Changes in Body Mass Index in Children and Adolescents with Asthma During the COVID-19 Pandemic

Background: Obesity in children has reached epidemic proportions in the United States, and increased weight gain in school-aged children during summer months has been well documented. During the COVID-19 pandemic in the United States, there was concern that extended school closures would lead to increased obesity due to risk factors including more sedentary lifestyle and increased caloric intake. Obesity has multiple effects on asthma including on lung function and response to therapy. Significant weight gain in children with asthma during the pandemic could have sequelae beyond the known health effects of overweight and obesity in the general population.

Methods: A retrospective chart review was performed of patients aged 6-18 years with asthma, seen in-person at a predominantly suburban pediatric pulmonology practice during four office visits from four time periods: January- April 2019 and July- October 2019 (pre-pandemic), January- April 2020 and July- October 2020 (pandemic). For each visit, data was collected on current height, weight, asthma medications, recent hospitalizations and exacerbations requiring systemic steroids. BMI and BMI percentile for age were calculated and patients were categorized by weight status based on Centers for Disease Control (CDC) definitions. Asthma severity was classified based on current therapies as per the Expert Panel Report-3 guidelines. Prevalence of overweight and obesity during each of the time periods was compared. Mean change in BMI between the two time periods in 2020 were compared to mean change in BMI between the two time periods in 2019.

Results: 267 patients were included. Mean age was 10.0 + 2.5 years at the beginning of the study. 163 patients (61%) were male. 50.9% were overweight or obese during the pandemic compared to 46.8% in the previous year (p=0.34). Mean change in BMI was 0.81± 1.75 during the pandemic as compared to 0.5 ± 0.95 in the previous year (p = 0.01). Figure 1 demonstrates that BMI steadily increased for children in all weight categories for the first three time periods. Unlike normal weight children, BMI of overweight or obese children decreased during the last time period, i.e., the pandemic summer (2020). There were no differences in mean change in BMI during the pandemic compared to the year prior when stratified by sex, age group, type of insurance, asthma severity or prior CDC weight category (Table 1).

Conclusion: In this single-site retrospective study of children with asthma, there was a greater overall increase in BMI during the pandemic as compared to the previous year. However, children who were overweight or obese were more likely to lose weight during the pandemic. Reasons for this are unclear, but in this suburban community, may include increased participation in family outdoor activities and better nutrition with increased consumption of home-cooked foods in at-risk children.