DE SOTO — When the pandemic first shuttered schools and moved classes online, Liam Ridley was home alone nearly every day while his mom and dad were at work. He found himself continuously snacking.
“I was home, bored sometimes, just eating,†said Liam, 12, of De Soto.
Since he didn’t know how to cook, Liam said he’d grab a muffin for breakfast. And then he’d have some more, along with a soda. He would heat up leftovers and throw frozen pizzas in the oven. He’d mindlessly munch on potato chips.
No matter the food, Liam said, “I would still want to eat and eat and eat and eat.â€
Obesity rates have long been on the rise among American children, but the pandemic hastened that rise, , the largest yet of the pandemic’s impact on obesity rates.
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Researchers studied over 432,000 children ages 2 to 19 and found the rate of increase in body mass index, or BMI, approximately doubled during the pandemic. Kids who were already overweight or obese experienced the largest increase, as well as those ages 6 to 11.
Dr. Sandy Hassink, medical director of the , said the pandemic brought school closures, eliminated organized activities and strained family budgets.
“Many families reported that keeping routines, such as scheduled meals and snacks, regular activity and limiting recreational screen time became increasingly difficult,†Hassink said. “Stress levels have been up all the way around, and disruptions in sleep such as late bedtimes, and screens in bedrooms increased.â€
The study compared medical records from January 2018 through February 2020, before the pandemic, to records from March 2020 through November 2020.
Before the pandemic, children who were a healthy weight were gaining an average of 3.4 pounds a year. That rose to 5.4 pounds during the pandemic.
The increase was more for kids already struggling with weight. Annual weight gain per year for those moderately obese went from 6.5 pounds before the pandemic, to 12 pounds after. For the severely obese, it went from 8.8 pounds to 14.6 pounds a year.
Overall, the percentage of obese children and teens increased to 22% from 19% before the pandemic.
One of the study authors, Dr. of the CDC, called the results “substantial and alarming.â€
Obesity can have serious impacts on long-term health and quality of life. Accelerated weight gain among children can cause long-lasting metabolic changes that put them at risk for Type 2 diabetes, hypertension and depression.
Early studies are already showing increases in these conditions, Hassink said.
The trend is also worrisome because as the COVID-19 pandemic wears on, obese children are more at risk of severe illness from a coronavirus infection.
In a , those with obesity have three times higher risk of hospitalization and one-and-a-half times higher risk of severe illness or death.
“This has made it imperative for children with obesity to continue their treatment,†Hassink said, “and for families to be able to access support from clinicians, community organizations, schools and food programs to maintain healthy nutrition and activity.â€
Liam was fortunate in November 2020 to be offered the opportunity to participate in an intervention program as part of a study by Washington University.
Researchers offered to work with his pediatrician as well as pair him and his mom with a coach to meet with them over the course of a year to talk about nutrition, portion control, planning meals and developing new habits.
Liam jumped at the chance.
“It was just knowing that I was getting heavier,†Liam said, “and I wanted to know how to lose it or just maintain it; so as I’m growing, it’s going to even out.â€
Intervention program
The program, , is part of a clinical study looking to enroll 1,300 children ages 6 to 15 with obesity in the ºüÀêÊÓƵ area as well as areas around Alton; Columbia, Missouri; Rochester, New York; and Baton Rouge and New Orleans, Louisiana.
The children are assigned to one of two groups and followed over a year.
One group has at least six visits with their primary care provider, who has completed additional training in how to address obesity in children. At the visits, the provider helps the child and caregiver set goals and identify ways to be healthier. The provider tracks their progress.
The other group meets with their primary care provider and spends additional time meeting with a health coach. The coach provides advice on how to create healthy habits and manage challenges. Parents learn more about positive reinforcement and how to address issues, such as bullying.
The programs help families not only learn what foods are healthy, but also think of everything inside and outside the home that make it easier for them make healthy choices, said , Washington University psychiatry professor and the study’s principal investigator.
They work on things like planning nutritious meals within their budget, maintaining regular eating times, getting enough sleep, finding activities in their neighborhood or school, limiting screen time and spending time with friends in ways that don’t always involve food or sitting.
“We are really trying to help the families engineer an environment that’s going to make it easy for them to keep these healthy habits going,†Wilfley said.
When the pandemic hit a few months into the study, that all became much harder, she said. Children and families lost their structure and routines. Kids had more access to the refrigerator and found themselves sitting at home. Anxiety and stress also led to overeating.
Even though kids returned to in-person class and activities this school year, the need for intervention programs continues, Wilfley said. Worker shortages continue to place extra stress and pressure on parents. Children are also still dealing with the repercussions.
“That makes it more challenging for caregivers to get to the grocery store and prepare meals at home,†Wilfley said. “It has really taken a hit on the caregiver, and we know there’s a crisis right now with youth feeling more anxious and depressed.â€
Family doctors
Dr. Abbe Sudvarg is a family physician at the in ºüÀêÊÓƵ’ Carondelet neighborhood. She has been participating in TEAM UP study since July of last year.
Just like the CDC study’s findings, she saw her patients who were already overweight or obese struggle the most.
Families without restrictions around food fell prey to the unlimited access and stress. Sweet drinks such as soda and juices were main calorie-drivers. On top of that, children lost access to gym class and recess.
“And kids who were already big just got bigger and bigger,†Sudvarg said, “and then it becomes more and more of a vicious cycle, and more and more difficult to help the families help their children.â€
Sudvarg said she enjoys having the extra one-on-one time with patients participating in the study, but it is a strain on her demanding schedule as well as those of her patients even as they switched to virtual visits with the pandemic. “Unfortunately they fall away from the program,†she said. “They don’t complete the whole process.â€
The TEAM UP study aims to better understand whether doctor visits without the frequent coaching sessions are enough to make an impact.
Family physicians have already established relationships and built trust with patients, Wilfley said, but doctors struggle with how to best counsel and motivate families, which is where the training offered by TEAM UP can help.
“The thing that is really difficult is how to approach these topics in a sensitive and compassionate manner,†Wilfley said, “because unfortunately, kids as well as parents have often been stigmatized around their eating, shape and weight; so they feel like they have a lack of knowledge and confidence in how do they communicate these issues with parents.â€
Sudvarg said she now focuses more praising positive behaviors rather than harping on the negative consequences. She’ll ask the child if it’s OK if they talk about their weight, she said, “giving them some control and showing respect for their feelings about the conversation.â€
‘It hits home’
Liam said despite the challenges of the pandemic, participating in the program helped him lose 5 pounds, and his mom lost 10. He’s always been active, he says, but now he reads food labels, cooks meals and eats in smaller portions.
“Before I did the program, I didn’t realize that even just the littlest things have so many more calories than you would imagine,†he said. “Portion control and looking at the calories will stay with me.â€
Melanee May, 42, of Wentzville, said she struggled with her weight most of her life and became worried when her sons — now ages 12, 13 and 17 — began to struggle as well.
May and her two youngest sons signed up to participate in an early phase of the TEAM UP study, which ended just a couple months into the pandemic.
The pandemic threatened the improvements they made during the program, May said.
“What made it hard was that we were all just in the house,†she said. “They were doing school from home every day. I was working from home every day. The food was just there. It wasn’t even that we were hungry, we were snacking and snacking and snacking.â€
However, May said they were able to use the lesson they learned to turn things around. They planned walks outside, found exercise videos online, located food pantries and stocked the fridge with healthier options.
It wasn’t easy. And they faced setbacks, May said. She got sick with COVID-19 in February. A month later, her oldest son was diagnosed with high blood pressure. The deadly diseases ended up being a wake-up call for them both.
“It hits home when people around you are passing away, and people that you’ve known for years in church setting or community setting are gone,†May said.
After moving in August from north ºüÀêÊÓƵ County to Wentzville, May said her family has settled into healthy routines. At their annual physicals in November, her younger sons had grown several inches and were slimming down. Her oldest son has lost weight and gotten his blood pressure under control.
“Had we not had this program,†May said, “it would have been more challenging to come out of this period on a healthier note. And it may have gotten worse.â€