P2.200: Regional impact of the COVID-19 pandemic on childhood obesity prevalence, Denver, Colorado 2019-2022

Background: Nearly 15 million US children and adolescents (21.1%) have obesity, which puts them at increased risk for type 2 diabetes, high blood pressure, abnormal lipid profiles, and other indicators of poor metabolic health. During the early COVID-19 pandemic, many children and adolescents experienced rapid excess weight gain and resulting increases in body mass index (BMI) and obesity prevalence. We leveraged electronic health record (EHR) data from a distributed data network of 3 large healthcare organizations in metropolitan Denver, Colorado (called the Colorado Health Observation Regional Data Services, or CHORDS) to assess regional trends in BMI and obesity prevalence before, during, and after the COVID-19 pandemic.

Methods: Approximately 323,000 patients aged 2-19y had valid height and weight data (cleaned using growthcleanr, an R package) in 2019-2022. BMIs were categorized based on sex- and age-specific BMI percentiles: underweight ( < 5th), healthy weight (≥5th to < 85th), overweight (≥85th to < 95th), moderate obesity (≥95th to < 120% of the 95th), and severe obesity (≥120% of the 95th or BMI ≥35 kg/m2). To be included in the retrospective longitudinal cohort, patients had to live in metropolitan Denver, have known race/ethnicity, and have ≥1 BMI measurement in each of the following time periods: pre-pandemic (January 2019-February 2020), early pandemic (June-December 2020), and later pandemic (2021-2022). We used linear mixed-effects regression models to estimate average monthly rates of change in BMI and obesity prevalence, overall and by patient characteristics.

Results: Among 54,104 patients included in the cohort, 51% were female, and mean age at the start of the pandemic was 10.3 years. Approximately 42% were Hispanic, 39% non-Hispanic (NH) White, 11% NH Black, 4% NH Asian, and 4% NH other/multiple. The average rate of BMI gain was nearly 70% higher during the early pandemic compared to pre-pandemic [rate ratio (RR): 1.68 (95% CI: 1.60, 1.76)] but attenuated substantially as the pandemic continued [RR: 0.37 (95% CI: 0.34, 0.40) for 2021 vs. early pandemic]. This coincided with changes in estimated obesity prevalence from 16-17% pre-pandemic to 21% by December 2020 and 20% by December 2022. School-aged children 6-13y, those with pre-pandemic healthy weight, and Hispanic, non-Hispanic Black, and non-Hispanic other race/ethnicity children had particularly increased rates of BMI gain in the early pandemic.

Conclusion: Although rates of BMI gain leveled out from early pandemic increases, obesity prevalence in our large cohort of children in metropolitan Denver remained substantially higher in 2022 than pre-pandemic, particularly in certain subgroups. Opportunities exist to strengthen institutions and programs that help youths eat nutritious foods, stay physically active, and maintain healthy weights. This work underscores the potential value of regional surveillance systems to monitor disease trends and inform local efforts to support children’s overall health.