A Weighty Matter: Quality Improvement Project in Pediatric Obesity During COVID-19 Pandemic at a Federally Qualified Health Center (FQHC)

Purpose/Objectives: Understand the rates of pediatric obesity in the Inland Empire of Southern California, in the context of COVID quarantine, to improve counseling and treatment of these patients.

Design/Methods: A retrospective chart review was performed on all patients seen at a FQHC in Southern California. Patients between 5 and 18, who had a clinic visit between 6/1/2020 to 7/31/2020 for a well-child visit, with at least one other well-child visit in calendar year 2019 and 2018 were included. Patients with congenital heart disease, short gut syndrome, ADHD on stimulant medications, G tube dependence, diseases affecting growth or stature, complex syndromes (CHARGE, VACTERL, DiGeorge), syndromes affected growth, oncologic conditions, intellectual disability, transplant recipients, incomplete BMI data or malnutrition (BMI Z score <= -1) were excluded. BMI values, Z-scores, and percentiles, as well as relative changes from 2018 to 2019, and 2019 to 2020 were analyzed using one-way ANOVA and Tukey post hoc test.

Results: There was a statistical difference in BMI between years as determined by a one-way ANOVA (F(2,509) = 2.811, P=0.05). A Tukey post hoc test revealed that the BMI of students in 2020 was statistically higher (19.87.65, p = 0.05) compared to the BMI in 2018 (18.25.71). There was no statistical difference in BMI between 2020 and 2019, and 2019 and 2018 (Figure 1). When groups were stratified into morbidly obese (BMI >= 99%), obese (BMI >=95% & <99%), overweight (BMI >=85% & <95%), and healthy weight (BMI >=5% & < 85%), patients who were not at a healthy weight increased from 36.8% in 2018 to 40.4% in 2019, to 44.7% in 2020 (Figure 2). As shown in the SANKEY diagram (Figure 3), while there was an initial decline in morbidly obese patients in 2018 to 2019 (-8.3%), there was a relatively large increase from 2019 to 2020 (+45.5%). From 2018 to 2019, 75 out of 141 patients (53.2%) had a decrease in BMI, while in 2019 to 2020 there were 56 out of 141 patients (39.7%) who had a decrease in BMI. Out of the 75 patients who had a decrease in BMI from 2018 to 2019, 49 (65.3%) had a rebound increase in BMI from 2019 to 2020.

Conclusion/Discussion: There was a significant increase in overall BMI from 2018 to 2020 with an overall increase in patients who fall into the obese and overweight categories in 2020. 65.3% of patients who had a decreasing BMI from 2018 to 2019 have a rebound increase in BMI in 2020. This can likely be contributed to the COVID-19 pandemic and stay-at-home orders leading to a more sedentary lifestyle. More research should be performed to elicit multifactorial (physical activity, diet, and psychosocial factors) etiology of the worsening obesity epidemic during the COVID-19 pandemic.