Original Investigation
Public Health
Body Mass Index in Children Before, During, and After the COVID-19 Pandemic
Frederik Kirkemann Jensen, Sigrid Bjerge Gribsholt, Sara Schwartz, et al
JAMA Netw Open 2025;8;(7):e2519528. doi:10.1001/jamanetworkopen.2025.19528
Question Did prevalence of underweight, overweight, and obesity in schoolchildren change during and after the COVID-19 pandemic compared with before the pandemic?
Findings This cross-sectional study including 426 935 children in Denmark found a higher prevalence of obesity among children in first grade and underweight among children in sixth grade after the COVID-19 pandemic compared with before the pandemic.
Meaning This cross-sectional study found that body mass index outcomes of COVID-19 pandemic–related control policies and restrictions were not exclusively observed among children with obesity, which suggests that pandemic-related mitigation policies targeting children and adolescents in all body mass index categories are warranted.
Abstract
Importance Significant changes in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) have been observed in children during the COVID-19-pandemic; however, changes in different BMI categories after COVID-19 remain largely unknown.
Objective To examine changes in prevalence of underweight, overweight, and obesity in first- and sixth-grade children in Denmark during and after the COVID-19 pandemic compared with before COVID-19.
Design, Setting, and Participants This cross-sectional prevalence study was conducted from March 11, 2019, to January 31, 2024, using nationwide, population-based data from Danish health care registries. All children in first or sixth grade in Denmark during the COVID-19 time periods (before, during, and after) were eligible for inclusion. Children with outcome data (ie, anthropometric assessments) available in the Children’s Database were included in the analysis. Data were analyzed in March 2024.
Exposure National COVID-19 lockdowns.
Main Outcomes and Measures The outcome of interest was changes in age- and sex-adjusted BMI (iso-BMI). Using log-binomial regression, crude and adjusted prevalence ratios (aPRs) of iso-BMI categories (ie, underweight [<18.5], normal weight [18.5-24.9], overweight [25.0-29.9], and obesity [≥30.0]) were calculated using pre–COVID-19 levels as the reference, adjusting for sex, household income, and parental education.
Results A total of 268 761 first-grade children (137 826 [51.3%] male; 42 464 children [15.8%] with high household income; 172 678 children [64.3%] with parents with tertiary education) and 158 174 sixth-grade children (80 958 [51.2%] male; 34 798 children [22.0%] with high household income; 95 492 children [60.4%] with parents with tertiary education at baseline) were included. In first-grade children, a decrease in underweight was observed during COVID-19 (aPR, 0.76 [95% CI, 0.71-0.83]); contrarily, an increased prevalence of underweight was found in sixth-grade children after COVID-19 (aPR, 1.15 [95% CI, 1.06-1.24]). The prevalence of overweight increased in first- and sixth-grade children during COVID-19, but both returned to pre–COVID-19 levels afterwards (first grade: aPR, 0.97 [95% CI, 0.94-0.99]; sixth grade: aPR, 0.95 [95% CI, 0.93-0.98]). Likewise, the prevalence of obesity increased in first- and sixth-grade children during COVID-19 and remained elevated in first-grade children after COVID-19 (aPR, 1.12 [95% CI, 1.07-1.18]).
Conclusions and Relevance In this cross-sectional study of changes in iso-BMI in children in Denmark, prevalence of overweight and obesity increased during COVID-19. The prevalence of overweight declined after COVID-19, but the prevalence of obesity remained increased among first-grade children. Additionally, the prevalence of underweight increased in sixth-grade children after COVID-19. These findings highlight differences among children of varying ages and BMI classes.
