Available online 6 January 2024

Author links open overlay panel, , , AbstractObjectives

To evaluate BMI change among a population of children with a high proportion residing in rural areas across two pandemic time periods.

Methods

Electronic health records were evaluated in a rural health system. Inclusion criteria: 2-17 years at initial BMI; >2 BMIs during pre-pandemic (1/1/2018–2/29/2020); >1 BMI in early pandemic (6/1/2020–12/31/2020); and >1 BMI in later pandemic (1/1/2021–12/31/2021). Mixed effects linear regression models were used to estimate average monthly rate of change in BMI slope (∆BMI) from pre-pandemic to pandemic and test for effect modification of sex, race/ethnicity, age, BMI, public insurance, and rural address.

Results

Among the 40,627 participants, 50.2% were female, 84.6% were non-Hispanic white, 34.9% used public insurance, and 42.5% resided in rural areas. The pre-pandemic proportion of children with overweight, obesity, and severe obesity was 15.6%, 12.8%, and 6.3%, respectively. The ∆BMI nearly doubled during the early pandemic period compared with the pre-pandemic period (0.102 vs. 0.055 kg/m2), however, ∆BMI in the later pandemic was lower (0.040 vs. 0.055 kg/m2). ∆BMI remained higher in the later pandemic for all race categories compared to Non-Hispanic white. Children with public insurance had higher ∆BMI compared to those with private insurance that remained higher in the later pandemic (0.051 vs 0.035 kg/m2). There was no significant difference between ∆BMI for rural and urban children during pandemic periods.

Conclusions

Despite the decreased ∆BMI among children in the later pandemic, prevalence of obesity and severe obesity remain high. Efforts must continue to be made to limit excess weight gain during childhood and to interrogate the impact of forces like structural and social factors in both etiology and prevention.

What’s New

This study adds knowledge BMI change among a population of children with a high proportion residing in rural areas across two pandemic time periods.

Section snippetsINTRODUCTION

Childhood obesity prevalence increased in the United States during the COVID-19 pandemic among both nationally representative 1 and urban samples, 2 but change among rural children has not been reported. Rural children face numerous health disparities including lower household income and greater community socio-economic deprivation; more than 1 in 5 rural children live in poverty and are more likely to utilize public insurance. 3 As a result, rural children face a 25% higher odds of obesity

METHODS

Electronic health records were evaluated from Geisinger, a large, integrated health system serving patients in over 40 counties in Pennsylvania. Geisinger’s service area covers predominantly rural areas in central and North-east PA (Figure). The primary care population represents the region’s general population in terms of age and sex. 11

To be included, persons had to be aged 2–17 years at their initial BMI measurement and have two or more BMI measurements before the COVID-19 pandemic (January

RESULTS

The longitudinal cohort included 40,627 persons who had a total of 411,487 BMI measurements collected from January 1, 2018, through December 31, 2021, including 245,654 pre-pandemic; 74,754 during the early pandemic; and 91,079 during the later pandemic period. Among participants, 50.2% were female, 84.6% were non-Hispanic white, and 34.9% indicated use of public insurance. Based on initial BMI measures, the proportion of children with overweight, obesity, and severe obesity was 15.6%, 12.8%,

DISCUSSION

This study evaluated changes in BMI among children from a rural health system across the start of the COVID-19 pandemic, early pandemic (2020), and later pandemic (2021).

Evaluating the impact of the COVID-19 pandemic on BMI change in a population with a high proportion of rural children was a key priority not only because this is an under-represented and understudied population, but also because rural children experience greater health disparities compared to non-rural and urban children.

We

Funding/Support

All phases of this study were supported by Geisinger. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Role of Funder/Sponsor (if any)

Geisinger had no role in the design and conduct of the study.

Clinical Trial Registration (if any)

Not applicable

Contributors Statement Page

Dr McCabe assisted with study conceptualization and design, drafted the initial manuscript, and critically reviewed and revised the manuscript.

Dr Bailey-Davis conceptualized and designed the study, directed data extractions, assisted with the initial draft of the manuscript, and critically reviewed and revised the manuscript.

G. Craig Wood assisted with study conceptualization and study design, extracted data, conducted the initial analyses, and critically reviewed and revised the manuscript.

Dr

Conflict of Interest Disclosures (includes financial disclosures)

The authors have no conflicts of interest to disclose.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References (21)

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© 2024 Published by Elsevier Inc. on behalf of Academic Pediatric Association