ESPE Abstracts

Introduction: Lockdown measures following the COVID-19 pandemic are shown to have greatly affected lifestyle behaviours and health-related quality of life (HRQoL) of children. The impact on children with severe obesity has not yet been described. Aim of this study was to investigate the impact of COVID-19 lockdown on eating behaviours, physical activity (PA), screen time, and HRQoL of children (including adolescents) with severe obesity.

Methods: Questionnaires and semi-structured telephone interviews were used in this mixed-methods study performed during the first COVID-19 lockdown in the Netherlands (April 2020). Children, who were treated at our obesity centre, were included. The Dutch Eating Behaviour Questionnaire – Child, Paediatric Quality of Life Inventory, and Dutch Physical Activity Questionnaire were completed by their families pre-pandemic and during lockdown. Changes over time in percentile scores, weekly PA, and screen time were assessed. Qualitative analyses were performed following the Grounded Theory.

Results: Ninety families were approached; 83 families included. Mean age of children was 11.2 years (SD 4.6), 52% were female, mean BMI SD score was +3.8 (SD 1.0) Weekly PA decreased, but emotional, restrained, external eating, HRQoL and screen time did not change on group level (Table). In 51% of the population, mean weekly PA decreased to ≤2 hours/week. Increased emotional eating during lockdown was observed mostly in older children, whereas increased external eating was observed mostly in younger children. Children with high emotional and external eating during lockdown or pre-existent psychosocial problems had the lowest HRQoL (P < 0.01). An increased demand for food was frequently observed (n = 21), mostly children aged <10 years (19/21), and was attributed to loss of daily structure or perceived stress. Families who reported unchanged (n = 15) or improved eating behaviours (n = 11) attributed this to already existing strict eating schemes.

Conclusion: We show differential responses to COVID-19 lockdown measures in children with severe obesity, with unfavourable changes in PA on group level and in eating styles and HRQoL in substantial minorities. Children with pre-existent psychosocial problems or pre-pandemic high external or emotional eating were most at risk. These children should be targeted to minimize short- and long-term negative physical and mental health consequences.