This article was originally published in the Washington Post on October 6, 2020.

Experts are worried about covid-19's effect on childhood obesity. Here’s what we can do.

By Debra Kamin

For the millions of American schoolchildren learning from home this school year, their “classroom” offers no playground or kickball courts for recess. Their school days end with no after-school sports or extracurricular activities. But what they do have, as the coronavirus pandemic forces a shift to virtual or hybrid education, is unfettered access to their home snack pantries and upheaval in their structures and routines. It’s a combination of forces, say experts, that has the potential to exacerbate another public health crisis: childhood obesity.

A study released this month by Trust for America’s Health, which based its findings in part on 2019 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factors Surveillance System, found that 19.3 percent of Americans ages 2 to 19 are obese, compared with 5.5 percent in the mid-1970s.

Obesity carries a range of risk factors for children, among them high blood pressure, breathing problems and Type 2 diabetes. And when it comes to the risk of covid-19, there’s increasing evidence that patients who are obese, even young patients, are far more likely to experience serious complications from the illness, including death.

American kids are now facing a worst-case scenario for their health, said Cedric Bryant, president and chief science officer of the American Council on Exercise, during a recent virtual press event on the topic of covid-19 and childhood obesity.

“It’s unprecedented that we’re inside, we’re out of normal routines. So it stands to reason that levels of inactivity are only going to worsen,” Bryant said. “And obesity makes it harder to deal with covid.”

Ilan Shapiro is the medical director of health education and wellness for AltaMed Health Services, a Southern California community health network, and he oversees its Stomp program (Solutions and Treatment to Obesity Management and Prevention).

He said he is seeing an uptick in young obese patients who have gained weight during the pandemic. And the advice he offers parents is simple: Stop focusing on your children, and start focusing on yourself.

 “We talk a lot about kids, but we need to talk about parents, too,” Shapiro said. “We need to set a good example with our kids. That’s the start for everything. No one can run a marathon without walking first.”

None of us knows for certain when schools are going to reopen, when playgrounds will be safe for kids to climb and jump on again, or when after-school sports will start up again. The routines that gave structure to our days and kept our children active and burning calories have been taken away from us, and for that, we have little control. But what we can do right now, Shapiro tells his patients, is take back control in smaller ways.

To start, Shapiro tells his patients that they need to start with two important steps: Clear the junk food out of the snack pantry, and make cooking meals together part of your family’s routine.

 “Get rid of the soda, the pepitas, the things with high calories. If your kid is going to have free access to the kitchen all day, stock it with carrots and apples. A lot of people think you need to have billions of dollars to eat healthfully, but you don’t. You just need to make better choices,” he said.

Crucially, Shapiro adds, parents need to focus on the example they are setting for their children. Healthful eating needs to be a family activity that the parents model, rather than simply enforce.

“Kids are visual learners,” he said. “If I’m eating a cheesecake while I’m telling my kids to eat their greens, it’s not the example they want to see,” he said.

Right now, Shapiro said, the issue runs deeper than lack of exercise and excess eating. Children (and adults) across America are using food as a way to find comfort in a time when routines have been taken away and life feels increasingly uncertain.

“When you have a lot of stress, and you’re bored, and you’re not moving, and apart from all that you have access to something that makes you feel better, you do it. The food becomes like your drug,” he said.

Shapiro encourages his clients to instead follow a five-step wellness plan that involves not only changes in diet but also exercise, sleep, stress management and getting more involved in their communities to build lines of support. Such moves, he says, help reduce reliance on unhealthful foods for comfort.

Kids’ stress, Shapiro says, is aggravated from upended schedules, so don’t let the absence of an ordinary school day rob you of other bookends on your day. Set a bedtime and stick to it. Encourage kids to talk about feelings of stress. Pencil in screen-free family time, and use it to cook a healthful meal together or connect with neighbors in a socially distanced way.

And what about movement? Even before the pandemic, researchers were concerned that young children were not moving enough. Amanda Staiano, assistant professor of pediatric obesity at Louisiana State University, has conducted numerous studies examining the associations between physical activity, motor skills and screen time in preschoolers, noting that 10 to 13 hours of sleep per day, less than one hour per day of screen time and at least one hour per day of moderate to vigorous physical activity were associated with higher fundamental motor skills than preschoolers who got less sleep and more screen time.

Working with Blue Cross Blue Shield and Louisiana State University, Staiano was part of a team that created the Painted Playgrounds Toolkit, a digital download that allows educators and parents to create outdoor play spaces for a socially distanced pandemic era. A simple stencil kit for parents and teachers to use when playgrounds are off-limits, the designs require only chalk or paint and can be applied to any flat surface. They include hopscotch games, number searches and other diversions designed to entertain while also encouraging kids in a family or pandemic “pod” to walk, hop, jump and run together.

For parents looking for more ideas to help their kids get moving, the Internet is packed with resources like the painted playgrounds tool kit — and many of them are also free or very low-cost. SpiderFit Kids is on online youth fitness program run by health-care professionals from which parents can download free activity guides and training programs for kids ages 5-12; Boks gives teachers and parents a 12-week fitness curriculum designed for growing bodies.

The American Council on Exercise does not yet have data available on how pediatric obesity rates have been affected by the coronavirus pandemic, but Bryant predicts that there will be a noticeable uptick.

“Reason would tell us that as children are less active, those obesity rates will increase and go in the direction that we don’t desire,” he said.

Parents, many of whom are already juggling working from home while caregiving and attempting to manage online schooling, shouldn’t consider managing their children’s weight as an additional task, Bryant said. For families to really succeed at getting and staying healthy, rather, they need to shift their entire perspectives on what it means to move enough, and what their relationship to food is. And that means doing it together, without guilt of feelings or burden attached. The parents need to lead the way.

“Behavior Change Science 101 is that the parents need to look at this as a collaborative relationship with their children,” said Bryant, adding that parents should focus on movement activities their kids enjoy and on what inspires them to get out of the house.

Then, they should do those things together. If their kids like riding bikes, weekend rides should be a priority. If they love climbing trees or playing tag, ditto. Parents should tap into what motivates their kids and then keep the momentum rolling.

Like all things in parenting, the key to exercise and staying healthy can be broken down into one simple rule, Bryant said.

“Find joy in the activity. That’s how you make it sustainable.”

Debra Kamin is an award-winning journalist based in San Diego.