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Kids' weight gain in the pandemic is alarming doctors

By Sumathi Reddy, WSJ,

A disruption in routine has contributed to worrying weight gain issues among children.

BMI percentile ranges to determine whether a child is overweight or obese. Image: iStock

Pediatricians say they are seeing alarming weight gains in children and adolescents as many return for in-person visits for the first time since the pandemic began.

Doctors say they are seeing normal-weight children become overweight or even obese, overweight children become obese, and obese children add more weight. Doctors also report increases in weight-related health conditions, such as high blood pressure, high cholesterol and fatty liver disease. And some children with prediabetes are being diagnosed with Type 2 diabetes.

“I’ve been really shocked by the amount of kids who have gone from normal weight to obese in a short period of time during the pandemic," says Rachana Shah, medical director of the healthy weight program at Children’s Hospital of Philadelphia. The clinic is seeing 300 new patients a month now; the next appointments aren’t available until August. Referrals have doubled since the start of the pandemic.

At the I.D.E.A.L. pediatric weight management clinic at Children’s National Hospital in Washington, D.C., many of the children with obesity gained 20 to 30 pounds during the pandemic, says Nazrat Mirza, the clinic’s medical director. “We were so alarmed at the accelerated weight gain that we decided we have to see all our patients even if it’s just touching base," she says.

Among her primary-care patients, Dr. Mirza says, she has seen an acceleration in the number of children jumping from the 10th or 20th percentile for body mass index to the 70th or 80th.

A May study in the journal Pediatrics found that the percentage of children ages 2 to 17 who are obese increased to 15.4% in June to December 2020 compared with 13.7% in the year-earlier period. Researchers at Children’s Hospital of Philadelphia analyzed pre-pandemic and pandemic body mass index calculations from more than 500,000 visits to doctors’ offices in 2019 and 2020.

“We found a pretty striking increase in obesity rates," says Brian Jenssen, first author of the study and a pediatrician at CHOP. The data indicated the percentage of children categorized as overweight grew to about 16% from about 14%, Dr. Jenssen says, although those numbers weren’t published in the study, which focused on obesity.

Dr. Jenssen said the biggest increase in obesity was in children ages 5 to 9; their obesity rate went to 16.8% from 14.2%. Children and adolescents from lower-income households and those who are Latino also showed larger-than-average increases.

Obesity and overweight categorizations in adults use body mass index, a calculation based on a person’s height and weight. Because children’s height and weight don’t always increase proportionally, doctors use BMI percentile ranges to determine whether a child is overweight or obese. If the BMI percentile is 85 to 94, a child is considered overweight; 95 and above is considered obese.

Like many adults, kids are snacking more and moving less. Doctors attribute the weight gain to a loss of routine over the past year—especially with remote schooling—which has disrupted kids’ usual eating, activity and sleep habits. Kids are also often eating without supervision, with parents working from home.

“Teenagers are going to sleep at 1 a.m. or 3 a.m. and napping during the day," says Dr. Mirza. “They’re up the whole night and they’re also snacking."

Elizabeth Shepard, medical director of the pediatric weight clinic at Stanford Children’s, says she sees children with double-digit weight gain every day, both in primary care and in the weight clinic. Many children started skipping breakfast, waking up five minutes before remote classes started, she says. This shifted their eating into the later hours, and they snacked more because they were home all day.

One 14-year-old patient who was already obese gained 37 pounds, and went from prediabetic to developing Type 2 diabetes, Dr. Shepard says. An 8-year-old who was obese but whose weight had stabilized before the pandemic gained 20 pounds, developing new onset prediabetes and worsening liver function related to fatty liver. And a 7-year-old girl in her primary-care clinic was in the overweight range at her last checkup in 2019 and gained 32 pounds, moving into the obese range.

The challenge, doctors say, is that even when children return to their normal routines of going to school in person, exercising and eating more regularly, the weight probably won’t automatically come off.

“It’s easier to prevent obesity than it is to treat it," says Ellen Rome, head of the Center for Adolescent Medicine at Cleveland Clinic Children’s Hospital in Cleveland. “Once that weight is on, our biggest challenge is to keep them from gaining at the same rate and to allow them to grow in height and to not develop an eating disorder in trying to lose the weight."

Doctors say they are careful to avoid focusing on weight and calories when discussing the topic of being overweight or obese with families. “We do not use the word diet," says Dr. Shah. “We focus on changes and goals. We don’t talk about diets and we don’t talk about calories. We really try hard not to talk about weight. We’re talking about health and the prevention of long-term complications."

Strategies to Help Kids Prevent Excessive Weight Gain
*If school is remote, encourage your children to get up for even five to 10 minutes for every hour of screen time, says Sandy Hassink, medical director of the American Academy of Pediatrics Institute for Healthy Childhood Weight. “Get them moving," she says. Apps like Go Noodle and Cosmic Kids Yoga help kids to move around, says Dr. Shepard. Or just dance. “One of the simplest things to do is just turn on the music and dance around," she says.

*Try to have at least one family meal a day. “When people sit down and eat, they talk and eat a bit more slowly rather than eating mindlessly in front of a screen," says Dr. Shepard. And avoid screens when eating meals.

*Help your child stay on a regular sleep schedule. Make sure screens aren’t used in the bedroom or before bedtime because they can disrupt sleep.

*Make sure children get outside for some physical activity, fresh air and sunlight every day.

*Make sure your kids are eating structured meals to cut down on snacking and binge eating. If you’re not home, try making the unhealthy food inaccessible and leave healthy alternatives out. “Children will not cut up an orange," says Dr. Mirza. “Have it cut up and let it be there for the child."

*Cut out intake of beverages with added sugars, such as juice and soda. Stick to water and low-fat milk.

*Aim for five servings of fruits and vegetables a day.

(This story has been published from a wire agency feed without modifications to the text.)

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