By Mara B., Lagniappe Wellness Dietetic Intern

On January 10th, 2020 the covid-19 outbreak was announced in Wuhan, China. By March and April, the “world [began] to shut down” (2). This closure brought about drastic changes such as school closures which forced children to stay home. Because of the shelter in place, children had fewer opportunities for physical activity, less access to balanced meals, and disrupted daily routines, among other detrimental outcomes. As a result of this, rates of childhood obesity have increased. 

As we address the covid-19 pandemic, it is important to discuss the epidemic of childhood obesity. Currently, 1 in 5 children are affected by childhood overweight and obesity. More than 30% of children are now considered to be overweight or obese (6). The Centers for Disease Control (CDC) and Prevention define overweight as 85-94 percentile of the CDC sex-specific weight for age growth charts. Obesity is considered to be within the 95-98 percentile and extreme obesity is classified as anything greater than the 99th percentile. 

Covid-19 and obesity overlap as obesity is a risk factor for increased severity of covid-19. Both diseases are influenced by ecological and biological factors. The figure below outlines how environmental factors such as an obesogenic environment, less physical activity, and weight bias/stress affect obesity (1). In comparison, environmental impacts from covid-19 such as shelter-in-place orders, decreased physical activity, and disruptions in the household can have deleterious outcomes for children. Additionally, a person’s genetics also impacts how both diseases affect children. Both obesity and covid-19 can alter the immune response, lead to states of stress, and cause inflammation. 

An important implication of school closures was that children wouldn’t have access to balanced meals provided throughout the school day. During the pandemic, many families experienced food insecurity. Food insecurity is defined as the “consistent lack of food to live a healthy life because of your economic situation”. Some parents were laid off from work meaning less money for groceries. As a result, cheaper foods high in calories and low in nutrients may have been more affordable options for families suffering from food insecurity. These cheaper food options put children at higher risk for obesity. The National School Lunch Program emphasizes the importance of incorporating meats/meat alternates, fruits/vegetables, grains, and fluid milk. The program has daily and weekly requirements for each food group to ensure children are receiving proper nutrition for their age group and reducing the risk of chronic diseases (4). Some families may not have the proper nutrition education required to provide balanced meals for their children especially when income is reduced. Proper nutrition is essential for growing children and should be of high importance to pediatricians as well. In order to create change, nutrition education should be a covered service for families to support the development of their children. 

Programs such as the Women, Infants, and Children (WIC) program can help families receive nutrition education and supplemental food assistance. The program is designed for pregnant moms and children up to the age of 5. However, during the pandemic enrollment for WIC only increased by about 2-3%. Participation in the program has been steadily decreasing within the past decade and did not drastically increase during the pandemic despite the need for supplemental assistance for families. Currently, WIC is trying to make enrollment and continued participation as easy and convenient as possible for families. The program is pushing for more video appointments making nutrition education more accessible for families. This “modernization” of WIC helps retain participants and supply supplemental assistance for children to have increased access to healthy foods (5). The WIC program also focuses on anthropometric data such as body mass index (BMI) and height to identify overweight, obesity, and proper growth in children. Referrals to WIC are of the utmost importance to support this valuable program and its efforts to reduce childhood obesity. Advocating for WIC by going to their website for advocacy https://www.nwica.org is also a great way to support the program. 

Physical activity in children was also significantly reduced as a result of school closures. Children were forced to stay home during the pandemic which reduced the amount of hours spent outdoors (3). With more time spent indoors the amount of screen time increased. It has also been noted that some children do not have access to a green area where they can exercise. Limited play area has been seen to disproportionately affect low-income populations as their households may be smaller meaning less space for children to play. Most children also began remote or hybrid schooling where their physical activity was done remotely during the day. However, not all households may have an area where physical activity can be done comfortably. Limited access to an environment conducive to movement increases a child’s risk for obesity. Providing education to parents on physical activity requirements, ideas for movement, and using daily child exercise videos can help get their children to be more active and reduce their risk for obesity. 

Clearly, the effects of the covid-19 pandemic have superimposed the epidemic of child obesity. Extended periods of isolation from school and social interaction have had lasting implications on the rates of child obesity. Consequences of covid-19 discussed for children include reduced access to healthful meals, less opportunity for movement, food insecurity, and immune system suppression. Children are one of the most vulnerable populations. For this reason, it is important to advocate for them by providing education on nutrition and physical activity to parents. Additionally, promoting community programs such as WIC provides supplemental assistance to families to reduce food insecurity. These strategies can lower rates of obesity in children to allow them to live a healthy balanced life.  

References:

1. Browne, Nancy T, et al. “When Pandemics Collide: The Impact of Covid-19 on Childhood Obesity.” Journal of Pediatric Nursing, U.S. National Library of Medicine, 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657263/.
2. Katella, Kathy. “Our Pandemic Year-A Covid-19 Timeline.” Yale Medicine, Yale Medicine, 9 Mar. 2021, https://www.yalemedicine.org/news/covid-timeline. 
3. Covid-19 and childhood obesity – researchgate.net. (n.d.). Retrieved December 31, 2022, from https://www.researchgate.net/profile/Ray-Marks/publication/359601351_COVID_19_AND_CHILDHOOD_OBESITY/links/6244aab17931cc7ccf0603a9/COVID-19-AND-CHILDHOOD-OBESITY.pdf
4. FNS nutrition programs. Food and Nutrition Service U.S. Department of Agriculture. (n.d.). Retrieved December 30, 2022, from https://www.fns.usda.gov/programs
5. USDA makes major investments in WIC to improve maternal and child health. Food and Nutrition Service U.S. Department of Agriculture. (2022, October 19). Retrieved December 30, 2022, from https://www.fns.usda.gov/news-item/usda-0224.22
6. “Childhood Overweight & Obesity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 1 Apr. 2022, https://www.cdc.gov/obesity/childhood/index.html.