{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T20:06:45Z","timestamp":1790453205994,"version":"4.1.0"},"reference-count":71,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>BACKGROUND AND OBJECTIVES<\/jats:title>\n                    <jats:p>Childhood obesity has remained persistently high in the United States. This study aimed to (1) assess changes in obesity prevalence and (2) examine the associations of ultra-processed food (UPF) intake and physical activity (PA) patterns with obesity, by obesity severity, before and during the COVID-19 pandemic among US 2- to 19-year-olds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A serial cross-sectional analysis using the National Health and Nutrition Examination Survey compared data from before (2017 to March 2020) and during (August 2021 to August 2023) the COVID-19 pandemic. Obesity was determined using body-mass-index-for-age percentiles: class I obesity (\u226595th percentile to &amp;lt;120% of the 95th percentile), class II (\u2265120% to &amp;lt;140%), and class III (\u2265140% of the 95th percentile). UPF intake was assessed via 24-hour dietary recalls. Participants self-reported the number of days\/week they engaged in moderate to vigorous PA. Survey logistic regression models assessed the odds of increasing obesity severity by UPF intake and PA, age, sex, race, ethnicity, and household income.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Analysis included 4756 participants in the pre-pandemic period and 2501 in the pandemic period. Obesity prevalence was 21.2% pre-pandemic (N\u2009=\u20091072) and 22.6% during the pandemic (N\u2009=\u2009694; P\u2009=\u2009.30). Mean %UPF intake decreased from 66.0% to 62.7% (P\u2009&amp;lt;\u2009.01). Before the pandemic, adjusted analysis showed youth with higher PA days had lower odds of class II obesity (odds ratio [OR]\u2009=\u20090.86, 95% CI: 0.76\u20130.97) and overall obesity (OR\u2009=\u20090.91, 95% CI: 0.85\u20130.97), with a protective effect across class I and III that did not reach significance. During the pandemic, meeting PA guidelines was also protective against overall obesity (OR\u2009=\u20090.86, 95% CI: 0.76\u20130.99). Although no significant predictors of obesity by class emerged during the pandemic, protective nonsignificant effects of PA were also observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Obesity prevalence trended up from before to during the pandemic, and PA was associated with obesity, whereas no distinct associations of UPF and increasing obesity severity emerged.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2024-070370","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T00:02:56Z","timestamp":1764633776000},"source":"Crossref","is-referenced-by-count":5,"title":["Obesity and Severe Obesity in Youth Before and During COVID-19"],"prefix":"10.1542","volume":"157","author":[{"given":"Sarah E.","family":"Messiah","sequence":"first","affiliation":[{"name":"1Department of Epidemiology, Peter O\u2019Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"2Department of Pediatrics, Division of General and Community Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"3Children\u2019s Health System of Texas, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujia","family":"Guo","sequence":"additional","affiliation":[{"name":"4Department of Health Data Science and Biostatistics, Peter O\u2019Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luyu","family":"Xie","sequence":"additional","affiliation":[{"name":"5Quantitative Biomedical Research Center, Department of Health Data Science and Biostatistics, Peter O\u2019Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepali K.","family":"Ernest","sequence":"additional","affiliation":[{"name":"1Department of Epidemiology, Peter O\u2019Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"6Department of Epidemiology, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eur\u00eddice Mart\u00ednez","family":"Steele","sequence":"additional","affiliation":[{"name":"7Center for Epidemiological Research in Nutrition and Health, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"8Department of Nutrition, School of Public Health, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Neri","sequence":"additional","affiliation":[{"name":"7Center for Epidemiological Research in Nutrition and Health, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"9Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret E.","family":"Sova McCabe","sequence":"additional","affiliation":[{"name":"10School of Law, University of Arkansas, Fayetteville, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacia M.","family":"DeSantis","sequence":"additional","affiliation":[{"name":"11Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany R.","family":"Cartwright","sequence":"additional","affiliation":[{"name":"3Children\u2019s Health System of Texas, Dallas, Texas"},{"name":"12Department of Pediatrics, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas"},{"name":"13Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven E.","family":"Lipshultz","sequence":"additional","affiliation":[{"name":"14Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Barlow","sequence":"additional","affiliation":[{"name":"3Children\u2019s Health System of Texas, Dallas, Texas"},{"name":"15Department of Pediatrics, Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"issue":"16","key":"2025123118574268900_r1","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1001\/jama.2018.3060","article-title":"Trends in obesity and 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