Health risks associated with obesity have been thrust into the spotlight since links were found between COVID-19 severity and total body weight.
In April 2020, obesity was found to be the biggest risk factor for death from the novel coronavirus in those under 64 years of age – beating heart disease, diabetes, chronic lung disease and high blood pressure.
Obesity – and in particular childhood obesity – again garnered attention when public health scientists in the US raised concerns that lockdown measures could exacerbate obesity due to enforced school closures.
Their thinking was that by staying at home, children would miss out on subsidised school lunches and organised school activity. Further, kids could also be exposed to more shelf-stable food during the pandemic.
As certain countries – such as Australia, the UK, Italy, and Spain – begin to loosen lockdown measures, researchers are now able to test this hypothesis.
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health, according to the World Health Organization (WHO).
Worldwide, obesity has nearly tripled since 1975, with childhood obesity levels also a growing concern. According to 2016 figures, over 340 million children and adolescents aged 5-19 were overweight or obese.
And indeed, findings reveal that obese children, when removed from structured school activities and confined to their homes during the COVID-19 pandemic, displayed ‘unfavourable trends’ in lifestyle behaviours.
Analysing homebound behaviours
Given that children and adolescents typically gain more weight during summer vacation than during the school year, a group of researchers from The State University of New York at Buffalo wondered whether being homebound would have a similar effect on kids’ lifestyle behaviours.
"School environments provide structure and routine around mealtimes, physical activity and sleep - three predominant lifestyle factors implicated in obesity risk," said childhood obesity expert and study co-author Myles Faith.
Forty-one overweight children under national lockdown in Verona, Italy, were examined throughout March and April. Researchers recorded information regarding their diet, activity and sleep for three weeks.
These findings were then compared to data on the same children gathered in 2019. Questions focused on eating habits and their consumption of red meat, pasta, snacks, fruits and vegetables. Children were also quizzed on physical activity and sleep.
How did Italian eating habits change during lockdown?
A recently published survey by Italy’s Council for Agricultural Research and Economics (CREA) has revealed how the Italian population's - rather than focusing specifically on children - food choices and behaviours were impacted by the COVID-19 lockdown.
Approximately 2,900 people from all regions of Italy responded. Significant numbers reported increases in the consumption of healthy foods and drinks: vegetables (33%), fruit (29%), legumes (26.5%), and extra virgin olive oil (21.5%).
However, 44.5% responded that they had increased consumption of sweets, and 16% admitted to drinking more wine.
Concerning overall body weight, 44% of respondents gained weight due to higher calorie intake related to lower levels of physical activity. A total of 37% of respondents expressed a need to go on a diet.
Compared to their behaviours recorded one year prior, the children ate an additional meal per day; slept an extra half hour per day; and spent nearly five hours more per day in front of a phone, computer or television screen during lockdown.
Their consumption of red meat, sugary drinks, and junk food also significantly increased, while physical activity decreased by more than two hours per week. There were no changes in reported vegetable intake, and fruit intake increased slightly.
The 'collateral effects' of COVID-19
The findings confirm that children did experience negative changes in behaviour, indicating that obese children fare worse on weight control lifestyle programmes while at home compared to when they are engaged in their school curriculum.
"The tragic COVID-19 pandemic has collateral effects extending beyond direct viral infection," according to Faith. "Children and teens struggling with obesity are placed in an unfortunate position of isolation that appears to create an unfavorable environment for maintaining healthy lifestyle behaviours."
Depending on the duration of the lockdown, Faith fears the excess weight gained may not be easily reversible, and could well contribute to obesity during adulthood ‘if healthier behaviours are not re-established’. "This is because childhood and adolescent obesity tend to track over time and predict weight status as adults."
"Recognizing these adverse collateral effects of the COVID-19 pandemic lockdown is critical in avoiding the depreciation of hard-fought weight control efforts among youths afflicted with excess weight," – Myles Faith, chair and professor of counseling, school and educational psychology at the UB Graduate School of Education.
Given these findings, government officials and policymakers should consider the potential harmful effects on lockdowns on youths with obesity when making decisions regarding how and when to loosen restrictions, Faith continued.
There is also a need, he argued, to establish and evaluate telemedicine programmes that encourage families to maintain healthy lifestyle choices during periods of lockdown.
‘Effects of COVID-19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study’
Published 30 April 2020
Authors: Angelo Pietrobelli. Luca Pecoraro, Alessandro Ferruzzi, Moonseong Heo, Myles Faith, Thomas Zoller, Franco Antoniazzi, Giorgio Piacentini, S. Nicole Fearnbach, Steven B. Heymsfield