The kids aren't all right: COVID-19-fueled stress eating, inequities, lack of fitness expected to boost obesity, experts say
Pediatricians and public health experts predict a potentially dramatic increase in childhood obesity this year as months of pandemic eating, closed schools, stalled sports and public space restrictions extend indefinitely.
About one in seven children have met the criteria for childhood obesity since 2016, when the federal National Survey of Children's Health changed its methodology, a report out Wednesday by the Robert Wood Johnson Foundation found.
Though the percentage of children considered obese declined slightly in the past 10 years, it is expected to jump in 2020.
"We were making slow and steady progress until this," said Diane Whitmore Schanzenbach, a Northwestern University economist and professor. "It's likely we will have wiped out a lot of the progress that we've made over the last decade in childhood obesity."
The trend, seen in pediatric offices, is especially concerning as the Centers for Disease Control and Prevention this week expanded its definition of those at elevated risk of severe COVID-19 disease and death to include people with a body mass index of 25 to 30. Previously, only those with a BMI of 30 and higher were included. That could mean 72% of all Americans are at higher risk of severe disease based on their weight.
Obesity is a top risk factor for nearly all of the chronic health conditions that make COVID-19 more dangerous, including diabetes, hypertension, heart disease and cancer. Childhood obesity is a leading predictor of obesity later in life.
BMI factors in weight and height to measure body fat. It can overestimate body fat in people with muscular builds and underestimate it in those who have lost muscle, according to the National Institutes of Health.
Children are "gaining not insignificant amounts of weight," said Dr. Lisa Denike, who chairs pediatrics for Northwest Permanente in Portland, Oregon. "We've seen kids gain 10 to 20 pounds in a year, who may have had a BMI as a preteen in the 50 or 75th percentile and are now in the 95th percentile. That's a significant crossing of percentiles into obesity."
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Denike said one 11-year-old patient at his physical was found to have gained 40 pounds. Type 2 diabetes rates in children are rising, and even though the boy doesn't have it now, Denike said, "I suspect he will in the coming years as his parents already have it."
"He's home in an environment struggling with parents with the same issues rather than learning in health class and having activity outside," she said. "Kids are reflections of what their parents do."
Racial, socioeconomic disparities
Disparities in childhood obesity rates have existed for decades and mirror the disproportionate way COVID-19 affects people of color and those with low incomes, said Jamie Bussel, a senior program officer at the Robert Wood Johnson Foundation.
“In both cases, these outcomes reflect decades of disinvestment in specific communities and specific groups of people, often driven by the systemic racism and discrimination that are still so prevalent in our society,” he said.
Young people in households making less than the federal poverty level are more than twice as likely to be obese as those at the highest income levels, the RWJF report said. The pandemic and economic recession made many of the factors leading to obesity worse, including poverty and health disparities, Bussel said.
"We know that families switch to lower-quality food when they face food insecurity – that is, more calorie-dense foods and less variety," said Schanzenbach, director of Northwestern's Institute for Policy Research.
Childhood obesity ranges from 11% in the highest-income families to about 20% in low- to middle-income ones, said Dr. Imelda Dacones, Northwest Permanente's CEO. That contributes to higher obesity rates in Black and Hispanic populations, which include more people at lower income levels. In California, for example, she noted the number of people classified as food insecure increased from one in nine to one in six.
A report in July by Northwestern University researchers found more than 41% of Black households with children experienced food insecurity from April 23 to June 23, compared with almost 40% of Hispanic households and slightly more than 23% of white ones. The rates have declined for Blacks and Hispanic families since then but remained unchanged for white families.
"Even though it's not as bad as it was during the peak of the pandemic, food insecurity rates are still awful," Schanzenbach said.
Poor fitness, eating disorders grow
Those who study food insecurity, mental health and fitness said trends already heading in the wrong direction are especially alarming now.
Jim Baugh is founder and president of PHIT America, which circulated a petition starting in August to require 30 minutes of recess at least three times a week for all students. He noted nearly half of grade schools have no physical education, and "kids are more sedentary than they've ever been." The USA ranks 47th out of 50 countries in the world in children's fitness.
University of Virginia School of Medicine researcher Zhen Yan has studied exercise’s role in curbing the effects of COVID-19 and agrees more effort needs to be made to increase activity during childhood.
“If we want to protect our kids from deadly COVID-19, we must increase their physical activity and get them healthier," Yan said. "Too many kids already have preexisting conditions such as obesity.”
Young adults who experienced weight stigma and mistreatment have "increased vulnerability to distress" and bad eating habits during the pandemic, researchers at the UConn Rudd Center for Food Policy and Obesity concluded in a study in the Annals of Behavioral Medicine. The likelihood of binge eating during the pandemic was almost three times higher for people who experienced weight stigma before the pandemic than those who hadn’t. The findings were true for men and women.
Denike said the "mental health crisis" that existed before the pandemic has heightened and contributed to an increased number of eating disorder patients.
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Young people at risk of eating disorders "seek areas to control during stressful times," Denike said. They have a "limited menu of options" as children, she said, so restricting or overindulging in food is convenient.
As far more people feel distress during social isolation, there's more risk for people who "had some tendency to use food for not so good things," Dacones said. "It's driving kids as well as adults to do more unhealthy things."
The National Eating Disorder Association said it's seen nearly 80% increases in monthly calls and online chats during the pandemic compared with the same months last year.
Social isolation hasn't changed much for Tierney Sadler, a work-at-home marketing writer in Alexandria, Virginia, who said she is "morbidly obese" and about 100 pounds over the weight she should be. She can easily identify with kids struggling as her childhood weight problems were a constant focus of her family and source of stress, which made her eat more, she said.
"It was never going to be good enough, and I couldn’t shake that," said Sadler, 57, who was on a diet in kindergarten. "Obese kids have a lot of company today, but back in the ’60s, if you were the one fat kid, it really kind of does a number on you."
Parents can help, she said, by shielding children from household stress.
"Food is one of the ways we comfort ourselves," Sadler said. "There are a lot of things children absorb from their parents, who may be unemployed and terrified of the whole COVID thing. Their pores are so wide, they can suck in all that negative energy."
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