Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

The COVID-19 pandemic: an unprecedented tragedy in the battle against childhood obesity

  • Received : 2020.06.23
  • Accepted : 2020.10.21
  • Published : 2020.12.15
Download PDF
⟨ Previous Next ⟩

Abstract

The childhood obesity pandemic has emerged as an important public health problem in many countries. Obese children are likely to become obese adults, and adult obesity is associated with an increased risk of morbidity. Therefore, controlling the childhood obesity epidemic has become a top public health priority worldwide. The current coronavirus disease 2019 (COVID-19) pandemic may significantly impede this important mission and constitute an unprecedented tragedy in the global battle against childhood obesity. This manuscript presents evidence that the COVID-19 pandemic will aggravate the childhood obesity epidemic and lead to significant weight gain in school children by creating an unprecedented obesogenic environment. Within the last few months, many countries took uncompromising measures in response to the COVID-19 pandemic, including school closures and quarantine. While these steps are often necessary to ensure infection control, they may have a significant negative effect on children's mental and physical health. Physical, nutritional, and psychosocial factors that promote obesity in children during this special situation complementarily contribute to an unprecedented obesogenic environment. Large-scale quarantine and home confinement will impose new and unfamiliar stressors on children, thereby worsening the childhood obesity epidemic. Most importantly, adverse childhood events resulting from a predicted increase in domestic violence within the next few months will significantly contribute to this concern. The scenario presented in this review is of paramount public health importance and must be considered during future pandemic planning. Involved stakeholders, including governments, schools, and families, must make all possible efforts to minimize the impact of the COVID-19 epidemic on childhood obesity.

Keywords

Acknowledgement

The author would like to thank Maria Brommer, MD, for providing the graphical abstract for this publication.

References

  1. Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin Med (Lond) 2020;20:124-7. https://doi.org/10.7861/clinmed.2019-coron
  2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. https://doi.org/10.1016/s0140-6736(20)30183-5
  3. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382:1708-20. https://doi.org/10.1056/NEJMoa2002032
  4. Singhal T. A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr 2020;87:281-6. https://doi.org/10.1007/s12098-020-03263-6
  5. Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res 2020;7:11. https://doi.org/10.1186/s40779-020-00240-0
  6. Chen S, Yang J, Yang W, Wang C, Barnighausen T. COVID-19 control in China during mass population movements at New Year. Lancet 2020; 395:764-6. https://doi.org/10.1016/s0140-6736(20)30421-9
  7. Prem K, Liu Y, Russell TW, Kucharski AJ, Eggo RM, Davies N, et al. The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study. Lancet Public Health 2020;5:e261-70. https://doi.org/10.1016/s2468-2667(20)30073-6
  8. Xiao Y, Torok ME. Taking the right measures to control COVID-19. Lancet Infect Dis 2020;20:523-4. https://doi.org/10.1016/s1473-3099(20)30152-3
  9. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42. https://doi.org/10.1001/jama.2020.2648
  10. Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet 2020;395:945-7.
  11. Wang H, Wang Z, Dong Y, Chang R, Xu C, Yu X, et al. Phase-adjusted estimation of the number of coronavirus disease 2019 cases in Wuhan, China. Cell Discov 2020;6:10. https://doi.org/10.1038/s41421-020-0148-0
  12. Centers for Disease Control and Prevention. Quarantine and Isolation [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [2020 Jun 14]. Available from: https://www.cdc.gov/quarantine/index.html.
  13. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395:912-20. https://doi.org/10.1016/s0140-6736(20)30460-8
  14. Coomes EA, Leis JA, Gold WL. CMAJ 2020:192(13). https://doi.org/10.1503/cmaj.200393.
  15. Day T, Park A, Madras N, Gumel A, Wu J. When is quarantine a useful control strategy for emerging infectious diseases? Am J Epidemiol 2006;163:479-85. https://doi.org/10.1093/aje/kwj056
  16. Rubin GJ, Wessely S. The psychological effects of quarantining a city. BMJ 2020;368:m313. https://doi.org/10.1136/bmj.m313
  17. Sood S. Psychological effects of the coronavirus disease-2019 pandemic. RHiME 2020;7:23-6. https://doi.org/10.53573/rhimrj.2020.v07i12.007
  18. Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health 2016;38:e2016048. https://doi.org/10.4178/epih.e2016048
  19. Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry 2012;53:15-23. https://doi.org/10.1016/j.comppsych.2011.02.003
  20. Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep 2015; 9:547-53. https://doi.org/10.1017/dmp.2015.38
  21. Foss B, Dyrstad SM. Stress in obesity: cause or consequence? Med Hypotheses 2011;77:7-10. https://doi.org/10.1016/j.mehy.2011.03.011
  22. Bradley P. Refined carbohydrates, phenotypic plasticity and the obesity epidemic. Med Hypotheses 2019;131:109317. https://doi.org/10.1016/j.mehy.2019.109317
  23. Bluher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol 2019;15:288-98. https://doi.org/10.1038/s41574-019-0176-8
  24. Di Cesare M, Soric M, Bovet P, Miranda JJ, Bhutta Z, Stevens GA, et al. The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med 2019;17:212. https://doi.org/10.1186/s12916-019-1449-8
  25. Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clin Proc 2017;92:251-65. https://doi.org/10.1016/j.mayocp.2016.09.017
  26. Llewellyn A, Simmonds M, Owen CG, Woolacott N. Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev 2016;17:56-67. https://doi.org/10.1111/obr.12316
  27. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics 2001;108:712-8. https://doi.org/10.1542/peds.108.3.712
  28. Walls HL, Peeters A, Proietto J, McNeil JJ. Public health campaigns and obesity - a critique. BMC Public Health 2011;11:136. https://doi.org/10.1186/1471-2458-11-136
  29. COVID-19 educational disruption and response [Internet]. Paris: UNESCO; 2020 [2020 Jun 14]. Available from: https://en.unesco.org/covid19/educationresponse.
  30. Rundle AG, Park Y, Herbstman JB, Kinsey EW, Wang YC. COVID-19-related school closings and risk of weight gain among children. Obesity (Silver Spring) 2020;28:1008-9. https://doi.org/10.1002/oby.22813
  31. Brazendale K, Beets MW, Weaver RG, Pate RR, Turner-McGrievy GM, Kaczynski AT, et al. Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act 2017;14:100. https://doi.org/10.1186/s12966-017-0555-2
  32. Ghosh R, Dubey MJ, Chatterjee S, Dubey S. Impact of COVID -19 on children: special focus on the psychosocial aspect. Minerva Pediatr 2020; 72:226-35.
  33. Rothstein R, Olympia RP. School nurses on the front lines of healthcare: the approach to maintaining student health and wellness during COVID19 school closures. NASN Sch Nurse 2020;35:269-75. https://doi.org/10.1177/1942602X20935612
  34. von Hippel PT, Workman J. From Kindergarten Through Second Grade, U.S. Children's Obesity Prevalence Grows Only During Summer Vacations. Obesity (Silver Spring) 2016;24:2296-300. https://doi.org/10.1002/oby.21613
  35. Rundle AG, Factor-Litvak P, Suglia SF, Susser ES, Kezios KL, Lovasi GS, et al. Tracking of obesity in childhood into adulthood: effects on body mass index and fat mass index at age 50. Child Obes 2020;16:226-33. https://doi.org/10.1089/chi.2019.0185
  36. Dunton GF, Do B, Wang SD. Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S. BMC Public Health 2020;20:1351. https://doi.org/10.1186/s12889-020-09429-3
  37. Fang K, Mu M, Liu K, He Y. Screen time and childhood overweight/obesity: A systematic review and meta-analysis. Child Care Health Dev 2019;45:744-53. https://doi.org/10.1111/cch.12701
  38. Robinson TN, Banda JA, Hale L, Lu AS, Fleming-Milici F, Calvert SL, et al. Screen media exposure and obesity in children and adolescents. Pediatrics 2017;140(Suppl 2):S97-101. https://doi.org/10.1542/peds.2016-1758K
  39. Nagata JM, Abdel Magid HS, Pettee Gabriel K. Screen time for children and adolescents during the coronavirus disease 2019 pandemic. Obesity (Silver Spring) 2020;28:1582-3. https://doi.org/10.1002/oby.22917
  40. Calcaterra V, Vandoni M, Pellino VC, Cena H. Special attention to diet and physical activity in children and adolescents with obesity during the coronavirus disease-2019 pandemic. Front Pediatr 2020;8:407. https://doi.org/10.3389/fped.2020.00407
  41. Food and nutrition during self-quarantine: what to choose and how to eat healthily 2020. Copenhagen (Denmark): WHO Regional Office for Europe UN City; [cited 2020 Jun 14]. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/news/news/2020/3/food-and-nutrition-during-self-quarantine-what-to-choose-and-how-to-eat-healthily.
  42. Weaver CM, Dwyer J, Fulgoni VL 3rd, King JC, Leveille GA, MacDonald RS, et al. Processed foods: contributions to nutrition. Am J Clin Nutr 2014;99:1525-42. https://doi.org/10.3945/ajcn.114.089284
  43. Poti JM, Braga B, Qin B. Ultra-processed food intake and obesity: what really matters for health-processing or nutrient content? Curr Obes Rep 2017;6:420-31. https://doi.org/10.1007/s13679-017-0285-4
  44. Lawrence MA, Baker PI. Ultra-processed food and adverse health outcomes. BMJ 2019;365:l2289. https://doi.org/10.1136/bmj.l2289
  45. Laster J, Frame LA. Beyond the calories-is the problem in the processing? Curr Treat Options Gastroenterol 2019;17:577-86. https://doi.org/10.1007/s11938-019-00246-1
  46. Monteiro CA, Moubarac JC, Levy RB, Canella DS, Louzada MLDC, Cannon G. Household availability of ultra-processed foods and obesity in nineteen European countries. Public Health Nutr 2018;21:18-26. https://doi.org/10.1017/S1368980017001379
  47. Louzada ML, Baraldi LG, Steele EM, Martins AP, Canella DS, Moubarac JC, et al. Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults. Prev Med 2015;81:9-15. https://doi.org/10.1016/j.ypmed.2015.07.018
  48. Pietrobelli A, Pecoraro L, Ferruzzi A, Heo M, Faith M, Zoller T, et al. Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: a longitudinal study. Obesity (Silver Spring) 2020;28:1382-5. https://doi.org/10.1002/oby.22861
  49. Ruiz-Roso MB, de Carvalho Padilha P, Mantilla-Escalante DC, Ulloa N, Brun P, Acevedo-Correa D, et al. Covid-19 confinement and changes of adolescent's dietary trends in Italy, Spain, Chile, Colombia and Brazil. Nutrients 2020;12:1807. https://doi.org/10.3390/nu12061807
  50. Adams EL, Caccavale LJ, Smith D, Bean MK. Food insecurity, the home food environment, and parent feeding practices in the era of COVID-19. Obesity (Silver Spring) 2020;28:2056-63. https://doi.org/10.1002/oby.22996
  51. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child Adolesc Health 2020;4:347-9. https://doi.org/10.1016/S2352-4642(20)30096-1
  52. Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 2004;10:1206-12. https://doi.org/10.3201/eid1007.030703
  53. Yeasmin S, Banik R, Hossain S, Hossain MN, Mahumud R, Salma N, et al. Impact of COVID-19 pandemic on the mental health of children in Bangladesh: a cross-sectional study. Child Youth Serv Rev 2020;117:105277. https://doi.org/10.1016/j.childyouth.2020.105277
  54. Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Med Public Health Prep 2013; 7:105-10. https://doi.org/10.1017/dmp.2013.22
  55. Rasheed N. Stress-associated eating leads to obesity. Int J Health Sci (Qassim) 2017;11:1-2.
  56. Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition 2007;23:887-94. https://doi.org/10.1016/j.nut.2007.08.008
  57. Jaaskelainen A, Nevanpera N, Remes J, Rahkonen F, Jarvelin MR, Laitinen J. Stress-related eating, obesity and associated behavioural traits in adolescents: a prospective population-based cohort study. BMC Public Health 2014;14:321. https://doi.org/10.1186/1471-2458-14-321
  58. Hossain MM, Sultana A, Purohit N. Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiol Health 2020;42:e2020038. https://doi.org/10.4178/epih.e2020038
  59. Headey DD, Alderman HH. The relative caloric prices of healthy and unhealthy foods differ systematically across income levels and continents. J Nutr 2019;149:2020-33. https://doi.org/10.1093/jn/nxz158
  60. NPR. Why processed food is cheaper than healthier options [Internet]. Washington, DC: NPROrg; c2020 [cited 2020 Jun 14]. Available from: https://www.npr.org/2013/03/01/173217143/why-process-food-is-cheaper-than-healthier-options.
  61. Perez-Escamilla R, Cunningham K, Moran VH. COVID-19 and maternal and child food and nutrition insecurity: a complex syndemic. Matern Child Nutr 2020;16:e13036.
  62. Wilson JM, Lee J, Fitzgerald HN, Oosterhoff B, Sevi B, Shook NJ. Job insecurity and financial concern during the COVID-19 pandemic are associated with worse mental health. J Occup Environ Med 2020;62:686-91. https://doi.org/10.1097/JOM.0000000000001962
  63. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 3 April 2020 [Internet]. Geneva (Switzerland): World Health Organization; 2020 Apr [cited 2020 Jun 14]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19--3-april-2020.
  64. Storz MA. Child abuse: a hidden crisis during COVID-19 quarantine. J Paediatr Child Health 2020;56:990-1. https://doi.org/10.1111/jpc.14919
  65. Graham-Harrison E, Giuffrida A, Smith H, Ford L. Lockdowns around the world bring rise in domestic violence [Internet]. London: The Guardian 2020; [cited 2020 Jun 14]. Available from: https://www.theguardian.com/society/2020/mar/28/lockdowns-world-rise-domestic-violence.
  66. Cobbe E. Self-quarantine amid coronavirus pandemic will likely lead to increase in domestic violence, WHO warns [Internet]. New York (NY): CBS NEWS; 2020 Apr [cited 2020 Jun 14]. Available from: https://www.cbsnews.com/news/coronavirus-self-quarantine-will-likely-lead-toincrease-in-domestic-violence-world-health-organization-warns/.
  67. Fuemmeler BF, Dedert E, McClernon FJ, Beckham JC. Adverse childhood events are associated with obesity and disordered eating: results from a U.S. population-based survey of young adults. J Trauma Stress 2009;22:329-33. https://doi.org/10.1002/jts.20421
  68. Danese A, Tan M. Childhood maltreatment and obesity: systematic review and meta-analysis. Mol Psychiatry 2014;19:544-54. https://doi.org/10.1038/mp.2013.54
  69. Hemmingsson E, Johansson K, Reynisdottir S. Effects of childhood abuse on adult obesity: a systematic review and meta-analysis. Obes Rev 2014;15:882-93. https://doi.org/10.1111/obr.12216
  70. Akseer N, Kandru G, Keats EC, Bhutta ZA. COVID-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr 2020;112:251-6. https://doi.org/10.1093/ajcn/nqaa171
  71. Green P. Risks to children and young people during covid-19 pandemic. BMJ 2020;369:m1669. https://doi.org/10.1136/bmj.m1669
  72. Mediouni M, Madiouni R, Kaczor-Urbanowicz KE. COVID-19: How the quarantine could lead to the depreobesity. Obes Med 2020:100255. https://doi.org/10.1016/j.obmed.2020.100255
  73. Bates LC, Zieff G, Stanford K, Moore JB, Kerr ZY, Hanson ED, et al. COVID-19 Impact on behaviors across the 24-hour day in children and adolescents: physical activity, sedentary behavior, and sleep. Children (Basel) 2020;7:138.
  74. Hull HF. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 2005;11:354; author reply 354-5. https://doi.org/10.3201/eid1102.040760
  75. Plessa E, Diakakis P, Gardelis J, Thirios A, Koletsi P, Falagas ME. Clinical features, risk factors, and complications among pediatric patients with pandemic influenza A (H1N1). Clin Pediatr (Phila) 2010;49:777-81. https://doi.org/10.1177/0009922810368558
  76. Kim CO, Nam CM, Lee DC, Chang J, Lee JW. Is abdominal obesity associated with the 2009 influenza A (H1N1) pandemic in Korean school-aged children? Influenza Other Respir Viruses 2012;6:313-7. https://doi.org/10.1111/j.1750-2659.2011.00318.x

Cited by

  1. Pediatric Endocrinology of Post-Pandemic Era vol.57, pp.2, 2020, https://doi.org/10.4068/cmj.2021.57.2.103
  2. Family Food Environment during the COVID-19 Pandemic: A Qualitative Study vol.8, pp.5, 2020, https://doi.org/10.3390/children8050354
  3. Joint Effort towards Preventing Nutritional Deficiencies at the Extremes of Life during COVID-19 vol.13, pp.5, 2020, https://doi.org/10.3390/nu13051616
  4. The indirect effects of COVID-19 on pediatric research vol.90, pp.2, 2020, https://doi.org/10.1038/s41390-021-01563-x
  5. 빅데이터를 이용한 소아청소년에서의 코로나 바이러스 감염증-19와 치과 방문의 연관성 분석 vol.48, pp.3, 2020, https://doi.org/10.5933/jkapd.2021.48.3.324
  6. Unfavorable progression of obesity in children and adolescents due to COVID‐19 pandemic: A school‐based survey in China vol.29, pp.11, 2020, https://doi.org/10.1002/oby.23276
  7. Contrasting Narratives of Race and Fatness in Covid-19 vol.43, pp.4, 2020, https://doi.org/10.1007/s40656-021-00477-5
  8. Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review vol.13, pp.12, 2020, https://doi.org/10.3390/nu13124459