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Updated: Sep 8, 2025

Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Body Mass Index in Children Before, During, and After the COVID-19 Pandemic
Frederik Kirkemann Jensen1, Sigrid Bjerge Gribsholt1,2,3, Sara Schwartz1
1Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark.
Insights
COVID-19 lockdowns significantly altered children's body mass index (BMI) categories. While overweight prevalence decreased post-pandemic, obesity remained elevated in younger children, and underweight increased in older children.
Area of Science:
- Pediatric Health
- Epidemiology
- Public Health
Background:
- Significant changes in children's body mass index (BMI) were noted during the COVID-19 pandemic.
- Understanding shifts in BMI categories (underweight, overweight, obesity) post-pandemic is crucial.
Purpose of the Study:
- To analyze changes in the prevalence of underweight, overweight, and obesity in Danish first and sixth graders.
- To compare BMI category prevalence during and after the COVID-19 pandemic versus pre-pandemic levels.
Main Methods:
- Cross-sectional population-based study using Danish health registry data (2019-2024).
- Inclusion of all first and sixth graders with available anthropometric data.
- Analysis of age- and sex-adjusted BMI (iso-BMI) categories using log-binomial regression.
Main Results:
- Overweight and obesity prevalence increased in both first and sixth graders during COVID-19.
- Overweight prevalence returned to pre-pandemic levels, but obesity remained elevated in first graders post-pandemic.
- Underweight prevalence decreased in first graders during COVID-19 but increased in sixth graders after the pandemic.
Conclusions:
- COVID-19 pandemic led to varied BMI category changes in children, differing by age group.
- Increased obesity in younger children and underweight in older children post-pandemic warrant attention.
- Findings underscore the need for age-specific public health interventions.
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.
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