P2B278: Health-related Quality of Life in Youth Participating in the fitkids360 Pediatric Weight Management Program: Impact of the COVID-19 Pandemic

Background: Obesity has been associated with several psychological comorbidities such as depression, anxiety, low self-image, behavioral problems, and low health-related quality of life (HRQL). Research indicates a reciprocal relationship between obesity and mental health such that exacerbations to one may worsen the other. In addition, the COVID-19 pandemic (COVID) may have further increased psychosocial stressors in many youth. Recent evidence suggests multidisciplinary pediatric weight management (PWM) may improve depressive symptoms and psychosocial outcomes for youth with obesity. The aims of the current study were to 1) evaluate changes in HRQL during a 7-week, group-based PWM program, and 2) compare the impact of COVID on baseline HRQL levels and changes during PWM treatment.

Methods: FitKids360 (FK) is a group-based, family-centered behavior modification program targeting physical activity, nutrition, sleep, and sedentary behaviors among youth with overweight and obesity. Study participants were youth aged 5-18y who participated in FK during an 8-year period from 2014 through 2022, and FK classes were designated as pre-COVID (before March 2020), COVID (March 2020 through August 2021), or late-COVID (after August 2021). Patient parents completed the Pediatric Quality of Life Inventory with scores ranging from 0-100 to index HRQL before and after FK.

Results: A total of 1482 participants aged 11.0 ± 2.8 years participated in a FK class and provided HRQL data at baseline, including 1299 pre-COVID, 90 during COVID, and 93 late-COVID. Baseline HRQL did not differ across pre-COVID (mean ± SD: 67.5 ± 17.0), COVID (65.4 ± 17.3), or late-COVID (66.5 ± 18.9; p=0.508). However, baseline HRQL was lower among youth ≥12y (64.3 ± 17.2) compared to those < 12y (69.0 ± 16.9; p< 001) and differed by weight status with reduced HRQL as weight status increased (overweight: 72.4 ± 16.7, obesity (class 1): 70.0 ± 16.8, severe obesity (class 2): 67.5 ± 17.3, severe obesity (class 3): 63.4 ± 16.5 (p < 0.001)). During FK, HRQL significantly improved 4.1 ± 15.3 points (p < 0.001) and did not differ by COVID period (pre-COVID: 3.9 ± 15.3, COVID: 4.6 ± 17.8, late-COVID: 5.4 ± 13.7; p=0.688) or by age group, gender, or race/ethnicity.

Conclusion: On average, baseline parent-reported HRQL did not differ by COVID time period for youth seeking PWM. HRQL levels were lower among youth with greater obesity severity at baseline, but scores consistently increased among all demographic and weight status groups during the FK intervention. Future research is needed to evaluate the durability of these HRQL changes long term, and to define PWM best practices for conferring mental and emotional health benefits in addition to physiological improvements.