Impact of the Covid-19 Pandemic on Childhood Obesity in North Macedonia: A Comparative Study.

Abstract

Childhood obesity is an escalating global health concern, with North Macedonia ranking among the top 10 European countries with a high prevalence of overweight and obesity. This study aimed to assess the impact of the COVID-19 pandemic on children's Body Mass Index (BMI) by comparing data collected before and after the pandemic. A prospective cross-sectional study was conducted between February and April 2022, involving 1,004 children (ages 6-13) from the northwestern region of North Macedonia. These findings were compared with retrospective data from 2019, which included 1,034 participants of the same age group. Our results indicate that restrictive measures contributed to an increase in overweight prevalence from 13.5% in 2019 to 15.9% in 2022 and obesity from 19.6% to 21.9%. Overall, the combined prevalence of overweight and obesity rose from 33.0% to 37.4% during this period. The statistical analysis confirmed a significant association between the pandemic and increased childhood obesity rates (Pearson's Chi-Square test: χ² = 13.813, df = 3, p < 0.003). Gender disparities were also observed. In 2019, overweight and obesity were 1.42 times more common in boys than in girls (OR = 1.42; 95% CI: 1.09-1.84). By 2022, this ratio had slightly increased to 1.45 (OR = 1.45; 95% CI: 1.12-1.88). Furthermore, a general decrease in undernutrition was observed in 2022 compared to 2019. A significant reduction in undernutrition was noted among boys aged six (p = 0.008) and overall among boys (p = 0.017). According to the World Obesity Federation (WOF), if no effective prevention and intervention strategies are implemented, North Macedonia could see childhood overweight and obesity rates rise to 52.4% by 2030-meaning that one in two children would be affected. These findings highlight the urgent need for targeted public health initiatives to mitigate the long-term consequences of childhood obesity.