Devin Pinaroc, FNP-C In March 2020, cities shut down, schools closed, and economies stalled, completely disrupting the routine of daily life. Public spaces no longer served the public, instead, posing as breeding grounds for an unfamiliar life-threatening virus. The coronavirus disease 2019 made the world hold its breath, and social distancing became the norm. Unfortunately, while isolation measures were meant to help decrease transmission of COVID 19, they caused unintentional suffering that may negatively impact people well into the future. Perhaps the most concerning, given the associated long-term health effects, is the exacerbation of pediatric obesity. Increased Risk Factors for Weight Gain The pandemic created new burdens and strengthened existing barriers to maintaining a healthy lifestyle for families. Social distancing caused limited physical activity, economic hardships, food insecurities, and a lack of social support that put children’s weight at risk (Jenson et al., 2021). Kids were unable to participate in organized sports, rely on appropriately portioned school breakfasts/lunches, or simply hang out with friends. As physical activity was severely limited, screen time inversely increased (American Academy of Pediatrics [APP], 2020a). Disrupted family routines from school closures and job losses caused sleep dysregulation (APP, 2020a). Both food insecurity and food scarcity issues, disproprotionately exacerbated by the financial implications of the pandemic, negatively impacted pediatric nutrition as families shifted to high-calorie snacks and processed, nonperishable foods (APP, 2020b). Pediatric Obesity Rates Pre and Post Combined with persistent financial and emotional stress, there is little surprise the data shows an increase in obesity in children and adolescents from pre-pandemic levels (AAP, 2021). Recently, the CDC reported that during the pandemc the body mass index (BMI) of persons 2-19 years approximately doubled as compared to the pre-pandemic period with the largest increases seen in younger school-aged children and children already moderately or severely obese. Between March and November 2020, moderately and severely obese children gained 1.0 and 1.2 pounds per month, resulting in a 6.1 and 7.3 pound gain over 6 months, respectively (Lange et al, 2021). As childhood obesity rates rise, there is also increased risk for other chronic diseases like hypertension, type 2 diabetes, and cardiovascular disease (APP, 2021b). The lifetime implications of chronic disease suggest the effects of the COVID 19 pandemic will span generations. Health Disparities Highlighted in the COVID 19 Pandemic The disruption from the COVID 19 pandemic did not affect all families equally. Families already negatively affected by the social determinants of health were particularly vulnerable to the new environment created by the COVID 19 pandemic (APP, 2021). Existing inequities in accessing healthy food or physical activity worsened, increasing some children’s risk for pediatric obesity more than others. The pandemic magnified health inequalities and widened pre-existing disparities with Black and Hispanic children, children with special needs, low income families, and children living in rural areas experiencing a higher risk for unmet health care needs (APP, 2020b). Guidance for Clinicians In response, the American Academy of Pediatrics released interim recommendations to help clinicians address pediatric obesity and help families sustain a healthy lifestyle during the pandemic. The guidance recommends detailed screenings for obesity (onset and worsening), continued assessment of physical activity and nutrition at well visits, and obesity treatment/management considerations as related to the COVID 19 pandemic (APP, 2020a). Clinicians are recommended to support families with their individual barriers that prevent adequate physical activity, food access, and sleep, tailoring the counseling to a family’s unique challenges and considering their cultural, socioeconomic, and psychological characteristics (APP, 2020b). The guidance also emphasizes the need for continued management and treatment for pre-existing pediatric obesity, avoiding any gaps or delay in treatment (APP, 2020a). Clinicians should consider new approaches that help maintain social distancing, but still promote physical activity and healthy lifestyle choices. Virtual workout classes and walking/running in the park can be great ways to get moving, and connecting families to local community resources that provide nutritious meals can improve dietary choices as well as relieve financial burdens. Exploring telehealth options can promote accessibility and reduce the burdens of coming to the clinic. Virtual obesity related visits allow clinicians to provide weight tracking and lifestyle counseling, successfully conducted over the phone or video. The American Academy of Pediatrics interim guidance can be found in the following documents: “Supporting Healthy Nutrition and Physical Activity during the COVID-19 Pandemic” “Obesity Management and Treatment During COVID-19” Want to know more… When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity Projecting the impact of the coronavirus disease-2019 pandemic on childhood obesity in the United States: A microsimulation model References American Academy of Pediatrics. (2020a, December 09). American Academy of Pediatric raises concern about children’s nutrition and physical activity during the pandemic. Retrieved October 09,2020, from https://www.aap.org/en/news-room/news-releases/aap/2020/american-academy-of-pediatrics-raises-concern-about-childrens-nutrition-and-physical-activity-during-pandemic/ American Academy of Pediatrics. (2020b, December 9). Supporting healthy nutrition and physical activity during the COVID-19 pandemic. Retrieved October 9, 2021, from https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/supporting-healthy-nutrition-and-physical-activity-during-the-covid-19-pandemic/. American Academy of Pediatrics. (2021, September 1). Obesity management and treatment during COVID-19. Retrieved October 9, 2021, from https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/obesity-management-and-treatment-during-covid-19/. Jenssen, B. P., Kelly, M. K., Powell, M., Bouchelle, Z., Mayne, S. L., & Fiks, A. G. (2021). Covid-19 and changes in child obesity. Pediatrics, 147(5). https://doi.org/10.1542/peds.2021-050123 Lange SJ, Kompaniyets L, Freedman DS, et al. Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep 2021;70:1278–1283. DOI: http://dx.doi.org/10.15585/mmwr.mm7037a3.