The impact of COVID-19 pandemic-related stressors on childhood obesity and cardiometabolic risk

Project Summary/Abstract The COVID-19 pandemic has had an alarming impact on already unacceptably high childhood obesity rates, and emerging evidence shows that traditional approaches to pediatric weight management have been markedly less effective since the onset of the pandemic. As obesity during childhood is much more likely to be sustained during adulthood, and children with obesity and other chronic conditions are more likely to have severe forms of COVID-19 requiring hospitalization, this alarming increase in childhood obesity rates is poised to have a broad and long-term impact on population health unless effective interventions are implemented. Yet, we know very little about the unique drivers of this dramatic increase in childhood obesity and whether BMI increases will persist and become lifelong. We know even less about the protective factors that mitigate this risk, as some youth will not develop obesity/worsening cardiometabolic health or may recover quickly despite risk exposures. Our goals are to uncover the biobehavioral pathways through which pandemic-related stressors drive childhood obesity and cardiometabolic risk, and to identify protective factors and intervention targets to mitigate the long-term impact of the pandemic on children's health. The proposed research offers a unique, time-sensitive opportunity to prospectively examine the impact of multilevel stressors brought on by the pandemic to identify factors influencing BMI and cardiometabolic health trajectories. We will leverage an established longitudinal cohort of racially/ethnically diverse children (60% Latino) from predominantly low- income households, who were enrolled at 2-4 years of age (U01HD068890) and followed annually through ages 7-11 (R01HD090059). Underscoring the timeliness, uniqueness, and significance of this cohort, body composition, cardiovascular and metabolic functioning, neuroendocrine, oxidative stress, and inflammatory biomarkers, and health behaviors were obtained just prior to the onset of the pandemic (n=338). Drawing on a rich history of longitudinal data over 5 previous timepoints including immediately prior to the pandemic, we propose to add two new waves of data collection (7- and 8-years after inception of the cohort, 2-3 years post- onset of the pandemic) when children will be 10-14 years of age, an important developmental window of obesity and cardiometabolic imprinting. Multiple levels of pandemic-related stressors will be measured, alongside gold standard biological measures of stress activation, adiposity and cardiometabolic health, objective health behavior measures, and parent-child surveys. Our specific aims focus on identifying the pathways, parent-child factors, and neighborhood/community contexts needed to guide effective childhood obesity interventions in the aftermath of the pandemic and reduce adverse health consequences among vulnerable and understudied populations.