LAUSR

Abstract Objective The COVID-19 pandemic in the U.S. led to nationwide stay-at-home orders and school closures. Declines in energy expenditure resulting from canceled physical education classes and reduced physical activity (PA) may elevate childhood obesity risk. This study estimated the impact of COVID-19 on childhood obesity. Methods A microsimulation model simulated the trajectory of a nationally representative kindergarten cohort's body mass index z-scores (BMIz) and childhood obesity prevalence from April 2020 to March 2021 under the control scenario without COVID-19 and under the 4 alternative scenarios with COVID-19—Scenario 1: 2-month nationwide school closure in April and May 2020; Scenario 2: Scenario 1 followed by a 10% reduction in daily PA in summer from June to August; Scenario 3: Scenario 2 followed by 2-month school closure in September and October; and Scenario 4: Scenario 3 followed by an additional 2-month school closure in November and December. Results Relative to the control scenario without COVID-19, Scenarios 1, 2, 3, and 4 were associated with an increase in the mean BMIz by 0.056 (95% confidence interval (95%CI): 0.055–0.056), 0.084 (95%CI: 0.084–0.085), 0.141 (95%CI: 0.140–0.142), and 0.198 (95%CI: 0.197–0.199), respectively, and an increase in childhood obesity prevalence by 0.640 (95%CI: 0.515–0.765), 0.972 (95%CI: 0.819–1.126), 1.676 (95%CI: 1.475–1.877), and 2.373 (95%CI: 2.135–2.612) percentage points, respectively. Compared to girls and non-Hispanic whites and Asians, the impact of COVID-19 on childhood obesity was modestly larger among boys and non-Hispanic blacks and Hispanics, respectively. Conclusion Public health interventions are urgently called to promote an active lifestyle and engagement in PA among children to mitigate the adverse impact of COVID-19 on unhealthy weight gains and childhood obesity.