- Oleg Chizhov | Dreamstime
In the midst of a pandemic — when so many people are out of work, feeling stressed about their finances and concerned about keeping their families healthy — it can seem trivial to worry that our kids have put on a few extra pounds.
But childhood weight gain remains a serious health concern, especially now. Experts predict that the prevalence of kids who are considered overweight or obese will increase by about 5 percent during this global health crisis. Dr. Lewis First, chief of pediatrics at the University of Vermont Children's Hospital, calls that increase "significant." But he has some advice for parents to help their kids keep the weight off, without becoming "the food police."
KIDS VT: What are the health concerns associated with weight gain in children, especially during the pandemic?
- Dr. Lewis First
LEWIS FIRST: Obesity is a chronic disease that increases children's short-term and long-term health risks. In the short term, we know that adults who are overweight or obese who get COVID-19 are more likely to have more serious complications from the illness, and we suspect that the same is true for children. Some studies suggest that being overweight or obese makes a child's body more susceptible to the coronavirus that causes COVID-19, which potentially can result in more significant complications, such as worsening respiratory symptoms, or a rare but serious complication called multisystem inflammatory syndrome in children, or MIS-C. This is a condition in which different parts of the body can become inflamed — including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs — as a reaction to being exposed to this virus.
We also know that about one in three children and teenagers nationally is overweight and about 15 to 20 percent are considered obese. The U.S. Centers for Disease Control and Prevention define children as "overweight" if their body mass index (BMI) is in the 85th to 94th percentile for children of the same age and gender, and "obese" if their BMI is in the 95th percentile or higher.
Before the pandemic, rates of childhood obesity had stabilized and even started to decline. Long-term, we also know from pre-pandemic studies that two-thirds of children who are obese by age 5 will be obese by age 50. And 90 percent of teenagers who are obese will remain so as adults, which puts them at heightened risk for hypertension, heart attacks, strokes, sleep apnea and type 2 diabetes.
KVT: Why has the pandemic reversed the progress made in reducing childhood obesity?
LF: Several factors are at work. First, access to in-person school means access to healthier foods for breakfast and lunch. With many schools operating remotely, children have less regimented schedules, are getting less physical exercise and are spending more time on screens, allowing them to snack more.
Many families also face heightened food insecurity, resulting in children consuming less-expensive, high-calorie snack foods and sugary beverages. We also know that when people are depressed, they tend to worry less about what they're eating or how much. Anxiety and lack of sleep can also contribute to weight gain. The hormones that rev up when you're stressed are also the ones that pack on the pounds.
KVT: Has the shift to more telehealth — medical visits done remotely via the internet — made it more difficult for health professionals to gather weight information?
LF: Unfortunately, when kids aren't in the office where we can gather their height and weight, we miss opportunities to make a difference. But the American Academy of Pediatrics is trying to find ways to gather this information. If a family has a scale at home when we do a telehealth visit, we try to record where kids are now weight-wise compared to when we last saw them.
Keep in mind that, at ages 8, 9 and 10, kids start to put on some weight before their height shoots up as puberty begins. That may be absolutely normal and follow a healthy growth curve. That's where your child's health professional can be helpful. If, all of a sudden, your child looks a little fuller in the face at that age, and you've already been focused on them eating right, it may be time for a discussion about puberty rather than increasing body weight.
KVT: What steps can parents take to keep their kids at a healthy weight?
LF: We want to help parents create schedules, lifestyles and behavioral patterns that reinforce the good, so that their children learn what they need to do to keep themselves healthy. Parents can start by putting healthy fruits and cut vegetables in the refrigerator that their children can "grab and go" if they want to snack healthy, and by getting rid of those high-calorie snack foods and sugary beverages. One good method to think about on a daily basis is the 5-2-1-0 plan: Eat five fruits and veggies; allow no more than two hours of nonacademic screen time; get at least one hour of physical activity, which can be spread throughout the day; and drink zero sugary beverages. Parents should become role models for their kids by following this model themselves.
KVT: How can parents avoid stigmatizing their child's weight?
LF: We really don't want parents fixating on their children's weight or banning certain foods altogether. When parents do that, it just makes kids feel more anxious. And it will reverse their good behaviors, make them crave those restricted foods even more, and can even contribute to future eating disorders. Parents can be in control of younger children's portion size, and offer them healthy choices as to what to eat and when meals and snacks will occur throughout the day for the entire family.
When families have meals together, children are more likely to eat a healthier and more varied diet, making them less likely to become picky eaters. Family meals have also been shown to reduce childhood obesity because people tend to talk more and eat slower.
Finally, we want parents to celebrate their kids' good behaviors, particularly in the midst of a pandemic. While there can be a genetic component to weight gain, most of the added pounds we're seeing right now are due to the environment we're all living in. This is a difficult time for everyone, so it's important to be kind to ourselves. The occasional indulgence is okay, as long as it doesn't become a source of anxiety or guilt, leading to more criticism for what children should not be eating. Instead, the emphasis should be on making kids feel good by pointing out all the healthy foods they are eating.