The COVID-19 pandemic has burdened families with economic hardship, food insecurity, school closings, and shutdowns, making it challenging for both adults and children and adolescents to maintain a healthy lifestyle. “Emerging data show that individuals with obesity, including children, are at higher risk for the severe effects of COVID-19,” says Sandra Hassink, MD, MS, FAAP. “This highlights the importance of recognizing obesity as a chronic disease affecting many patients and with disease characteristics that make severe COVID more likely, such as dysregulated immunological function and chronic inflammation. Just as with other chronic diseases, obesity treatment during the epidemic should not be put on hold.”

In December 2020, the American Academy of Pediatrics (AAP) recently released two new interim guidance documents to help pediatricians support children struggling to access nutritious food and engage in physical activity during the pandemic, including those who have obesity. The recommendations are available for free at www.aap.org. “This guidance was issued to promote greater attention to obesity prevention and surveillance for situations in which a child’s weight starts to escalate,” says Dr. Hassink. “Both documents highlight the need for pediatricians to help families find ways—often under difficult circumstances—to maintain healthy lifestyles.”

Nutrition & Physical Activity

According to AAP, it is vital for pediatricians to recognize new barriers that have resulted from the pandemic. Pediatricians are recommended to assess and screen children and adolescents for nutrition and physical activity disruptions that are attributable to the pandemic and to screen for obesity onset or worsening at all well visits.

“Clinicians should aim to help their patients stick with well-balanced scheduled meals and snacks and limit or eliminate sugary drinks from their diet,” says Dr. Hassink. “They should be encouraged to eat together as a family when possible and turn off screens when eating. Regarding physical activity, patients should get up and move frequently during the day, take 10-minute breaks for every hour of screen time, walk outside, use the stairs, and stretch. Safe outdoor time is good for mental and physical health. To help with sleep, adhering to a bedtime routine and planned bedtimes, even on weekends, is important, and digital screens should not be used in the bedroom. The guidance also recommends outdoor play, creative activities, talking with family and friends, and meditation to help relieve stress and facilitate healthy decisions.” AAP notes that tailored counseling should be provided using positive strategies that build on family strengths. Counseling should be tailored to developmental stage and socioeconomic, cultural, and psychological characteristics of families. Pediatricians should also become familiar with the complex and interconnected factors that lead to poor nutrition, decreased activity, and excessive weight gain and how these factors may be affected by the pandemic.

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Obesity

AAP recommends that healthcare providers continue treatment for obesity during the pandemic, including intensive lifestyle counseling and pharmacotherapy and bariatric surgery. “Patients need to keep their follow up appointments for their obesity treatment, either by telemedicine or in person,” says Dr. Hassink (Table). “We cannot delay needed treatment for obesity or obesity related comorbidities, and we must continue counseling patients on precautions to prevent COVID-19 infection.”

Of note, children and adolescents with obesity may face increased stigma. The AAP recommends pediatricians be aware that weight bias and stigma may increase during the pandemic. Clinicians are urged to use a nonjudgmental approach with their patients and families and to continue advocating for reduction of weight bias and stigma.

Looking Ahead

With the COVID-19 pandemic in full effect, many once familiar environments have changed to unrecognizable scenarios, increasing stress for children and families. “We still need to continue conducting research on the chronic disease of obesity and its effects on anatomy, physiology, metabolism, even with the ongoing pandemic,” says Dr. Hassink. “We also must research the most effective ways to help families maintain and sustain healthy lifestyle changes in the face of adverse food and activity environments. Furthermore, studies are needed to establish effective ways to impact change to a healthier food supply, to reduce advertising of unhealthy food to children, and to increase physical activity options.”