Significant Weight Gain Observed in Low-Income Youth During the Early COVID-19 Pandemic

Significant Weight Gain Observed in Low-Income Youth During the Early COVID-19 Pandemic 150 150 JoAnna Pendergrass, DVM

Low-income youth experienced significant weight gain during the first six months of the COVID-19 pandemic, highlighting the need for simultaneous childhood obesity prevention and treatment.


The COVID-19 pandemic and subsequent mitigation efforts profoundly affected children. Specifically, remote learning and cancellation of extracurricular activities disrupted children’s daily routines and reduced opportunities for physical activity, increasing the risk of weight gain.

“Before the pandemic, children tended to gain more weight during the summer,” says Ihuoma Eneli, MD, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital. The pandemic, she adds, has closely mirrored the weight changes we see during the summer months out of school.

Studies have reported pandemic-associated weight gain in children, with some data indicating higher weight gain rates in children with public insurance. These data suggested that children with low socioeconomic status had a disproportionate burden of the weight gain during the pandemic.

Dr. Eneli and her research team recently conducted a retrospective study to analyze changes in pediatric weight gain category during the first six months of the pandemic in approximately 4,500 low-income children aged 2 to 17 years. The children were seen at Nationwide Children’s network of primary care clinics.

Study results, published in Clinical Obesity, indicated significant pediatric weight gain, with the most weight gained by children who were already obese.

“These results underscore the need for all healthcare providers who care for children to become comfortable addressing childhood obesity and implementing obesity prevention and treatment in tandem,” she says.

The research team analyzed the patients’ electronic health records according to designated timeframes: quarter 1 (pre-COVID, January 1 to March 30, 2020) and quarter 3 (June 1 to September 30, 2020). Quarter 2 (April 1 to June 30, 2020) was the timeframe in which the children were initially exposed to the pandemic’s early mitigation efforts and was therefore excluded from the data analysis.

Weight categories were defined using the 2000 CDC growth chart: underweight, healthy weight, overweight, obesity, and severe obesity. Weight category changes were classified as concerning (e.g., healthy weight to overweight) or non-concerning (e.g., overweight to healthy weight).

The percentage of children in the overweight, obesity and severe obesity categories increased from 38% in Q1 to 45% in Q3. Nearly 20% of children had concerning weight category changes.

Children with severe obesity had the highest median weight gain — about 11 pounds during the 3-6- month period. Treatment for severe obesity includes lifestyle changes, behavioral therapy, medication and bariatric surgery, explains Dr. Eneli, adding that it is important to offer all of these options.

Seven percent of children improved their weight category. For example, 45% of the underweight children moved into the healthy weight category.

Weight category change was significantly associated with age and ethnicity. Children aged 2 to 5 years and 6 to 9 years were twice as likely as 14- to 17-year-old children to have concerning weight changes. Similarly, Hispanic children were twice as likely as non-Hispanic White children to have concerning weight changes.

Bias and stigma are significant obstacles to discussing obesity and obesity treatment with children and their families. To minimize this stigma, Dr. Eneli advises providers to adjust their language and avoid defining children according to their obesity. For example, the statement “Taylor has obesity” is less stigma-inducing than “Taylor is obese.”

She adds that it is important to remember that risk factors for childhood obesity are complex. They include those that may be within a patient’s control (e.g., dietary choices) and those not within a patient’s control (e.g., social determinants of health, genetics).

“Obesity is not all about ‘willpower,’ says Dr. Eneli. “Thinking about obesity this way will help clinicians be less judgmental.”

Dr. Eneli and her team will continue collecting the patients’ data through October 2022. With data collection and analysis still in process, her impression, based on the patients seen at the Center for Healthy Weight and Nutrition clinics, is that the rapid weight gain observed early in the pandemic has slowed.



Eneli I, Xu J, Pratt K. Change in weight category among youth early in the COVID-19 pandemic. Clinical Obesity. 2022 Jun;12(3):e12522. doi: 10.1111/cob.12522. Epub 2022 April 6.

Image credit: Adobe Stock

About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.