Reducing childhood obesity now may help in next pandemic

Obesity amplifies the life-threatening effects of viral infections like H1N1 and now COVID-19. With a prevalence of 42 percent among U.S. adults and just over 18 percent in children and adolescents, obesity is a pandemic in its own right.

During the 2009 H1N1 pandemic, numerous reports identified obesity and severe obesity as risk factors for hospitalization. In one study, more than half of California adults with severe or fatal H1N1 had obesity; a quarter had severe obesity.

Similar trends are becoming apparent with COVID-19. In a study of more than 4,000 New York City COVID-19 patients, obesity emerged as a powerful predictor of hospitalization, second only to older age (over 65). Even among COVID-19 patients younger than 60, those with obesity were twice as likely to be hospitalized and 1.8 times more likely to need critical care.

Rates of obesity are higher among people of color, driven by structural racism that creates disparities such as poverty, economic disadvantage and lack of access to healthy food. In addition, many people of color experience higher rates of COVID-19 hospitalization and death than whites. Many are also essential workers along the food supply chain—including farm workers, workers in meat processing plants, grocery clerks, and food deliverers—which increases their vulnerability to infection. Unfortunately, the wages, benefits, and working conditions of these workers do not reflect their essential status. Combined with the impacts of COVID-19 on their daily lives, including disruption of the food supply and layoffs of family members, many are having a harder time than usual putting enough food on the table for themselves and their families—let alone healthful foods that can be more expensive than the alternatives. As a result, food insecurity has increased, and undernutrition may be just around the corner.

These factors add to family stress, including stress on children, who are already lacking normal support structures like schools. It’s important also to remember that going hungry is an Adverse Childhood Experience (ACE), a potentially traumatic event that impedes healthy development, contributes to chronic health problems in adulthood, and can negatively impact educational attainment and job opportunities.

In the short term, the disproportionate impact of COVID-19 on people of color and people with obesity should heighten awareness of the adverse effects of COVID-19 infections. It should also emphasize the need for increased prevention and aggressive care for those who are affected. Vaccine efficacy must be tested in an adequate sample of people of color and people with obesity. Furthermore, when we finally have an effective COVID-19 vaccine, we should prioritize its use to assure that people at highest risk for severe illness receive it first.

We also need to ensure that children continue to have access to fresh, healthy foods, especially in light of projections that the pandemic will double out-of-school time for many, increasing the risk for weight gain often seen during summer vacation. This will require:

• Strengthening the food support system: The most urgent need is to strengthen the food support system to ensure that all families have access to enough food to live healthy lives. The COVID-19 pandemic has underscored the importance of school nutrition programs, food banks, and food assistance programs like the Supplemental Nutrition Assistance Program (SNAP) to many vulnerable communities.
• Expanding SNAP eligibility: Recently, the U.S. Department of Agriculture announced that the Families First Coronavirus Response Act is providing emergency allotments to SNAP recipients totaling $2 billion a month—a 40 percent increase. The emergency increase is a good start, but both the minimum and maximum benefit should be increased. Strong evidence shows that an increase in the level of the overall benefit could help stabilize the economy and reduce poverty and food insecurity. Because many more people currently need assistance, SNAP eligibility should be expanded and additional flexibilities added to allow for benefits to be used virtually.
• Increasing funding for school foods: School meal programs will also need additional funding and continued flexibility to serve families across our communities. School districts have done a superb job of adapting their meal programs to meet the needs of children and their families during the COVID-19 crisis, but their resources are limited.
• Sustaining the many positive changes in school meals mandated by the Healthy Hunger-Free Kids Act.

However, strengthening the food security system is only the first step. The COVID-19 pandemic has starkly illustrated the fragility of our food supply chain, from field to fork, and how easily disruptions can exacerbate the food environments that lead to obesity. The essential people on whom we depend for our food harvesting, processing, transport, and distribution are also those who are most vulnerable to COVID-19 and least protected from job loss. A critical step in repairing the food supply chain will require us to address the issues that make these workers vulnerable, like housing, immigration status, living wages, paid sick leave, and workplace protections against injury and illness.

The COVID-19 pandemic has laid bare stark health and social inequities in our country and underscores the urgent need to build healthy and equitable communities that can withstand future public health crises like the one we face today. We need to apply the lessons we are learning from the COVID-19 pandemic to generate the political will necessary to reduce obesity and health, achieve health equity, and establish a sustainable food system. Achieving these goals will help our children and the generations that follow grow up healthy, strong, and resilient.