BMI status and associations between affect, physical activity and anxiety among U.S. children during COVID‐19

Summary Background There is concern regarding how the COVID‐19 pandemic may impact the psychological and physical health of children, but to date, studies on mental health during the pandemic in children are limited. Furthermore, unprecedented lifestyle stressors associated with the pandemic may aggravate the childhood obesity epidemic, but the role of BMI on child activity levels and psychological outcomes during COVID‐19 is unknown. Objectives We investigated how emotional responses (positive/negative affect), physical activity (PA) and sedentary behaviours related to anxiety among U.S. children with healthy weight and overweight/obesity during the pandemic. Methods Sixty‐four typically developing children (63% girls, 53% healthy weight) aged 9 to 15 years completed two virtual visits during the height of ‘stay‐at‐home’ measures from April 22 to July 29, 2020. Children completed 24‐hours PA recalls, state portion of State‐Trait Anxiety Inventory for Children and the 10‐item Positive and Negative Affect Schedule for Children. Results Independent of child BMI status, child anxiety scores were over five standard deviations greater than normative values from paediatric populations prior to the pandemic. Higher positive affect and PA were each associated with reduced anxiety levels in children with overweight/obesity, whereas higher positive affect was associated with reduced anxiety in children with healthy weight. Greater leisure screen time was associated with higher negative affect irrespective of child BMI status. Conclusions These associations highlight the potential mental health benefits of maintaining positive affect, engaging in PA and limiting leisure screen time for children during the pandemic and suggest that these associations may be particularly relevant for children with overweight/obesity.