The American Academy of Pediatrics has reported that nearly 2.3 million children in the United States have tested positive for coronavirus since the start of the pandemic. In addition to the health impacts of COVID-19 itself, there is evidence that COVID can be connected to other diseases as well, including obesity. The Centers for Disease Control and Prevention lists obesity as one underlying risk factor for severe consequences from COVID-19.
Early evidence is also beginning to show that COVID-19, and the economic consequences of the pandemic, may be increasing the risk for obesity. Factors such as limited access to affordable, healthy food, fewer places or chances to be physically active, or uncertain access to healthy school meals, can increase a child’s risk for obesity.
To get a better understanding of how COVID-19 might ultimately impact childhood obesity rates in the future, we spoke with Dr. Punam Ohri-Vachaspati of Arizona State University and Dr. Lindsey Turner of Boise State University.
Prior to the pandemic, what impact does school attendance have on a child’s risk for obesity?
Dr. Lindsey Turner: There’s a fair amount of evidence accumulating that school can reduce the risk for obesity. That’s most likely because of the structure and predictability of school days, as well as access to healthy school meals, physical education, and other supports for students. There’s also some good evidence to suggest that for lower-income students who eat meals at school, those meals are associated with a lower risk of obesity. So ensuring that students continue to be able to access healthy meals at school is important.
Dr. Punam Ohri-Vachaspati: Prior to this very unusual school year, the vast majority of school-going children in the U.S. have had access to healthy school breakfast and lunch, and maybe a healthy snack. Nutritional standards were updated for these meals nearly a decade ago, and there is evidence that those changes may have contributed to healthier weight among school-age children, especially those from families with low incomes. School attendance also provides opportunities for physical activity—either through activities in school or through active commuting to school such as biking or walking—which are associated with healthier weight outcomes in children. There is emerging evidence that elementary school-age children gain weight at a rapid rate when the school is out during summer. So, as Lindsey noted too, schools can reduce the risk for obesity among children.
“Especially early in the pandemic, it was difficult for families to find healthy, affordable foods regularly, making them more likely to purchase processed and packaged foods. The absence of school meals in a child’s day or the change in composition (because of much needed waivers) of meals offered during the pandemic are areas that need examination.”
With so many kids out of school much more than normal in 2020-21, what do we know about how some of the policy responses (e.g., school meal waivers, Pandemic EBT, etc.) may have impacted risk for obesity?
LT: Pandemic EBT (P-EBT) was put into place to allow the families of students who most relied on access to free or reduced-priced meals at school to be able to replace those meals with items purchased locally from supermarkets or other locations. The quick availability of this program from USDA was necessary to address skyrocketing rates of food insecurity early in the pandemic. In addition, USDA allowed all schools waivers for flexibility in how and where meals are served, and allowed schools to offer free meals. That rapid response was crucial to meet the needs of children and families nationwide.
POV: Some of our early assessments have shown that parents find the P-EBT benefits very useful. These benefits need to continue until children are back in schools on a regular basis and have the ability to access school meals. The school meal waivers have allowed schools and communities to offer much needed school meals to children during COVID-19 school closures. Parents find the access to these free meals critical, but there have still been challenges related to limited hours and location of meal distribution sites, lack of feasible delivery options, as well as families running out of meals before the next pickup day. We need innovations in program delivery to meet the needs of parents (re)-entering the workforce while their children are still not attending school on a regular basis. With growing food insecurity rates, these benefits are extremely helpful for families in need.
What kind of questions do we need to study to better understand the connection between COVID-19 and childhood obesity?
LT: There are a lot of important questions on this topic. While pre-existing obesity can lead to more severe consequences of COVID-19, it’s likely that the circumstances caused by the pandemic will also increase the prevalence of obesity. I say this because for many students there are fewer options for them to be physically active if they are not in school regularly during the week, and there are probably also dietary consequences from changes in where students eat and what they are eating. It will be important to study the behaviors that combine to increase risk for overweight– that is, physical activity, sedentary time, and dietary intake. Changes in any one of these are likely to increase the risk of childhood obesity, and the pandemic has impacted all three types of behavior.
POV: There is growing evidence that food and physical activity environments where children live can impact their health. For example, in our recent work we showed that over time, having additional convenience stores in a child’s neighborhood had a negative impact on their weight status. During extended school closures, children are much more likely to go to these kinds of stores in their neighborhoods, so we need to investigate if the negative impacts of these features get exacerbated when schools are closed for extended periods. Another concern is shifts in household purchasing behaviors during this time. Especially early in the pandemic, it was difficult for families to find healthy, affordable foods regularly, making them more likely to purchase processed and packaged foods. The absence of school meals in a child’s day or the change in composition (because of much needed waivers) of meals offered during the pandemic are areas that need examination.
Similarly, on the physical activity front, when children are not in school they are not participating in the structured physical education or walking / biking to school. Absence of these options, especially among children living in communities that are not safe from traffic or crime and/or do not have access to safe public parks, sidewalks, or other features that can promote physical activity, has the potential to result in unhealthy outcomes. Are children living in walkable communities or close to safe public parks protected from some of the negative impacts of pandemic school closures on physical activity and weight?
“With so many families dealing with financial challenges due to the pandemic, the connection between food insecurity, unhealthy eating habits, and obesity, have become even more evident. Finding ways to support the health of children year-round—whether during a pandemic or not—must be a priority for our nation.”
Are there policy changes that have been put in place because of the pandemic that you think ought to be maintained even without the pandemic? Are there things that are working well now that we should keep doing?
LT: I think it’s going to be very important to learn more about school meal delivery during the pandemic, because this is an area where so many changes were made rapidly by incredibly committed and creative school nutrition professionals. With the changes in school nutrition programs, it’s possible that some changes—such as making all meals free—might be worth keeping after the pandemic is over.
POV: At the outset of the pandemic the school food systems were challenged to deliver free meals to all children and they did a remarkable job organizing and delivering these meals. These programs were implemented on a very short time scale. The lessons learned from this experience can be instrumental in exploring universal free meals for children or expanding eligibility criteria—we know school meal participation rates are higher among those who receive free and reduced-price meals. On the flip side, waivers relaxed some of the nutritional requirements for school meals—these waivers were critical to ensure children were fed during the uncertain times. However, when we return to the post-pandemic era, it is important to ensure that the advances made on the nutritional quality of school meals are reinstated and further improved.
At the end of the day, what does the research tell you about the impact COVID-19 is likely to have on childhood obesity rates?
LT: The pandemic has definitely shone a bright light on the crucial role that schools play in supporting healthy behaviors among children and adolescents. The pandemic has also reduced opportunities for physical activity even outside of school times, in terms of sports and play time outdoors. With so many families dealing with financial challenges due to the pandemic, the connection between food insecurity, unhealthy eating habits, and obesity, have become even more evident. Finding ways to support the health of children year-round—whether during a pandemic or not—must be a priority for our nation.
POV: COVID-19 is likely to affect obesity rates in children in a significant way. Absence of regular school attendance over extended periods is a major concern. Schools play a critical role in keeping our children healthy by providing a structure that includes provision of healthy meals and opportunities of physical activity as well as limits to sedentary time. In addition to school closures, the pandemic created environments, whether because of lockdowns or public health measures, that may be more conducive to unhealthy behaviors in children. Social distancing prevented children from being physically active and increased sedentary time. Parents’ shopping patterns changed—less frequent trips and increased reliance on non-perishable foods. Disruptions in the food supply chain meant changes in what was available in stores. Loss of jobs and disruptions in income increased food insecurity rates—all impacting households with children disproportionately. Children and their families most certainly need support now and will continue to do so over time—this is necessary to protect children from long-term negative impacts of the pandemic.
State of Childhood Obesity: Prioritizing Children’s Health During the Pandemic
This report, released in October 2020, presents the latest childhood obesity rates and trends, expert insights, relevant research, and policy developments, including emergency relief efforts to support major federal nutrition programs. It highlights promising strategies for prioritizing children’s health and improving equity in response to the pandemic and throughout recovery.
School Meals and Snacks
Many children consume up to half their daily calories at school. Nationwide more than 29 million children participate in the National School Lunch Program and nearly 15 million participate in the School Breakfast Program.
Innovative Heroes, Ensuring No Child or Family Goes Hungry During COVID-19
Six school nutrition professionals from the Midwest to the East Coast share their inspirational stories about helping to ensure that kids and families have healthy foods during the COVID-19 pandemic.