Introduction: The Covid-19 pandemic drastically modified social life and lifestyle in particular among children and adolescents, promoting sedentary behaviors and unhealthy eating habits. In this scenario, the effectiveness of the outpatient approach for pediatric obesity may decrease. Objectives: Aims of this study were to assess the rate and the factors associated with outpatient drop-out by comparing two groups of children and adolescents with obesity evaluated at the pediatric endocrinology outpatient clinic before and during the Covid-19 pandemic, respectively, and to evaluate how Covid-19 pandemic influenced the weight status and lifestyle of children and adolescents with obesity. Results: One hundred and forty-five children and adolescents with obesity were evaluated, including 80 subjects (mean age 11.6 ± 2.3 years) evaluated before the Covid-19 pandemic (group A) and 65 subjects (mean age 11.8 ± 2.7 years) in the period straddling the Covid-19 pandemic (group B). Anamnestic (dietary habits, physical activity, screen time, family history of obesity), socio- cultural (economic status, employment and schooling of parents, household composition, place of living) and clinical (weight, height, BMI, waist circumference) data were analyzed at baseline (T0) and at 12-months (T1) in-person assessment. Glico-lipids biochemical profile was assessed at T0. The drop-out rate did not differ significantly between the two groups. BMI SDS at T0 (OR=2.52; p=0.004), female sex (OR=0.41; p=0.035) and incomplete household (OR=5.74; p=0.033) significantly influenced drop-out in both groups. BMI SDS, not significantly different between the two groups at T0, was significantly higher in group B than group A at T1. Consistently, weight loss between T0 and T1 was significantly greater among group A patients compared to group B (p=0.031). Hours spent in physical activity decreased significantly in group B from T0 to T1 and were significantly lower than group A at T1. Screen time increased significantly in group B from T0 to T1 and were significantly greater than group A subjects at T1. The consumption of sugary drinks and snacks was significantly greater in group B than group A at T1. Hours spent in physical activity (OR=2.27, p=0.038) and group A belonging (OR=0.16, p=0.028) significant influence weight loss. Conclusions: Our study documented that the Covid-19 pandemic, although it has not affected the drop-out rate of obese children, negatively influenced lifestyle and reduced the effectiveness of outpatient counseling in childhood obesity treatment.
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