ESPE Abstracts

Background: The COVID-19 pandemic has had wide effects on child health globally. Increased prevalence of childhood obesity has been observed during the pandemic. The absence of a formal societal lockdown during the pandemic, made Sweden stand out compared to other countries. Several studies have shown increases in obesity in children during the COVID-19 pandemic. These studies mainly focused on school age children and adolescents in countries that underwent periods of societal lockdown. Child health nurses in socioeconomically deprived areas in Sweden have signalled a rise in childhood obesity during the pandemic, however not yet analysed scientifically. This study hence aimed to examine changes in BMI among pre-school children in Sweden before and during the COVID-19 pandemic.

Methods: Retrospective population based cross-sectional study, with longitudinal follow-up for a portion of the children, data was obtained from the national quality register for child health care, BHVQ. The study included 25049 children from three Swedish regions, with growth measures at three- (n=16237), four- (n=14437) and five-years of age (n=11 711). Care Need Index was used as a socioeconomic parameter at health centre level. BMI was calculated and categorized based on sex-specific BMI-for-age in months (IOTF body mass index cut-offs for thinness, overweight and obesity).

Results: There was an increase in BMI in children aged three (P=0.028), and four (P<.001) during the COVID-19 pandemic. Obesity in three-year-old girls increased from 2.8% to 3.9%. Four-year-olds increased in obesity (both sexes), overweight (girls) and the prevalence of underweight decreased in boys. A lower proportion of girls had a normal weight status during (80.9 %), compared to before the COVID-19 pandemic (82.6 %) (P=0.049), while no difference in normal weight status was found in boys the same age (P=0.977). No change in BMI was observed in five-year-olds. Children in areas with the lowest socioeconomic status had higher risk of obesity, increasing from 2.4% to 4.4% during the pandemic, overweight increased in these areas from 9.5% to 12.4%.

Conclusions: Overweight and obesity increased among three-four year old Swedish children, especially for children attending child health centres in areas with lower socioeconomic status. The COVID-19 pandemic is likely to have affected health behaviours negatively in Swedish pre-school children. Our results expose the need for extended efforts directed to prevent childhood obesity, especially targeting lower socioeconomic areas.