Monday, September 27, 2021

Is the pandemic worsening childhood obesity rates?

 - Jennifer Middleton, MD, MPH

The COVID-19 pandemic is correlating with worsening health measures in adults (obesity and alcohol consumption, for starters), and new evidence demonstrates concern with increasing rates of childhood obesity as well. 

Centers for Disease Control and Prevention (CDC) researchers examined data from IQVIA's electronic records, including over 432,000 children and teens aged 2-19 years from across the United States (US). Among this relatively diverse cohort (34.3% non-white), they found that:

Between the prepandemic and pandemic periods, the rate of BMI increase approximately doubled, from 0.052 (95% confidence interval [CI] = 0.051–0.052) to 0.100 (95% CI = 0.098–0.101) kg/m2/month (ratio = 1.93 [95% CI = 1.90–1.96]). Persons aged 2–19 years with overweight or obesity during the prepandemic period experienced significantly higher rates of BMI increase during the pandemic period than did those with healthy weight. 

The rate change was most dramatic for children aged 5-11 years (0.09 kg/m2/month or 3 oz/m2/month which is 2.5 times higher than during the prepandemic time period.). The CDC authors posit that school interruptions are a likely contributor to these changes which makes sense given that school is, for many children, an essential source of nutritious meals and physical activity

A somewhat smaller study of 191,000 US children published last month using Kaiser Permanente data from Southern California had similar findings, with statistically significant differences in weight gain among children aged 5-11 years ("a mean gain among 5- through 11-year-olds of 2.30 kg (95% CI, 2.24-2.36 kg) more during the pandemic than during the reference period"). These researchers provided more information about the diversity of their cohort, with "10.4% Asian and Pacific Islander, 50.4% Hispanic, 7.0% non-Hispanic Black, and 25.3% non-Hispanic White."

Ensuring access to nutritious meals and physical activity are necessary components of a healthy school environment. A bill is currently pending in the US Congress to fund universal free meals in all US schools. Studies show that providing time for physical education does not harm children's educational gains. Additionally important is creating a healthy psychological environment, as weight-based bullying in school is very common, with both peers and educators as perpetrators. Family physicians can support children by letting their US congressperson know of their support for the Universal School Meals Act, by encouraging school leaders to allow time for physical activity during the school day, and by educating ourselves about our conscious or subconscious biases about overweight persons. We can then work with families to have nonjudgmental conversations about behavior modifications to limit or reverse weight gain. 

If you'd like to read more, check out this AFP article on "Evaluation and Treatment of Childhood Obesity" and this AFP Cochrane review on "Interventions for Reducing Childhood Obesity." These AFP patient education handouts on "Helping Your Child Keep a Healthy Weight" and "Helping Your Child Lose Weight" contain several practical tips to discuss with families as well.