(P31-006-23) Disparities in Childhood Obesity and Early Life BMI Gains Associated With COVID-19 in a Large Rural Health System

Objectives: Childhood obesity prevalence increased during the pandemic among nationally representative and urban samples but change among rural children has not been reported. This study aimed to identify longitudinal changes in growth related to COVID-19 among rural children, a population with known disparities.

Methods: Electronic health records were evaluated from Geisinger, a rural health system. Body mass index (BMI) was calculated from height and weight measurements and categorized by CDC BMI-for-age and sex percentiles. Inclusion criteria were aged 2-17 years at their initial BMI and have two or more BMIs before the pandemic (at least one BMI recorded 3/1/2019 – 2/29/2020) and one or more BMI after the initial 3 months of the pandemic (6/1/2020 – 12/31/2020). Linear mixed-effects regression models were used to examine differences in the average monthly rate of change in BMI. Mixed effects linear regression models were used to estimate change in BMI slope from pre-pandemic to pandemic while adjusting for sex, race/ethnicity, age at start of COVID, and baseline BMI. Data were analyzed using SAS; statistical significance was defined as p< 0.05.

Results: Among the 53,987 persons aged 2-17 years in the longitudinal cohort, there were 403,202 BMI measurements and 50.2% were male and 83.2% were white. Based on initial BMI, the proportion of children with overweight, obesity, and severe obesity was 15.5%, 12.7%, and 6.1%, respectively. Overall, the monthly relative change in BMI nearly doubled during the pandemic period compared with the pre-pandemic period (0.105 vs. 0.054 kg/m²; ratio = 1.93).  Among children 3-5 years, the monthly relative change in BMI was highest during the pandemic period compared to the pre-pandemic period (0.058 vs. -0.002 kg/m²; ratio = 29). Significant monthly increases in BMI during the pandemic were observed across all weight categories and more than doubled among persons with a BMI >50^th— < 85^th percentile.

Conclusions: Compared to the national estimates, the prevalence of overweight, obesity, and severe obesity was higher in the pre-pandemic period among children at a rural health system. Healthy weight and preschool-age children experienced BMI increases at higher rates during the pandemic compared to national estimates, potentially widening disparities.

Funding Sources: Geisinger