In this context, public health and obesity experts have expressed concern that a byproduct of the COVID-19 pandemic-related shutdowns will be excess weight gain among children. Such weight gain is problematic because it is maintained at least through the following school year, 5 and, in general, weight gain in childhood is predictive of later risk of being overweight and obese into adulthood, 10, 11 with later health consequences. 4– 8 The Structured Days Hypothesis explains this weight gain as due to changes to or lack of structured opportunities for physical activity through school physical education classes, recess, or recreational sports activities, the loss of regulated meal times and limits on amount and types of food, and more obesogenic screen time and sleep routines 9 these changes were also present as the pandemic disrupted normal school and childcare routines. 2, 3 Before the COVID-19 pandemic, higher rates of weight gain among school-aged children across the United States were observed during the summer months, when children are out of school, particularly among children who are overweight or obese and among racial and ethnic groups at a higher risk of obesity. 1 Starting in March 2020, the widespread closure of schools, recreation facilities, and recreational or sports activities because of the coronavirus disease 2019 (COVID-19) pandemic may have resulted in decreased physical activity and altered dietary habits in children, placing them at higher risk for excess weight gain. Childhood obesity is a serious problem with long-term health and quality of life concerns nearly 1 in 5 US children were categorized as obese in 2018.
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