Five-year trends in overweight and obesity among preschool children before and during the Covid-19 period
A retrospective repeated-measures analysis in Southwest China
Bibliographic Data
Background COVID-19-related school closures and subsequent control measures may have altered children’s daily routines and contributed to changes in weight status. However, evidence on sex-specific and age-specific patterns of overweight and obesity among preschool children across both pre-pandemic and COVID-19 periods remains limited. This study aimed to examine five-year trends in overweight and obesity among preschool children in Southwest China from 2018 to 2022. Methods This retrospective repeated-measures analysis used annual routine health examination records of preschool children aged 3.0 to 7.0 (exclusive) years in Wuhua District, Kunming, Yunnan Province, Southwest China, from 2018 to 2022. Annual examinations were conducted during the same calendar window each year, from May 25 to June 30. In 2020, this window corresponded to the initial kindergarten reopening period in Kunming after COVID-19-related school closures. The full analytic dataset was used to describe annual patterns in overweight, obesity, and combined overweight and obesity (OwO). Children with at least two annual health examination records were further included in generalized linear mixed model (GLMM) analyses. Overweight, obesity, and OwO were modeled as binary outcomes, respectively. Year of examination was included as the main fixed effect, with 2020 as the reference year, and child ID was included as a random effect. Age and sex were adjusted in the overall models, and age was adjusted in sex-stratified models. Results A total of 17,561 children contributing 26,246 annual health examination records were included in the full analytic dataset. The repeated-measures subset included 7,175 children contributing 15,860 records. In the full analytic dataset, obesity prevalence was highest in 2020, whereas overweight and OwO prevalence were highest in 2022. Among boys, obesity prevalence peaked in 2020 at 4.7%. Among girls, overweight, obesity, and OwO were highest in 2022, reaching 12.1, 2.9, and 15.1%, respectively. In the overall GLMM analyses, the odds of overweight were higher in 2022 than in 2020 ( OR : 1.92, 95% CI: 1.26–2.92), while the odds of obesity were lower in 2018, 2019, and 2021 than in 2020. The odds of OwO were lower in 2018, 2019, and 2021 than in 2020, but higher in 2022 ( OR : 1.82, 95% CI: 1.14–2.89). Sex-stratified GLMM analyses showed that the higher obesity burden around 2020 was more evident among boys, whereas girls showed higher odds of overweight, obesity, and OwO in 2022. Conclusion Preschool children in Southwest China showed heterogeneous temporal patterns of overweight and obesity before and during the COVID-19 period. Obesity was more prominent around the initial kindergarten reopening period in 2020, particularly among boys, whereas overweight, obesity and OwO were higher in 2022, particularly among girls. These findings support continued monitoring of preschool children’s weight status and the implementation of targeted early-life obesity prevention strategies following major public health disruptions.
Body mass index · China · Medical record · Obesity · Overweight · Retrospective cohort study · COVID-19 and Mental Health · COVID-19 Impact on Reproduction · Obesity, Physical Activity, Diet
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