Parental Perspectives of the Impact of COVID-19 Lockdown on Food-Related Behaviors: Systematic Review

A Scale-Out Study of an Evidence-Based Family Meals Program Delivered in the Head Start Setting: Results, Challenges, and Opportunities

Background: There is need to identify evidence-based early childhood obesity prevention programs that are feasible and demonstrate cost-effectiveness for a broader health impact. This scale-out study leveraged community-engaged principles to compare the feasibility and cost-effectiveness of three delivery modes of a childhood obesity prevention family meals program (Simple Suppers) that demonstrated positive impacts on child and caregiver diet/nutritional health-related outcomes in a previous experimental trial tested among elementary-aged children. Methods: This three-arm (in-person, online, hybrid) pre-(T0) and post-(T1)-test study included families recruited from Head Start. Forty-five families (45 caregivers; 55 children) completed the study. The program was adapted to families with younger children (3-5 years). During the 8-week program, participants received weekly group education and meals through in-person, online, or hybrid format. Feasibility outcomes were attendance, acceptability (post-test survey; focus groups), fidelity, and cost (food; staff). Participant outcomes were related to diet/nutritional health. Kruskal-Wallis test was used to compare T0 to T1 differences in participant outcomes across delivery modes. Qualitative data were analyzed using thematic analysis. Cost-effectiveness was calculated as the net-cost of the program by changes in outcomes. Results: Overall attendance was 51.2%, and higher for in-person (72.0%) and hybrid (59.7%). Program satisfaction rate was highest for hybrid (93.0%), as well as program fidelity (96.7%). Focus group results revealed areas of program improvement, behavior change, and program approval. Cost was lowest for hybrid ($17.09/family). Children in the hybrid group had a reduced waist circumference (p = 0.02) versus in-person and online groups. Conclusion: The hybrid mode of Simple Suppers demonstrated the greatest scaling potential for a broader public health impact.

Multilevel Factors Influencing Food Purchasing Decisions Among Families With Low Incomes During the COVID-19 Crisis: A Qualitative Study

BACKGROUND

The COVID-19 crisis caused large-scale changes to the US food landscape, including food availability and prices, shopping practices, and food assistance programs. Understanding how these changes converged to influence food choices among families is critical for program and policy design to support children's healthy development.

OBJECTIVE

To explore food purchasing and feeding practices among low-income caregivers of young children during the COVID-19 crisis and economic recovery, including changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and neighborhood characteristics.

METHOD

This qualitative research conducted focus groups via videoconference with caregivers of young children with low incomes. Focus groups were stratified by WIC participation and language (English/Spanish).

PARTICIPANTS AND SETTING

Eligible participants were adult primary caregivers of a child younger than age 5 years who is a primary care patient at 1 of 2 participating pediatric health care systems, residents of Pennsylvania, fluent in English or Spanish, and were WIC eligible. Nine focus groups were held (7 English and 2 Spanish; N = 51 participants) during April to July 2023.

STATISTICAL ANALYSES PERFORMED

Focus group transcripts were analyzed with a combination of a priori and inductive codes, guided by grounded theory, resulting in a consensus-created coding scheme applied by 2 coders.

RESULTS

Three major themes developed: the COVID-19 crisis exacerbated existing food purchasing challenges and added new challenges; neighborhoods, shaped by structural barriers, do not adequately meet families' food needs; and administrative burdens continue to inhibit WIC use, although pandemic-related changes to WIC were beneficial.

CONCLUSIONS

Complex interactions between the food system, federal assistance program participation, and individual needs add burden to families struggling to make food purchasing choices. Results support the development of solutions to preserve families' agency to enact their beliefs and needs around healthy eating while accessing food assistance programs and managing the lasting economic impacts of the pandemic.

COVID-19-related lockdowns and changes in overweight and obesity, movement behaviours, diet quality, and health-related quality of life among regional Australian primary school children: A repeat cross-sectional study

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, the Australian state of Victoria (in particular, its capital, Melbourne) experienced some of the longest lockdowns in the world.

OBJECTIVE

This repeated cross-sectional study examined changes between March to June 2019 (pre-pandemic) and April to August 2022 (6 to 11 months following pandemic-related lockdowns) in overweight and obesity prevalence, physical activity, sedentary behaviour, sleep, diet quality, and health-related quality of life (HRQoL) among primary school children in north-east Victoria, Australia.

METHODS

Height and weight were measured for Grade 2, 4, and 6 students in 2019 (3889 children) and 2022 (1816 children). Grade 4 and 6 students self-reported on their movement behaviours, diet quality, and HRQoL.

RESULTS

Participation declined among schools (2019:56%, 2022:34%) and students (2019:87%, 2022:75%). Compared to children in 2019, children in 2022 had a higher prevalence of overweight and obesity; were less likely to have met guidelines for moderate-to-vigorous physical activity, recreational screen time, and vegetable consumption; had higher intakes of takeaway food, energy-dense nutrient-poor snacks, and sugar-sweetened beverages; and had lower HRQoL.

CONCLUSION

Children's health-related behaviours and outcomes seemed not to have returned to pre-pandemic levels 6 to 11 months after the final lockdowns lifted for their communities. Continued monitoring and interventions targeting the drivers of childhood obesity are urgently needed.

Changes in Body Mass Index during the COVID-19 Pandemic among Indonesian Adolescents: The Role of Sex, Urban Area, Baseline BMI, and Appetitive Traits

INTRODUCTION

Little is known about how the COVID-19 situation affected weight development among Indonesian adolescents. This longitudinal study examined whether, and for whom, the COVID-19 situation affected weight outcomes over time among adolescents from private schools and higher socio-economic positions in Indonesia, where being overweight is a rather prevalent characteristic. This study specifically examined whether appetitive traits (i.e., emotional overeating, food responsiveness) as well as baseline zBMI, sex, and urban area could explain changes in zBMI.

METHODS

At baseline, 411 adolescents from 5 private schools in Indonesia (53.3% males, Mage = 12.02 years, SD = 0.45) filled out questionnaires on appetitive traits and background characteristics. In addition, their height and weight were measured. Of these, 336 adolescents (81.8%) also participated at follow-up. At follow-up, height and weight were measured or reported. We used linear regression to analyze the association between predictors and interactions with zBMI.

RESULTS

The results showed a significant decrease in zBMI over time, with a lower average zBMI during COVID-19 compared to before COVID-19. Female adolescents and adolescents with higher baseline zBMI values particularly tended to show this zBMI decreasing pattern. We did not find statistically significant main effects of baseline emotional overeating, food responsiveness, and urban area or any interactions.

CONCLUSIONS

Indonesian adolescents appeared to decrease in terms of zBMI during COVID-19, particularly females and adolescents with higher pre-COVID-19 zBMI. Our findings suggest that (culturally-specific) contextual changes (i.e., less exposure to the Indonesian food environment at schools and more exposure to the home environment) might have a beneficial impact in terms of preventing overweight among Indonesian adolescents, particularly among those being more vulnerable (i.e., having higher baseline zBMI).

Pandemic-induced changes in household-level food diversity and diet quality in the U.S

Using household-level U.S. food-purchase data, this study investigates pandemic-induced changes in two measures of diet quality, a Berry Index that measures food diversity and a USDAScore that measures adherence to dietary guidelines. Using NielsenIQ consumer panel data and a total of XXX households that neither moved location nor left the panel from 2018 through 2020, we estimate an event-study model where each household's diet quality measures before and during the pandemic period are compared against the same households' scores one year prior. In the two-to-three months following pandemic-based school closures, which spanned the March-June 2020 period, depending on the specific U.S. state, we find modest increases in food diversity (of up to 2.6 percent compared to the prior year) for the Berry Index and larger temporary increases (of up to 8.5 percent) in diet quality as measured by the USDAScore. We also find that households with different demographic characteristics generally follow the same patters; however, households with young children, low-income households, and households that do not own a vehicle exhibit smaller increases.

Food-related consumer behaviours in times of crisis: Changes in the wake of the Ukraine war, rising prices and the aftermath of the COVID-19 pandemic

When the COVID-19 pandemic subsided, the war in Ukraine led to further disruptions in consumers' daily behaviours, with rising prices for food and energy. We conducted a survey study on self-reported changes in food-related consumer behaviour in ten European countries and compared the results to a similar study conducted two years ago. A latent class cluster analysis distinguished five clusters and showed that different types of consumers can be distinguished based on how they react to the crisis as regards their eating habits. 19% of survey participants reported no major changes, and 32% reported changes mostly in terms of more price sensitivity. Among those that reported changes beyond reacting to higher prices, there are indications of more mindful eating and more deliberate choices. The changes already found earlier in response to the COVID-19 pandemic therefore seem to have been strengthened and supplemented by reactions to price increases. The results present a challenge to the food industry in terms of supplying healthy and sustainable food at affordable prices.

Quantifying the Impact of Supermarket Distance on Childhood Obesity in Greater London, United Kingdom: Exploring Different Access Measures and Modification Effects of Transportation

Background: Healthy food access may be relevant for predicting trends in childhood obesity. The goal was to determine associations between childhood overweight (including obesity) and distance to three nearest supermarkets stratified by transportation modes (walking, cycling, driving). Methods: Bivariate and multivariate linear regressions examine the relationship with obesity, including interacting active and inactive modes. Results: Proximity to at least three supermarkets shows small but significant positive association with obesity. Walking mode showed higher obesity rates than driving, and distance was not related to the mode of travel. Conclusions: Disparities in healthy food access may not contribute meaningfully to childhood obesity, as other individual factors may be largely at play.

Vitamin D Levels in the Pre- and Post-COVID-19 Pandemic Periods and Related Confinement at Pediatric Age

Coronavirus disease 2019 (COVID-19) restrictions have been correlated with vitamin D deficiency in children, but some uncertainties remain. We retrospectively studied vitamin 25-(OH) D blood levels in 2182 Italian children/adolescents hospitalized for various chronic diseases in the year before (n = 1052) and after (n = 1130) the nationwide lockdown. The type of underlying disease, gender, and mean age (91 ± 55 and 91 ± 61 months, respectively) of patients included in the two periods were comparable. Although mean levels were the same (p = 0.24), deficiency status affected a significantly higher number of subjects during the lockdown period than in the pre-COVID period (p = 0.03), particularly in summer (p = 0.02), and there was also a smoothing of seasonal variations in vitamin D levels. Particularly at risk were males (OR = 1.22; p = 0.03), the 1–5 year age group (OR = 1.57; p < 0.01) and the 6–12 year age group (OR = 1.30; p = 0.04). Infants appeared not to be affected (p = 1.00). In the post-COVID period, the risk of vitamin D deficiency was unchanged in disease-specific groups. However, the proportion of deficiency or severe deficiency differed significantly in the subgroup with endocrinopathy (higher; Chi-square p = 0.04), and with respiratory problems and obesity (lower; Chi-square p = 0.01 and p < 0.01, respectively). Conflicting/opposite literature results advocate for further studies to clearly indicate the need for supplementation during possible future periods of confinement.

Czech Consumers' Preference for Organic Products in Online Grocery Stores during the COVID-19 Pandemic

A major advantage of online organic produce shopping is the fact that it saves energy and reduces emissions otherwise generated by customers during their time spent on the road and while shopping. Organic products in general positively impact sustainability, the environment, and the regions of their origin along with the social changes in these regions and further rural development. Moreover, these products positively impact the perceived health benefits and quality of food labeled as organic. The Czech Republic has currently seen a rise in organic food purchasing and supply trends. This study maps the factors possibly influencing consumers' decision to go shopping for organic food online. Observed factors include the following demographic characteristics of consumers (respondents): gender, age, education, household income, number of children in the household and number of household members. A total of 757 respondents from the Czech Republic from September 2020 to December 2020 took part in the research. Logistic regression, used for data processing, identified the statistically significant effects of education, income and number of household members on online purchases. These conclusions were confirmed by a detailed contingency tables analysis, including the almost monotonous trend of the dependencies, with only minor deviations in a maximum of one category. The strongest influence of some categories on the emergence of partial dependencies was found by residue analysis. The research confirmed that the frequency of online grocery shopping increases significantly with increasing education and income of respondents and decreases with increasing the number of household members. Most respondents apparently shop for groceries online because of time savings, better product choice and more convenient and easier search.