1. Introduction
Since December 2019, the SARS-CoV-2 virus, responsible for the COVID-19 disease, has spread across the globe and caused a global pandemic. The World Health Organization (WHO) declared it a public health emergency of international concern on 30 January 2020 [
1].
On 12 March 2020, Romania declared a state of emergency [
2]. The COVID-19 pandemic has had an adverse influence on the whole of society. Many national governments introduced measures to counteract the disease and avoid infections, such as social distancing policies, closures of schools, shops and leisure opportunities, and contact restrictions. This unprecedented situation led to significant changes in children’s daily routine; they no longer attended school and out-of-school activities (e.g., participation in sports, free play at playgrounds, etc.), but were isolated at home with their families. Furthermore, self-isolation has also been linked to boredom and stress, which lead to higher consumption of energy-dense comfort food and emotional eating. Home quarantine and online schooling have led to unhealthy food alternatives, increased time spent in front of screens, chaotic sleeping hours, and it being challenging to practice physical activities (PA) outside the home. Typically, children undertake many additional activities besides school, such as horse riding, swimming, dancing, and learning foreign languages. The limitation of these activities also limited contact with friends, which significantly increased efforts to maintain relationships through social media and various types of communicators [
3]. This significantly influenced their health, including nutrition, physical exercise, sleep, and social functioning, increasing their media use [
4].
Any unhealthy eating habits in the growth period of life can lead to irreversible consequences such as increased risk of obesity, non-communicable diseases, and decreased immune system function [
5,
6].
A reduction in PA during the pandemic could have harmful effects, as PA during youth is an essential determinant for future PA [
7,
8], preventing future obesity and cardiovascular diseases and providing mental health [
7].
Restrictive social interactions imposed by the pandemic aggravated the overuse of digital devices for socializing, which included virtual dates, virtual tourism, and virtual parties and family conferences. While mindful (and regulated) use of digital devices is linked with well-being, excessive screen time is reportedly associated with a range of adverse mental health outcomes such as psychological problems, low emotional stability, and greater risk for depression or anxiety [
8]. Studies from the literature showed an increase in total screen time among children, adults, and adolescents [
9].
Children who regularly get the right amount of sleep benefit from better attention, behavior, learning ability, memory, and overall better mental health. Sleep deprivation can lead to high blood pressure, obesity, and depression [
10]. Sleep disturbance can significantly impact the ability to concentrate, emotional health, immune function, and academic performance. Its deficiency increases the risk of cardiovascular disease in children and adolescents and can result in mood swings, which may be exacerbated by poor mental health caused by the COVID-19 pandemic [
11]. Data from the literature regarding sleep among children and adolescents during the pandemic are controversial. Some studies reported an increase in sleep time per day during the pandemic compared with the pre-pandemic period [
12,
13]. Another study mentions that 40% of Chinese teenagers experienced problems falling asleep, staying asleep, and not sleeping too much [
14].
In Romania, there is a gap with respect to studies investigating lifestyle and behaviors among adolescents during the COVID-19 pandemic, and particularly during the period of remote learning. Therefore, this study aimed to evaluate the lifestyle during remote schooling for secondary school students from the Northwest Romanian region (the equivalent of NUTS 2 regions in the European Union). Another aim was to assess the effect of lifestyle behaviors on the nutritional status of adolescents during the COVID-19 pandemic. We evaluated body mass index, nutrition, PA, interaction with electronic devices, and sleep.
To the best of our knowledge, this is the first study in Romania to investigate behavioral factors related to weight status during the distance learning of adolescents.
4. Discussion
The study aimed to evaluate the lifestyle and the effect on the nutritional status of secondary school students and adolescents from the north-western part of Romania during the COVID-19 pandemic distance learning. We evaluated body mass index, nutrition, PA, interaction with electronic devices, and sleep.
The nutritional status was assessed in our study by the BMI indicator, using self-reported weight and height. According to the results of our research, over half of the boys were overweight or obese, compared to only 21.6% of girls that were overweight or obese. Data from the literature investigating BMI changes during the pandemic showed an increase in annual BMI during the COVID-19 pandemic compared to previous years, especially among children in the obese range [
21]. School closures may have affected children’s increased weight gain [
22]. Other studies showed a reduced pattern of PA, increased sedentary activities, and sleeping and screen time, leading to an increase in BMI [
23]. In the present study, the results showed that the adolescents’ BMI was associated with the BMI of the parents and the number of hours spent on screen time in their free time during the pandemic. These results support the role of environmental factors as modifiable factors influencing the nutritional status of children.
Regarding food intake, the study’s results revealed an appropriate consumption of fruits by the majority of adolescents, 88% of girls, and 88.1% of boys consumed 1–2 or at least three portions per day. Vegetable intake was very low in comparison to the recommended intake. Most respondents did not consume three portions per day, many of them avoiding consumption altogether. These results are consistent with studies on different Romanian populational groups, confirming the trend of insufficient vegetable consumption in contrast with an appropriate fruit intake [
15,
24,
25].
In this study, we considered comfort foods, the consumption of sweets, fast food, chips, sweetened sugar beverages, and even cereals (pasta, rice, bread, and other cereals). The present study revealed high consumption of sweets, SSB and cereals among Romanian secondary school students during the pandemic. Our results are similar to studies among children from Poland showed increased intake of sweets and reduced SSB and fast food [
26]. These findings are also consistent with a survey taken in Italy among children and adolescents that evidenced an increase in sweetened snack packages [
27], bread, pizza, and bakery products.
Other review studies showed an increase in snacks and sweets consumption similar to the present study [
28,
29]. Moreover, previous Romanian studies carried out on adolescents evidenced a high intake of SSB (especially among boys) and other types of sweets (chocolate, added sugar, candies, and cookies) [
30].
Regarding the distribution of meals, we found statistically significant differences between girls and boys who did not eat breakfast (22.85 vs. 13.6%). These results are similar to other studies in the literature that revealed that Romanian pupils tended to skip breakfast [
31,
32]. Previous research has evidenced that childhood obesity is associated with lifestyle factors, such as lack of sleep, excess screen time, skipping breakfast, and a lower frequency of family meals [
33,
34,
35,
36].
One of the disadvantages of the present study was the lack of the data from pre-pandemic period. Previous reports from the National Institute of Public Health in our country [
37] reported an obesogenic environment, with consumption based on refined cereals, added sugars and fats, and a reduced intake of vegetables, fruits and fish. This pattern of energy-dense food consumption can lead to overweight and obesity. It is possible that the results of our study evidenced dietary cultural habits of the Romanian population that were preserved and perhaps augmented during the pandemic.
Another important lifestyle component that was estimated in our study was PA. It is well established that PA and exercise are essential to improving/maintaining physical and mental health and improving quality of life [
38]. Studies from the literature have evidenced that measures restricting the spread of COVID-19 led to a decline in PA for most children and adolescents, especially among boys and older children and adolescents [
7]. Data from the literature evidenced that girls usually performed less PA than boys [
39].
Even when students learn at home, health and physical educators should provide guidance and activities to help them meet the recommended 60 min or more of moderate-to-vigorous PA daily for children and adolescents ages 6–17 [
40].
According to the results of our study, the respondents met the recommendation of daily PA, mainly due to unorganized PA (e.g., playing with other children). PA was lower, especially in boys, but the results were not statistically different. These results are similar to those of other studies from the literature concluding that children and adolescents performed less PA and more sedentary activities, and the most common PA during the pandemic was free-play/unstructured PA (e.g., going for a walk, running) [
41,
42].
The move to online schooling during the pandemic led school-aged children to spend many hours a day in front of the screen interacting with their teachers and classmates [
43]. The results of our study showed that almost all the adolescents spent 4–6 h or more during the remote school, exceeding the recommendation of the American Academy of Pediatrics (AAP) for recreational screen time, which should be limited to less than 2 h per day for children 11–13 years old [
44].
In addition, a previous study found that children’s screen time (e.g., watching television and playing video games) increased significantly from 2.6 h to 5.9 h/day (on average 3.2 h/day) during the pandemic-related school closures [
45]. Evidence from the literature shows that changes in children’s screen time use are associated with greater parental involvement, a modifiable risk factor in promoting children’s well-being [
46,
47]. In our study, almost half of the secondary school students, both girls and boys, spent 4–6 h or more in front of different devices. Parental control was reported in a low percentage, about a third of the children (32.3% for girls and 33.1% for boys).
One other lifestyle factor that could have been modified during the pandemic and was important to consider was sleep. Sleep and mental well-being are intimately linked. Studies conducted during the pandemic suggest that COVID-19 impacted sleep and anxiety in multiple countries and across age groups [
48,
49]. Sleep disturbance among children was attributed to bedtimes and wakeup times, inability to do outdoor activities during the lockdown, remote learning, and lack of interpersonal social activities. Although intrinsic factors regulate sleep, extrinsic factors are essential in determining sleep duration, timing, and quality. Behavioral factors (e.g., screen time, PA, bedtime routine), physical and environmental factors (e.g., light and noise exposure), and parental factors (e.g., parental child attachment, parental education, parental stress) all affect the sleep health of children [
50]. The recommended sleep amount for school-age children of 6–13 years of The Sleep Foundation Organization is about 9–11 h per night [
51,
52]. In our study, Romanian pupils had, on average, 8.11 hours of sleep, and significantly more for boys than for girls. The study results revealed that most respondents went to bed between 22:00 and 24:00, and a significant percentage after 24:00 (19.2% of girls and 13.6% of boys). Sleep quality was also affected; 44.9% of girls and 22.0% of boys (
p = 0.001) reported unrestful sleep. These results are consistent with other studies that showed poor quality sleep among children and adolescents during the pandemic [
53] and changes in sleep habits [
48,
54].
Our study is subject to some limitations. First is the method of the online questionnaire. Bias can appear through overestimation or underestimation of food intake and PA. Self-reported weight and height were other limitations of the study. Respondents with overweight, especially girls, may under-report their weight. Overweight status may be also a predictor of reporting error in height. However voluntary participation in the study may limit these unreliable answers. Objective methods to measure weight, height, and PA would lead to more accurate data results. Another limitation of our study was that we selected children from environments with digital resources to make the data collection possible. Because of voluntary participation, there may have been participation bias favoring students who are more willing to answer questionnaires. Another limitation of our study was the lack of data from the pre-pandemic period, which would have allowed us to make comparisons with the pandemic lifestyle. However, to the best of our knowledge, this is the first study from Romania that evaluates the lifestyle of adolescents during remote learning. Follow-up studies are necessary to investigate whether these behaviors will be adopted in the future.
This future research must be applied on a larger sample size to better understand the environmental factors involved in children’s lifestyles that can lead to overweight and obesity during or outside the pandemic.
These findings identify targets for behavioral and environmental interventions to reduce childhood obesity risks and promote a healthy lifestyle.