Covibesity: Rapid Weight Gain Among Children and Teens Alarms Doctors
It’s alarming but not uncommon these days in health care settings to see children and teens who gained a significant amount of weight in the past year … 20, 30, 40 or even 50 pounds.
What played a role? In some cases, junk food and lack of exercise as the COVID-19 pandemic wears on.
Childhood obesity was already a concern in the United States. In 2018, the Centers for Disease Control (CDC) reported that 19.3% of the 2-19 age group were considered obese. That’s about 14.4 million children and adolescents with excessive weight that could lead to other medical problems like diabetes, heart disease, high blood pressure, and joint pain.
But doctors and dietitians fear obesity has gotten worse due to habits that changed during the COVID-19 lockdown and afterward, continuing today. A study cited by the National Institutes of Health (NIH) even uses the term “covibesity” to describe the phenomenon of rapid weight gain that resulted when people changed their eating and exercise routines during the pandemic.
If the early months of the pandemic set the stage for higher obesity rates, the toll on health is current and ongoing. Consider diabetes, for instance: Cook Children’s has seen 91 new cases of Type 2 diabetes diagnosed already this year.
Escalation in childhood obesity becomes an even more relevant and urgent concern given reports of higher risk of severe COVID-19 symptoms for those with obesity. The CDC points out that excessive weight can cause impaired immune function and decreased lung capacity, which may worsen the illness. The CDC cites one study that linked obesity in pediatric patients to higher rates of hospitalization, admission to intensive care, invasive mechanical ventilation and death from COVID-19. At Cook Children’s Medical Center, this rings true. Many of the patients admitted to the COVID-19 ICU are obese are require life-saving measures.
Alice Phillips, M.D., a pediatrician at Cook Children’s, described the accelerated rise in childhood obesity as an outcome of the dramatic lifestyle changes brought on by the COVID-19 lockdown beginning in 2020. Multiple times a day, Dr. Phillips encounters and counsels patients whose body mass index (BMI) has surged since their last checkup.
When the schools were closed, lots of homebound kids began to snack out of boredom. They watched more TV and did online learning in front of a computer – no walking required. Recess, PE classes and team sports were canceled.
“Parents have been trying to nurture their children during a very difficult time. Food remains a cultural norm of nurture for families, and we are seeing the unexpected consequences,” she said.
Dr. Phillips emphasized it’s appropriate to expect a child to pick up some weight during a growth spurt. Pediatricians track the curve using the BMI calculations, which take a patient’s age, height and gender into consideration. Obesity by definition occurs when BMI reaches the 95th percentile or higher.
Dr. Phillips and her colleagues at Cook Children’s point out two trends: an increase in patients whose recent weight gain put their BMIs in the 95th percentile for the first time, and previously obese patients who became even heavier.
“When you see an acute change in the BMI from the 75th percentile to the 99th percentile, that’s when it catches your eye and you say, ‘What was different this year that caused that change?’” she said. “All too often during the pandemic the families will say, ‘We haven’t been getting any exercise, and our eating habits are maybe a little worse.’”
She worries about the long-term consequences on their health. When she raises the subject of obesity with her patients, she speaks with sensitivity and tries to help the families feel empowered to set goals they can achieve.
“You have to be very careful that you handle that conversation in an empathetic way,” Dr. Phillips said. “I don’t want how I handle it to be part of the problem for this child.”
Here’s what’s important to know:
- Obesity commonly begins between the ages of 5 and 6, or during adolescence. The causes include overeating, genetic predisposition, stressful life events (such as divorce or a move), depression and low self-esteem.
- Obesity is a chronic disease that adversely affects both physical and mental health. It’s easy to diagnose but hard to treat – potentially setting up a lifetime of complications.
- Studies referenced by the NIH show that a child who is obese between the ages of 10 and 13 has an 80% chance of becoming an adult with obesity.
Susan Hsieh, M.D., a pediatric endocrinologist at Cook Children’s, is seeing more patients diagnosed with obesity-related spinoffs that used to be considered adult diseases: hypertension, high cholesterol and Type 2 diabetes. She also points to the COVID-19 lockdown as a tipping point for kids who gained 30-40 pounds since last year. “The body isn’t designed to take on that much weight in such a short period of time,” Dr. Hsieh said.
She explained that obesity causes insulin resistance, impeding the body’s ability to control the blood sugar. It used to be rare, she said, to see an 8- or 9-year-old diagnosed with Type 2 diabetes. Not anymore.
Data at Cook Children’s show that Type 2 diabetes has been on the rise, with 55 new diagnosed cases in 2018, 107 new cases in 2019, and 126 new cases in 2020. The count so far for 2021 is 91 new cases through early September.
Early onset diabetes, if hyperglycemia is mild, can be treated with oral medications. For those patients who require insulin injections, Dr. Hsieh encourages weight loss as a motivation to wean themselves off the injections. She urges families to address their child’s escalating obesity sooner rather than later.
“In general, it’s easy to gain weight and very hard to lose weight,” Dr. Hsieh said. “The more we educate, the better, because prevention goes a long way.”
The Endocrine Clinic at Cook Children’s offers a program called Risk Evaluation to Achieve Cardiovascular Health (REACH), targeting kids affected by cardiovascular diseases caused by obesity or other factors.
Since the start of the pandemic, registered dietitian Lauren Williams found that her REACH patients and their parents often report more junk food consumption and less physical activity. She counsels them to treat food as a source of nourishment.
Williams’ main message? “We need a healthy relationship with food. We don’t snack throughout the day when we’re not hungry. We move our bodies because our bodies were made to move. Exercise helps our mind; it helps our sleep. Get out and run and play even if it’s just with your siblings in your backyard, having fun.”
Cook Children’s also offers a one-time, free-of-charge class called Healthy Weight Healthy You, which promotes the MyPlate nutrition guide and other tools to eat right. The class is offered in both English and Spanish for children ages 5-18 and their parents. A physician’s referral is needed.
Another resource to fight obesity is the Cook Children’s Outpatient Nutrition Services, available only through referral from physicians in the network. Jean Mankin, a registered dietitian in the outpatient clinic, said the incidence of childhood obesity “exploded” during the COVID-19 pandemic.
“Almost every patient that I’ve seen will admit to boredom eating. And the parents will agree,” Mankin said. “The parents will say ‘I was trying to work… I was there for emergencies but the kids were left to their own devices and they were grazing all day on chips and cookies and crackers.’”
Now she works with families to undo the damage. Bad habits – constant snacking, inactivity -- can be corrected. But it starts with recognizing the problem.
The patients Mankin meets with often arrive with complications tied to the excess weight on their bodies. She lists orthopedic problems, respiratory issues, elevated lipids, elevated liver enzymes and sleep apnea among the ailments.
A one-hour consultation with Mankin encompasses a review of the family’s journal of food intake over several days; guidance on problems she identifies; a packet of information to take home; and lots of encouragement. No one is forced to get on the scale. Mankin says she frames the conversation around the proper nutrition necessary for growth and development -- avoiding the word “obesity” out of sensitivity.
“Some of these little ones and adolescents can easily get their feelings hurt. And when that happens, they shut down. I also encourage parents to be mindful of the language used at home,” she said. “I work really hard to focus on overall health and to keep a positive vibe in my office. Initially, many kids that come to me are somewhat fearful or trepidatious, but most leave with a smile on their face.”
She emphasized that parents must be committed to making changes in the family’s approach to meals and exercise. Improvements don’t usually happen right away. A follow-up visit with the dietitian might be needed after the initial consultation.
If you have a concern about your child’s weight, contact your pediatrician.
Reversing Weight Gain
Jean Mankin, a registered dietitian with Cook Children’s Outpatient Nutrition Services, offers these tips to prevent or correct obesity:
- Focus on nutritional balance for all food groups, including whole grains, low-fat dairy, fresh fruits and vegetables, and lean proteins. Be mindful of portion size.
- Limit the calorie-dense snacks, and offer healthier options. “Scheduled snacks are fine, but it shouldn’t be a free-for-all,” Mankin points out.
- Stay away from sodas and other sugary drinks. Don’t keep junk food at home … Mankin calls easy access to junk food like “sabotage” to a child struggling with obesity.
- Eat fast food only occasionally (once a week or less).
- Exercise for one hour every day. It should be intentional exercise, and can be broken up throughout the day.
- Plenty of sleep is a must.
- Get the whole family on board with healthy habits, so that everyone benefits and no one feels singled out.
“If these things are happening, most kids’ weight can be improved and eventually normalized,” Mankin said.
For healthy recipes, referral forms and more information about Cook Children’s Outpatient Nutrition Services, go to Nutrition Services | Cook Children's (cookchildrens.org)
The REACH team at Cook Children’s is committed to helping every child achieve the goal of being heart healthy. For more information about specialty programs for children affected by high blood fats or diabetes, go to REACH Clinic | Cook Children's (cookchildrens.org)