As a pediatric endocrinologist in a busy New York City hospital, I am acutely aware of the impact COVID-19 has had on my patients. The physical, emotional, social, and academic costs of the pandemic are evident every time I examine a child diagnosed with the virus. However, I am also deeply aware of another health risk that is threatening the well-being of my patients -- the significant increase in obesity that we have seen in children and teenagers over the past 18 months.
Before COVID-19, obesity affected around 20% of American children 2 to 19 years of age. Now, the numbers are expected to rise much further, with modeling studies predicting at least a 3% to 4% weight gain in children during the pandemic. In my obesity practice, children who had been losing weight before the pandemic are now returning with an average weight gain of 10 to 20 lb.
In fact, the signs I'm seeing suggest we are facing a dangerous collision between the COVID-19 pandemic and a surging obesity epidemic. Obesity and overweight have soared among my patients due to a number of factors directly related to the pandemic, including less access to physical education at school, a drop in extracurricular sports activities, and fewer healthy food choices because of financial challenges and shopping restrictions. The pandemic also exacerbated an already existing mental health crisis in youth, with an increase in emotional eating among children who are experiencing greater anxiety and depression.
If we do not urgently address the obesity epidemic, the pandemic's impact on the health of children with overweight and obesity will remain, with potential long-term consequences for our nation's wellbeing.
Adolescent Obesity Has More Than Tripled Over the Past 30 Years
While the spike in pediatric obesity during the pandemic is especially severe, it's part of a long-term trend. In September 2021, the CDC released results of a study that found that 22% of children and adolescents had obesity last August, up from 19% one year prior. The study showed that children with healthy weight were gaining an average of 3.4 lb per year before the pandemic but gained 5.4 lb per year during the pandemic. For children with obesity, the expected annual weight gain rose from 6.5 to 12 lb after the pandemic began, and from 8.8 lb to 14.6 lb in those with severe obesity.
Over the past 30 years, the childhood obesity rate has more than doubled in kids ages 2 to 5 years, tripled in youth ages 6 to 11, and more than tripled among adolescents ages 12 to 19. In fact, pediatric overweight and obesity affects more than 30% of children, and it is the most common chronic disease of childhood. Looking at the long-term consequences of this disease, children with obesity are more likely to become adults with obesity and all of its associated health problems, including type 2 diabetes, stroke, and ischemic heart disease later in life.
Physicians Must Take Steps to Address Our Dual Crises
Programs promoting nutritional and lifestyle resources and getting kids active again are vital to supporting children and their families during this collision between the obesity epidemic and the COVID-19 pandemic. At my practice, we converted our weight program from in-person to a virtual format last summer to continue providing group nutritional education and physical activity opportunities for our patients. We engage children in cooking and physical activity demonstrations, with a focus on promoting healthy weight by maintaining a balanced diet and finding safe opportunities for exercise.
When discussing healthy food options, we highlight foods with a lower glycemic index to promote more stable blood sugar levels. These foods include nuts, beans, high-fiber fruits such as pears, berries, and apples, and whole-grain breads. We encourage carbohydrate choices that provide vitamins, minerals, and fiber, and discourage high-calorie sugary drinks. We stress the importance of family support. Encouraging children as they try new foods and helping them enjoy balanced meals opens up the entire family to healthier dietary choices.
Physicians also have an important role to play in advancing initiatives that support healthier outcomes for children and their families. Pediatricians are particularly well positioned to discuss diet, nutrition, and exercise with patients or their parents. Government plays a part too -- we need national health policies that will provide guidance and resources to families and schools. These recommendations must include support for increased funding for healthy meals, physical activity opportunities, and access to healthcare services for families in need. And finally, we must ensure access to COVID-19 vaccines for children who are eligible, and for younger kids once they're authorized. Helping children stay in school will support their physical and emotional wellbeing and health.
As physicians, we serve as advocates for the health of our patients, today and tomorrow. If we intervene early to prevent the health complications caused by obesity and overweight, we can help give children a healthier future. Staying up to date on the latest pediatric-focused obesity resources and research can help.
Marisa Censani, MD, is a pediatric endocrinologist and the director of the Pediatric Obesity Program in the Division of Pediatric Endocrinology at Weill Cornell Medicine and NewYork-Presbyterian Hospital. She currently serves on the Board of Trustees of the Obesity Medicine Association (OMA) and is co-author of OMA's Pediatric Obesity Algorithm.
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