How to reduce the risk of childhood obesity

Alexandra Chung and colleagues call for governments to prioritise child obesity as they implement measures to recover from the pandemic

This is an edited version of an article that originally appeared on The BMJ

The swift and necessary public health response to the COVID-19 pandemic has had detrimental consequences for the prevention and management of childhood obesity, a concern critically in need of public health action. Although children are not as severely affected by COVID-19 as adults – experiencing fewer or no symptoms – the public health response to mitigate its spread has exacerbated several risk factors for childhood obesity. Extended lockdowns and social distancing measures have increased children’s exposure to obesogenic environments and disrupted their participation in health promoting behaviours.

Childhood obesity affects an estimated 50m girls and 74m boys worldwide. These children are at greater risk of developing related functional, metabolic and psychological conditions, experiencing pervasive weight bias and stigma and having greater healthcare costs. Childhood obesity is strongly correlated with risk of adult obesity and poor health, which bring considerable social and economic consequences. Despite efforts, no country is on track to meet the targets set out by the World Health Organization’s Commission on Ending Childhood Obesity (ECHO).

As we look towards recovery from COVID-19 we have the chance to ‘build back better’, with the opportunity for increased focus on the role of public health and prevention to protect and promote the health of populations. With the public health response to COVID-19 exacerbating risk factors for childhood obesity, there is an increased urgency for evidence-based action.

We highlight the effect of the public health response to COVID-19 on risk factors for childhood obesity and discuss evidence-based action across two key areas – providing healthy food and physical activity environments for preschool and school age children and reducing children’s exposure to unhealthy food marketing. These actions are outlined in WHO commission’s recommendations to prevent the development of obesity among infants, children and adolescents. International evidence suggests that they are effective, equitable and cost-effective in improving diets and thus, reducing obesity among children. Although much of the evidence to date is drawn from high income countries, these approaches have been identified as double-duty actions, simultaneously dealing with the common drivers of overweight, obesity and undernutrition across countries of all levels of development.

Healthy school food and physical activity environments

As part of government efforts to reduce the spread of COVID-19 schools and early childhood education and care settings have sometimes been closed for long periods; more than one year into the pandemic, school closures continue for millions of children worldwide. As a consequence, many schools have turned to home learning, with reduced opportunities for physical activity and a reliance on screens for education and communication. Excess sedentary time and inadequate physical activity are known risk factors for the development of childhood obesity.

School closures have also reduced the availability of nutritious foods. Data from the US indicate that many children rely on food provided by schools and nurseries for up to two thirds of daily dietary needs; without these programmes during school closures or holidays, children miss a vital source of nutrition for healthy growth and development and are at increased risk of food insecurity and health inequities.

Fast food chains have indicated their willingness to replace missed meals during school closures. For example, in the United Kingdom, McDonald’s announced it would provide one million free meals during the October school holidays. The provision of school meals by the fast food industry is not a suitable alternative to government policy and might increase children’s consumption of unhealthy food and beverages.

Marketing of unhealthy foods and non-alcoholic beverages to children

A further consequence of COVID-19 restrictions has been an increased reliance on digital platforms for children’s learning and communication. Screen time increases exposure to unhealthy food and beverage marketing. Evidence consistently shows that the marketing of unhealthy foods and beverages impairs children’s dietary preferences and consumption; research from many countries has also found that children from minority and socioeconomically disadvantaged backgrounds are disproportionately exposed to such marketing.

Despite this – or perhaps because of it – food and beverage industries have seized the opportunity to turn COVID-19 into a new marketing strategy, with stay at home messaging and the promotion of home delivery or drive through services prominent features of advertising. Industries also promoted their donations of fast food and confectionery to frontline workers throughout the pandemic. These strategies show opportunism by an industry that that cannot self-regulate effectively and places profits ahead of public health.

Actions by the food and beverage industry pose key challenges to government policies to restrict the marketing of unhealthy food and beverages to children; policy development, and its introduction, require strong political will. Guidance has been outlined by WHO, including recommendations for regulation that restricts all forms of marketing of unhealthy food and beverages.

The COVID-19 pandemic has shown that governments can act swiftly to protect health and healthcare services. Leaders worldwide have gone to unprecedented lengths in the interest of public health during the COVID-19 crisis, restricting societies in ways never witnessed by this generation. As a result, risk factors for the development and progression of childhood obesity have been exacerbated. As societies build back from COVID-19, it is time to focus on the childhood obesity risk factors amplified by the response, and to leverage growing support for public health action to promote population health.

Priorities for action include promoting healthy school food and physical activity environments, reducing children’s exposure to unhealthy food marketing and imposing taxes on sugar-sweetened beverages. These actions are successful, cost-effective, can improve health equity and contribute to a comprehensive approach to prevention of childhood obesity.

The COVID-19 pandemic presents an opportunity for governments worldwide to prioritise action as we rebuild economies and public health systems to deal with the problem of childhood obesity effectively and equitably.

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