Food and Housing Insecurity, COVID-19 Pandemic Effects on Health-Related Activities, and Care Plans for Children with Obesity

Kelsey A Egan; Jennifer G Fiore; Man Luo; Sheila Kelly; William G Adams; Elsie M Taveras; Meg Simione; Caroline J Kistin

doi:10.1016/j.acap.2024.10.010

Food and Housing Insecurity, COVID-19 Pandemic Effects on Health-Related Activities, and Care Plans for Children with Obesity

Acad Pediatr. 2024 Oct 28;25(2):102598. doi: 10.1016/j.acap.2024.10.010. Online ahead of print.

Authors

Kelsey A Egan¹, Jennifer G Fiore², Man Luo³, Sheila Kelly³, William G Adams⁴, Elsie M Taveras⁵, Meg Simione⁵, Caroline J Kistin⁶

Affiliations

¹ Division of Health Services Research (KA Egan and WG Adams), Department of Pediatrics, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Mass. Electronic address: kelsey.egan@bmc.org.
² Pediatric Primary Care (JG Fiore), Department of Pediatrics, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Mass.
³ Division of General Academic Pediatrics (M Luo, S Kelly, EM Taveras, and M Simione), Department of Pediatrics, Mass General for Children, Boston, Mass.
⁴ Division of Health Services Research (KA Egan and WG Adams), Department of Pediatrics, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Mass.
⁵ Division of General Academic Pediatrics (M Luo, S Kelly, EM Taveras, and M Simione), Department of Pediatrics, Mass General for Children, Boston, Mass; Department of Pediatrics (EM Taveras and M Simione), Harvard Medical School, Boston, Mass.
⁶ Hassenfeld Child Health and Innovation Institute (CJ Kistin), Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI.

PMID: 39490687
DOI: 10.1016/j.acap.2024.10.010

Abstract

Objective: To understand the association between food insecurity (FI) and housing insecurity (HI) risk, the effects of the COVID-19 pandemic on health-related activities among children with overweight or obesity, and caregivers' and clinicians' challenges and priorities related to pediatric weight management.

Methods: We conducted surveys with caregivers of children with overweight and obesity and pediatric clinicians at two academic medical centers in the Greater Boston area. We used multivariable logistic regression models to examine associations between FI and HI risk and the effects of the COVID-19 pandemic on health-related activities and descriptive statistics to summarize caregivers' and clinicians' challenges and priorities related to pediatric weight management.

Results: We analyzed data from surveys with 344 caregivers and 100 pediatric clinicians. Overall, 37% of caregivers endorsed both FI+HI, 18% FI alone, 10% HI alone, and 35% neither FI/HI. In the adjusted logistic regression models, combined FI+HI (reference: neither FI/HI) was significantly associated with higher odds of sleeping less (aOR 2.96 [95% confidence interval (CI): 1.46, 6.01]) and higher odds of spending less time outside (aOR 2.10 [95% CI: 1.06, 4.16]). Top priorities for pediatric weight management identified by both caregivers and clinicians were related to physical activity and availability of outdoor spaces.

Conclusions: Endorsement of both FI+HI was associated with children getting less sleep and spending less time outside during the COVID-19 pandemic. Future innovations in care plans for children with overweight and obesity should be adapted to a family's social context and should incorporate caregivers' and clinicians' challenges and priorities.

Keywords: food insecurity; housing insecurity; pediatric obesity; pediatric overweight; pediatric weight management.