Family food insecurity associated with childhood weight gain: a longitudinal analysis of multiple adversities

Pandemic control practices had the unintended consequences of increasing children’s risk for multiple adversities, including food insecurity (FI). Understanding longitudinal patterns of children’s weight gain related to FI during the pandemic may provide insight into links between multiple adversities and child health. This study aimed to examine (1) pandemic-related changes in body mass index-for-age z-score (BMIz) among school-age children and (2) changes in BMIz by household FI risk across time. Participants were 367 children (pandemic onset age: 3.4-15.5y) and their caregivers residing in Maryland, US. Data were collected pre-pandemic (2017–2020), early pandemic (2020), mid-pandemic (2021), and late pandemic (2022). Children’s weight and height (BMIz calculated) were measured at pre-, mid-, and late pandemic. At all assessments, caregivers reported FI risks via validated 2-item screener, creating four patterns: always food secure; food secure at pre-pandemic then food insecure at mid- and/or late pandemic; food insecure at pre-pandemic then food secure at mid- and/or late pandemic; and always food insecure. Linear mixed models were used to examine (1) changes in BMIz (2), FI risks at mid- and late pandemic in relation to BMIz change, and (3) FI patterns in relation to BMIz change, adjusting for sociodemographic covariates. BMIz increased from pre- to mid-pandemic (β = 0.09;SE = 0.03; P < 0.01) and decreased from mid- to late pandemic (β = -0.12;SE = 0.04; P < 0.01), with no significant difference between pre- and late-pandemic BMIz. In adjusted models, children in families experiencing mid-pandemic FI had a greater BMIz increase from pre- to mid-pandemic versus counterparts (β = 0.20;SE = 0.10; P = 0.04). Children with persistent FI had the greatest increases in BMIz from pre- to mid-pandemic (difference-in-differences = 0.28; P = 0.035) and from pre- to late pandemic (difference-in-differences = 0.30; P = 0.033), compared with persistent food secure counterparts. The increase in children’s BMIz from pre- to mid-pandemic, followed by a late-pandemic decrease suggests that children’s BMIz was responsive to pandemic-related adversities. The heightened pandemic BMIz increase among children from households experiencing FI illustrates increased vulnerability with multiple adversities.