decreases in PA and greater increases in SB from the pre- to early-COVID-19 periods. Children were more likely to perform PA at home indoors or on neighborhood streets during the early- vs. pre-COVID-19 periods. |
This article says about children behavior, location, online studies, parents thinking, physical activity, sedentary behaviors |
|
Androutsos O et al.[11] |
online survey among 397 children/adolescents and their parents across 63 municipalities in Greece
All data was collected between 30 April and 24 May 2020. 397 days of children/adolescents (51.4% boys) with an average age of 7.8 (4.1) years |
The COV-EAT study adhered to the Declaration of Helsinki and the conventions of the Council of Europe on human rights and Biomedicine. The study protocol was approved by the Ethical Committee of the Department of Physical Education and Sport Science in the School of Physical Education, Sport Science, and Dietetics, University of Thessaly, and registered at clinicaltrials.org (NCT04437121). All parents electronically signed an informed consent form prior to their participation in the study. Only one child per family was included in this study. | There is limited information regarding the effects on youth.
The COV-EAT study aimed to report changes in children’s and adolescents |
children/adolescents tended to sleep longer than 10 h/night, and fewer slept less than 8 h/night than before the lockdown.
Similarly, the children/adolescents who spent more than 3 h/day in front of a screen were more during home isolation. 66.9% of the parents reported that their child’s physical activity level decreased during the lockdown, and that their child’s body weight increased 35%. children’s eating behavior, the consumption of fruits and fresh fruit juices, vegetables, dairy products, pasta, sweets, total snacks, and breakfast significantly increased (p < 0.05). In contrast, fast-food consumption significantly decreased (p < 0.001). |
Article says about the the coronavirus disease 2019 (COVID-19) lockdown-imposed changes in adults’ lifestyle behaviors |
| Knebusch V et al.[12] | children and adolescents, aged between 8 and 18, with overweight or obesity in follow up at the Pediatric Endocrinology clinic of our hospital. | 3rd June 2020 to 28 th June 2020
The study was conducted at the Pediatric Endocrinology Department of a third-level University Hospital in Rome, including children and adolescents with overweight and obesity. Personal, anthropometrics data and other information about physical activity, eating habits and psychological aspects were collected. |
Afterward, they filled out questionnaires and were weighed and measured.
While watching, the children could freely eat palatable food. |
64 participants, of which 33 (51.6%) were patients with overweight and 31 (48.4%) with obesity. showed that patients whose BMI increased were more sedentary (p=0.024 for physical activity and p=0.005 for hours spent with videogames) during the pandemic. As for eating habits, more than half of the subjects (67.2%) had increased the consumption of homemade desserts, bread, pasta and pizza, and a worse diet was found in patients with BMI gain (p=0.000). Regarding the psychic condition the 80% of patients reported psychological discomfort, and patients with an increase in BMI had episodes of emotional feeding more frequently (p=0.016). | |
| Kang Z et al.[13] | 226 children between the ages of 4-14 years without comorbidities | 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.” |
Lack of physical activity has led to increased obesity.
Vitamin D deficiency has affected school age children due to staying at home orders with little to no exposure to sunlight. |
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 norm weight 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). |
|
| Yang D et al.[14] | A total of 6047 junior high school students participated in physical examinations and questionnaire surveys for 2 years | 6047 adolescents aged 11–16 years by health professionals in Shanghai,
China, before the COVID-19 pandemic (September–November of 2019) and 1 year after the outbreak of the COVID-19 pandemic (September–November of 2020). Paired urn:x-wiley:20476302: media: ijpo12874:ijpo12874-math-000 |
Proportion of subjects that watched television for 2 hours or more and those who used mobile electronic devices were increased during the pandemic. Physical | 1 year after the outbreak of the COVID-19 pandemic, 14.2% to 15.4% (p < 0.01), mainly because of the increase in boys. And the average BMI increased from 20.3 to 21.2 kg/m2 (p < 0.01). Their lifestyle behaviors have also significantly changed. The mobile screen time increased from 0.25–1.50 h/day to
0.33–2.00 h/day (p < 0.01). MVPA for ≥60 min/day on all 7 days during the past week dropped |
The BMI and obesity prevalence of Chinese adolescents increased, mainly because of the increase in boys.
Obesity-related lifestyle behaviors have also changed.
|
| Hu J et al.[15] | Children and adolescents aged 6 to 17 years in Changsha, China | Health Promotion Program for Children and Adolescents (HPPCA), which is a prospective cross-sectional and school-based study, BMI assessed in seven consecutive years (2014 to 2020) among children and adolescents aged 6 to 17 years in Changshu city was extracted. The standardized BMI z scores (zBMI) and prevalence of obesity between 2020 (after COVID-19 home confinement) and the previous 6 years were compared among age-specific subgroups and between sexes. | Due to the pandemic, student sleep was irregular, indoor and sedentary activities increased, and sports/outdoor activities have decreased.
There was also an increase intake of snacking, sugary drinks, and meals |
The mean number of participants per year was 29,648. The overall mean zBMI drastically increased from 0.29 in 2019 to 0.45 in 2020, resulting in a rise of 0.16 (95% CI: 0.14-0.18); the prevalence of obesity substantially elevated to 12.77% in 2020 (versus 10.38% in 2017), with an acceleration of 2.39% (95% CI: 1.88%-2.90%). Of
note, these increases were more likely to be observed in boys and those 6 to 11 years old. |
COVID-19
Confinement may aggravate the childhood obesity epidemic as children may be more sensitive to environmental changes. |
| Papadaki S et al.[16] | aged 12–16 years old from secondary schools around Athens | The KIDSCREEN-27
questionnaire for children and adolescents, the KIDMED test, the Godin and Shephard Leisure Time Physical Activity Questionnaire and the Family Affluence Scale III, were used for the statistical analysis. T-tests, Kruskal Wallis, Chi-square, Anova tests and multiple regression analyses were employed. |
higher physical activity, higher family affluence, more night sleep duration, more screen time for adolescents | Econometric analysis reveals that adolescents’ health related quality of life is higher among boys, adolescents who live with both parents tend to sleep more during night and do not spend many hours on screen viewing. Also, adolescents with higher family affluence level, being physically active and with a high adherence to the mediterranean diet have higher health related quality of life. | Lockdown changed the adolescent’s habits, also correlating these habits to the overall health quality of life. |
| Kim et al.[17] | pediatric patients with obesity aged between 6- and 18-year-old | between December 2019 and May 2020.
clinical data including sex, age, body weight, height, and BMI were collected before and after school closing. BMI was calculated as weight/height2 (kg/m2). Z-scores for body weight and BMI were calculated based on the 2017 Korean National Growth Charts for children and adolescents. Data at each visit to the outpatient clinic were collected retrospectively from electronic charts and laboratory results, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting glucose, uric acid, cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and HbA1c. We compared data between pre-school closing and during school closing and also according to the presence of NAFLD. |
homes, physical activity, dietary habits
increases in body weight, BMI, metabolic disease, such as AST, ALT, triglyceride, and LDL |
Comparing the variables between pre-school closing period and school closing period in patients suffering from obesity revealed significant differences in variables related to metabolism such as body weight z-score, body mass index z-score, liver enzymes and lipid profile. We further evaluated the metabolic factors related to obesity. When comparing patients with or without nonalcoholic fatty liver disease (NAFLD), only hemoglobin A1c (HbA1c) was the only difference between the two time points (p < 0.05). We found that reduced physical activity due to school closing during COVID-19 pandemic exacerbated obesity among children and adolescents and negatively affected the HbA1C increase in NAFLD patients compared to non-NAFLD patients. | school closing in COVID-19 pandemic led to a rapid decline in metabolic homeostasis increases in body weight, BMI, and laboratory such as AST, ALT, triglyceride, and LDL, |
| Kenđel Jovanović G et al.[18] | school children of 5th to 8th grade (aged 10 to 15
years, 639 boys and 731 girls) in Primorsko-Goranska County, Croatia |
questionnaire consisted of four sections:
socio-demographic data; children’s lifestyle habits which include physical activity (sitting, sports, activities during leisure time), |
nutritional status, lifestyle and emotional status, and to assess their nutrition knowledge | BMI-for-age level did not differ regarding gender before (p = 0.344) and during lockdown (p = 0.607), but there was a significant increase in overweight and obesity in boys (Δ2.0% (95% CI 0.9–3.1), 0.9% (95% CI 0.2–1.7), respectively, p = 0.007). In girls, there was a significant increase in overweight 3.3% (95% CI
2.1–4.9), and a decrease in underweight for 4.1% (95% CI 2.8–5.8) (p = 0.001) Before the COVID-19 lockdown boys were significantly more active than girls (p < 0.001), who were in a significantly higher proportion having a low PA level than boys (22.0%, 16.3%, respectively; p = 0.003) During COVID-19 lockdown, both boys and girls significantly reduced their average PA (Δ1468.9 ± 1107.8 MET-min/week; p < 0.001, Δ1234.1 ± 964.8 MET-min/week; p < 0.001 |
physical activity and healthy diet, as well as the responsible use of screen-based media, which are all important for mental and overall health greater risk of noncommunicable disease development |
| Hanbazaza M et al.[19] | aged 6–15 years in Saudi Arabia during the
COVID-19 curfew |
280 children aged 6–15 years in Saudi Arabia during the COVID-19 curfew. The survey included questions on sociodemographic characteristics, anthropometric measures, and health behaviors including eating habits, physical activity, and sedentary behavior. | eat /sleep / watch TV/ use computer/ video games/ exercise. | We observed a significant difference in the body mass index before and after the COVID-19 pandemic (P < 0.001). Children significantly tended to skip breakfast, along with a decreased intake of dairy products and fast food (P < 0.001). Moreover, children were less physically active and significantly tended to be involved in leisure screen-based activities, including watching TV and using computer/games (P < 0.001). | Children significantly tended to skip breakfast, along with a decreased intake of dairy products and fast food, less physically active and significantly tended to be involved in leisure screen-based activities, including watching TV and use of computer/games |
| Allabadi H et al.[20] | 600 adolescents (10-19 years old) The
study was conducted on a sample of 600 adolescents (10-19 years old) in the West Bank, Palestine. Participants were selected for the study using randomly generated phone numbers and snowball sampling. Interviews were conducted by telephone to assess dietary habits, physical activity, screen time, sleeping patterns, sources of stress and socio-demographics |
Telemedicine programs to promote nutritional and physical activity programs, emphasizing at least 60 minutes of daily moderation
intensity activity along with reduction of screen time, restriction of poor micronutrient foods and promotion of specific mealtimes. Mental health programs to guide adolescents and families through stress may be implemented. |
Food intake increased: increase in (31.5%) sugar added drinks like
soda, processed juices etc., (36.7%) fried foods, (46.5%) sweets and sugar added food, fruits. *More in females than males* Decrease in physical activity: (45%) no physical activity, (29.5%) exercise one to three times a week *More in males than females* Increase in screen time: (74.7%) increase in TV and computer/mobile/ tablet {(78.5%) one to three hours per day, 53.0% four hours or more} Increase in sleeping hours: Average hours of sleep: 9. 69.7% reported increase in sleep time. *Females more than males* |
Stress due to
(i) staying at home (ii) Being away from friends (iii) financial situation family relationships There was an increase in weight gain, food intake, consumption of non-nutritional foods, screen time and sleeping hours as well as a decrease or lack of physical activity in comparison to before the lockdown. Weight gain was independently associated with increased food intake. |
With the knowledge of the significant independent associations of weight change with increased food intake, decrease in physical activity, worsening of household financial situation and others, future public health policies may be
planned to contribute to better management of Lifestyle behaviors and dietary changes during future pandemic crises. |
Table 1: Table of evidence
Discussion
The COVID-19 pandemic introduced a slew of measures aimed at reducing the spread of the disease. Preventative measures, including stay-at-home orders, lockdowns in various countries, and the closure of public facilities, have impacted the health of children in a multitude of ways. These strict measures lead to significant changes in the various aspects of the lives of children all around the world. The mandatory requirements of social distancing and closure of schools led to confinement of children in their homes and brought about a shift in daily routines. These shifts have the potential to give rise to weight gain in children, with obesity as an endpoint.[21-24]
Participation in physical activities such as sports or exercise, from as simple as walking to as heavy as running, has decreased significantly due to the limitations brought about by house quarantines. Physical inactivity is becoming more prevalent among the youth. Children have also become engrossed in the use of electronic devices and televisions, leading to an increased amount of time spent in front of screens. As educational institutions wanted to continue operations without halting, the stay-at-home orders were quickly followed by online learning platforms for their students. The downside was the continuous use of electronic devices for students to access said platforms and engage in learning. Children also experienced a disruption in their sleeping patterns, leaning towards an overall increase in the number of hours of sleep during the lockdown period. Finally, dietary changes were noted among all children during the lockdown period, with increased consumption of sugary foods and drinks, red meat, pasta, desserts, fruits, and calorie-dense foods. Vegetables were not favored among youth in their diets, and the number of meals consumed increased as they partake in meals between eating periods. An interesting trend is the overall decrease in fast food consumption, which can be attributed to an inability to access the restaurants.[25,26]
The rise in obesity can lead to consequences for the health of children over the long run. Most studies point to the development of mental stigma, anxiety, and depression among obese children when compared to their peers. Obesity is an independent risk factor for COVID and raises the risk of cardiovascular and respiratory diseases throughout an individual’s life. According to Nogueira-de- Almeida et al.[3] obese children tend to have more severe COVID infections as well as an increased risk for cardiac, respiratory, renal, and immunological symptoms. As of yet, there are limited interventions to tackle the growth of obesity among the pediatric age group during the COVID pandemic. This may have been due to the need to allocate resources for the fight against the pandemic. However, with the administration of the vaccines and the embracing of the new normal, public health programs that impart education and advice on lifestyle modifications must be imparted to the families of children. With the support of their caregivers, the pediatric population can take necessary steps to reduce the trends in weight gain and improve their health even during lockdown periods. Fitness programs that exercise social distancing may be designed to provide a safe environment where children may interact and partake in physical activities to keep their health in check. Future programs, as well as follow-ups on lifestyle modifications, are potential areas of study and development in the fight against obesity.[27]
Limitations of this review stem from the cultural differences among the participants of the various studies. Dietary habits among different cultures are very different, leading to differences in the rate of weight gain among children in these cultures. Some studies employed non-randomized sampling methods, such as snowball sampling, for their data collection due to the social distancing protocols in effect. As such, certain results may be skewed to certain areas in the region assessed in those studies.
Conclusion
The COVID-19 pandemic has affected the lives of families across the globe. The implementation of social distancing and isolation to curb the spread of the virus led to changes in daily living, in turn leading to changes in physical, mental, social, and spiritual health. The lifestyle changes in children in activity, use of electronic devices, eating patterns, and sleep schedules affected them in different ways, with a significant rise in obesity.
Examination of the factors leading to such changes and the generation of new programs like public health education, fitness regimes, and the promotion of healthy living can help combat the worrying situation and bring about a peaceful transition into the new normal.
References
- Zemrani B, Gehri M, Masserey E, Knob C, Pellaton R. A hidden side of the COVID-19 pandemic in children: the double burden of undernutrition and overnutrition. Int J Equity Health. 2021;20(1):44. doi:10.1186/s12939-021-01390-w
PubMed | Crossref | Google Scholar - Browne NT, Snethen JA, Smith Greenberg C, et al. When pandemics collide: The impact of COVID-19 on childhood obesity. J Pediatr Nurs. 2020;56:90–98. doi:10.1016/j.pedn.2020.11.004 PubMed | Crossref | Google Scholar
- Nogueira-de-Almeida CA, Del Ciampo LA, Ferraz IS, et al. COVID-19 and obesity in childhood and adolescence: a clinical review. J Pediatr (Rio J). 2020;96(5):546-558. doi:10.1016/j.jped.2020.07.001 Crossref | Google Scholar
- Azoulay E, Yackobovitch-Gavan M, Yaacov H, et al. Weight Status and Body Composition Dynamics in Children and Adolescents During the COVID-19 Pandemic. Front Pediatr. 2021;9:707773. doi:10.3389/fped.2021.707773
Crossref | Google Scholar - Yang S, Guo B, Ao L, Yang C, Zhang L, Zhou J, Jia P. Obesity and activity patterns before and during COVID-19 lockdown among youths in China. Clin Obes. 2020;10(6):e12416. doi:10.1111/cob.12416 PubMed | Crossref | Google Scholar
- Maltoni G, Zioutas M, Deiana G, Biserni GB, Pession A, Zucchini S. Gender differences in weight gain during lockdown due to COVID-19 pandemic in adolescents with obesity. Nutr Metab Cardiovasc Dis. 2021;31(7):2181-2185. doi:10.1016/j.numecd.2021.03.018 PubMed | Crossref | Google Scholar
- Adıbelli D, Sümen A. The effect of the coronavirus (COVID-19) pandemic on health-related quality of life in children. Child Youth Serv Rev. 2020;119:105595. doi:10.1016/j.childyouth.2020.105595 PubMed | Crossref | Google Scholar
- Sol Ventura P, Ortigoza AF, Castillo Y, et al. Children’s health habits and COVID-19 lockdown in Catalonia: Implications for obesity and non-communicable diseases. Nutrients. 2021;13(5):1657. doi:10.3390/nu13051657
PubMed | Crossref | Google Scholar - Pietrobelli A, Pecoraro L, Ferruzzi A, et al. Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: A longitudinal study. Obesity (Silver Spring). 2020;28(8):1382-1385. doi:10.1002/oby.22861 PubMed | Crossref | Google Scholar
- Dunton GF, Do B, Wang SD. Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S. BMC Public Health. 2020;20(1):1351. doi:10.1186/s12889-020-09429-3
PubMed | Crossref | Google Scholar - Androutsos O, Perperidi M, Georgiou C, Chouliaras G. Lifestyle Changes and Determinants of Children’s and Adolescents’ Body Weight Increase during the First COVID-19 Lockdown in Greece: The COV-EAT Study. Nutrients. 2021;13(3):930. doi:10.3390/nu13030930 PubMed | Crossref | Google Scholar
- Knebusch V, Williams J, Yordi Aguirre I, Weber MW, Rakovac I, Breda J. Effects of the coronavirus disease 2019 pandemic and the policy response on childhood obesity risk factors: Gender and sex differences and recommendations for research. Obes Rev. 2021;22(Suppl 6):e13222. doi:10.1111/obr.13222 PubMed | Crossref | Google Scholar
- Kang Z, Luo S, Gui Y, et al. Obesity is a potential risk factor contributing to clinical manifestations of COVID-19. Int J Obes (Lond). 2020;44(12):2479-2485. doi:10.1038/s41366-020-00677-2 PubMed | Crossref | Google Scholar
- Yang D, Luo C, Feng X, et al. Changes in obesity and lifestyle behaviours during the COVID-19 pandemic in Chinese adolescents: A longitudinal analysis from 2019 to 2020. Pediatr Obes. 2022;17(5):e12874. doi:10.1111/ijpo.12874
PubMed | Crossref | Google Scholar - Hu J, Liu J, Wang J, et al. Unfavorable progression of obesity in children and adolescents due to COVID-19 pandemic: A school-based survey in China. Obesity (Silver Spring). 2021;29(11):1907-1915. doi:10.1002/oby.23276
PubMed | Crossref | Google Scholar - Papadaki S, Carayanni V. Health-related quality of life, Mediterranean diet, physical activity, and socioeconomic factors of Greek adolescents during COVID-19: A cross-sectional study. J Adolesc Health. 2022;70(1):479-491. doi:10.3233/MNM-220008 Crossref | Google Scholar
- Kim ES, Kwon Y, Choe YH, Kim MJ. COVID-19-related school closures aggravate obesity and glucose intolerance in pediatric patients with obesity. Sci Rep. 2021;11(1):5494. doi:10.1038/s41598-021-84766-w
PubMed | Crossref | Google Scholar - Kenđel Jovanović G, Dragaš Zubalj N, Klobučar Majanović S, et al. The outcome of COVID-19 lockdown on changes in body mass index and lifestyle among Croatian schoolchildren: A cross-sectional study. Nutrients. 2021;13(11):3788. doi:10.3390/nu13113788 PubMed | Crossref | Google Scholar
- Hanbazaza M, Wazzan H. Changes in eating habits and lifestyle during COVID-19 curfew in children in Saudi Arabia. Nutr Res Pract. 2021;15(Suppl 1):S41-52. doi:10.4162/nrp.2021.15.S1.S41 PubMed | Crossref | Google Scholar
- Allabadi H, Dabis J, Aghabekian V, Khader A, Khammash U. Impact of COVID-19 lockdown on dietary and lifestyle behaviors among adolescents in Palestine. Dyn Hum Health. 2020;7(2). Impact of Lockdown on Dietary and Lifestyle Pattern of Adolescents
- Al Hourani H, Alkhatib B, Abdullah M. Impact of COVID-19 lockdown on body weight, eating habits, and physical activity of Jordanian children and adolescents. Disaster Med Public Health Prep. 2022;16(5):1855-1863. doi:10.1017/dmp.2021.79 PubMed | Crossref
- Woo S, Yang H, Kim Y, et al. Sedentary time and fast-food consumption associated with weight gain during COVID-19 lockdown in children and adolescents with overweight or obesity. J Korean Med Sci. 2022;37(12):e103. doi:10.3346/jkms.2022.37.e103 PubMed | Crossref | Google Scholar
- Alves JM, Yunker AG, DeFendis A, Xiang AH, Page KA. Associations between Affect, Physical Activity, and Anxiety Among US Children During COVID-19. Preprint. medRxiv. 2020;2020.10.20.20216424. doi:10.1101/2020.10.20.20216424 PubMed | Crossref | Google Scholar
- Qiu N, He H, Qiao L, et al. Sex differences in changes in BMI and blood pressure in Chinese school-aged children during the COVID-19 quarantine. Int J Obes (Lond). 2021;45(9):2132-2136. doi:10.1038/s41366-021-00871-w
Crossref | Google Scholar - Surekha BC, Karanati K, Venkatesan K, Sreelekha BC, Kumar VD. E-learning during COVID-19 pandemic: A surge in childhood obesity. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 2):3058-3064. doi:10.1007/s12070-021-02750-2
PubMed | Crossref | Google Scholar - Androutsos O, Perperidi M, Georgiou C, Chouliaras G. Lifestyle changes and determinants of children’s and adolescents’ body weight increase during the first COVID-19 lockdown in Greece: The COV-EAT study. Nutrients. 2021;13(3):930. doi:10.3390/nu13030930 PubMed | Crossref | Google Scholar
- Child I, Loza A, Doolittle B. Collateral damage from the COVID-19 pandemic: Pediatric obesity. Popul Health Manag. 2022;25(4):573-574. doi:10.1089/pop.2022.0030 PubMed | Crossref | Google Scholar
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Author Information
Corresponding Author:
Kalupatti Varshini Reddeppa
Department of Medicine
Our Lady of Fatima University, Valenzuela, Philippines
Email: 01179257@student.fatima.edu.ph
Co-Authors:
James Jivin Blesson, Afrin Fatima, Praveen Kumar Roopali, Khairnar Darshan Kiran, Jangpangi Ashutosh
Department of Medicine
Our Lady of Fatima University, Valenzuela, Philippines
Authors Contributions
All authors contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles. They were collectively involved in the writing – original draft preparation, and writing – review & editing to refine the manuscript. Additionally, all authors participated in the supervision of the work, ensuring accuracy and completeness. The final manuscript was approved by all named authors for submission to the journal.
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DOI
Cite this Article
Varshini Reddeppa K, James JB, Afrin F, Roopali PK, Darshan Kiran K, Ashutosh J. Rise of Obesity in Children During the COVID-19 Pandemic and its Effects on their Health: A Systematic Literature Review. medtigo J Med. 2025;3(1):e30623115. doi:10.63096/medtigo30623115 Crossref
