Impact of COVID-19 Diagnosis on Weight Trajectories of Children in the US National COVID Cohort Collaborative.

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The COVID-19 pandemic has exacerbated the obesity epidemic, with both adults and children demonstrating rapid weight gain during the pandemic. However, the impact of having a COVID-19 diagnosis on this trend is not known. Using longitudinal data from January 2019 to June 2023 collected by the US National Institute for Health's National COVID Cohort Collaborative (N3C), children (age 2-18 years) with positive COVID-19 test results (n=11,474, 53% male, mean [SD] age 5.57 [±3.29] years, 54% white, mean [SD] 5.2 [±2.9] BMI observations per participants) were matched with COVID-19 negative children with identical demographic characteristics and similar observation window. We compared BMI percentile trajectories between the COVID-19 positive and COVID-19 negative cohorts, with further evaluation performed on COVID-19 positive patients stratified by hospitalization status. COVID-19 positive patients had a greater increase in %BMI p95 than COVID-19 negative patients (average increase of 2.34 (±7.73) compared to 1.46 (±6.09), p<0.0005). COVID-19 positive patients gained more weight after their diagnosis of COVID-19 than before. Non-hospitalized children gained more weight than hospitalized children (average increase in %BMI p95 of 2.38 (±7.65)) compared to 1.87 (±8.54)). Mixed effect regression analyses demonstrated that these associations remained even after adjusting for time, demographics, and baseline %BMI p95 . Having a COVID-19 diagnosis was associated with more rapid weight gain, especially after diagnosis and early in the pandemic. Future research should explore the reasons for this association and the implications for future health emergencies. M.M.M. drafted the initial manuscript and assisted with the data curation, formal analysis, methodology, and visualization. T.T.P. assisted with the study design, interpretation of results, funding acquisition, and manuscript drafting and editing. C.T.B. and C.G.C assisted with formal analysis and interpretation of results. L.A.P. assisted with the interpretation of results and manuscript editing. R.B. supervised the study with study design, resources, funding acquisition, and manuscript editing. All authors assisted in the conceptualization of the study and approved it for publication. The authors declare no conflicts of interest. This study investigating the weight trajectories of children during the COVID-19 pandemic shows that the pandemic has led to a significant increase in weight gain among US children aged 6-11, with boys gaining more weight than girls. Non-hospitalized COVID-19-positive children were found to be at greater risk of gaining weight. The analyses described in this publication were conducted with data or tools accessed through the NCATS N3C Data Enclave https://covid.cd2h.org and N3C Attribution & Publication Policy v 1.2-2020-08-25b supported by NCATS U24 TR002306, Axle Informatics Subcontract: NCATS-P00438-B, [DUR RP-0BDD0E] and was supported by NIH awards, P20GM103446 and U54-GM104941. This research was possible because of the patients whose information is included within the data and the organizations ( https://ncats.nih.gov/n3c/resources/data-contribution/data-transfer-agreement-signatories ) and scientists who have contributed to the ongoing development of this community resource [ https://doi.org/10.1093/jamia/ocaa196 ].