Politics, to paraphrase the philosopher John Gray, is nothing more than a series of imperfect remedies for recurring problems. No policy results in unmixed blessings; every decision we make has both good and bad consequences. So it is with the mandates and restrictions that have ruled our social life for the past two years. Lockdowns, school closures, and mask-wearing reduced the transmission of COVID-19 and prevented some serious illnesses and deaths. But two years on, we are vastly more knowledgeable about COVID itself and about the benefits and drawbacks of our public health policies. We must now address the detrimental impacts these policies have had on some of the most helpless members of our society: children.
Even in the early days of the pandemic, researchers on children’s health sensed a crisis in the making. Articles published in The Lancet in the spring of 2020 predicted that children’s health would suffer as schools closed and states restricted social and outdoor activity. Experts in childhood development warned that mask-wearing for young children could negatively affect their ability to recognize faces and understand speech, which would in turn inhibit their social development. Other obvious dangers were on the horizon: children would have to increase their screen time drastically to attend school virtually. Heavy use of screens (even for educational purposes) is correlated with a number of health problems: poor sleep quality, attentional difficulties, anxiety and depression. It didn’t take an oracle to predict that rates for these problems would increase during the pandemic.
Indeed, child psychiatrists have noted increases in emotional disorders particularly among children who were already struggling before the pandemic. A U.K. study that focused on children ages 4 to 10 found that “the level of lockdown greatly affected mental health and behavioral issues, with England’s first complete lockdown greatly exacerbating issues from hyperactivity to depression.” In the U.S., in just a seven-month period from March to October 2020, mental health-related emergency department visits increased 24% for children ages 5 to 11 and 31% for those ages 12 to 17 compared with 2019 visits. A 2020 technical report from UMass Boston and UMass Amherst also found socioeconomic disparities in the effects of pandemic policies, with students who relied on school-based mental health services rather than private or more expensive care suddenly unable to access them and faring worse as a result.
But among these pandemic-related health issues, one in particular is being referred to as a “pandemic within a pandemic”: childhood obesity. Obesity already affected 1 in 5 children before the pandemic – with higher rates among communities of color – but the numbers have risen significantly over the past two years and health experts are calling for the problem to be addressed. We will likely have better data in the coming months as researchers are able to study the issue in more detail, but the numbers we do have tell a disturbing story. In the United States, among people ages 2 to 19, the rate of body mass index increase per month (i.e. how much weight people were gaining per month as it related to their height) nearly doubled during the pandemic. Young children and people who were already obese saw the largest increases.
Obesity is correlated with all sorts of terrible health outcomes, especially in younger people. Children with obesity are more likely to have type 2 diabetes, high blood pressure and high cholesterol, and muscle and joint problems. Obesity can impact their development during puberty and put them at risk for other health issues, such as heart disease, as they age. Childhood obesity is more common among Black, Hispanic, and immigrant children and children of lower socioeconomic status. And as with mental health issues, weight gain and other physical health problems increased disproportionately among these groups during the pandemic.
The causes of the increases in childhood obesity during the pandemic are obvious. Children spent far more time indoors and on screens. Physical activity outside was actively discouraged. Students who relied on school meals found themselves without nutritional options as schools closed, while other children found it easier to snack and eat processed foods at home. A multi-country study showed that food consumption and eating patterns of many adolescents “deteriorated” during the pandemic, with children having more snacks, eating out of control, and eating unhealthy food types. And of course, children were far more stressed and more prone to emotional problems during lockdowns and school closures. Childhood obesity and poor mental health often go hand-in-hand, with obese children at a much higher risk for psychosocial problems and mental health conditions and children with mental health conditions more likely to be physically unhealthy.
Addressing children’s physical health, then, can have positive impacts on their mental health, and addressing their mental health can positively influence their physical health. Tackling one set of problems means tackling the other set. But what are we actually doing to improve children’s health after the pandemic? So far, not much. More and more media outlets are recognizing the problems, but solutions range from the vague (more federal funding) to the cruel (place the burden on teachers). There is also a frustrating lack of self-awareness in the coverage of these issues.
The progressives at NPR, who in 2020 hosted guests who called enthusiastically for school closures and who promised the negative consequences could be mitigated with more government spending and Zoom classrooms, are now publishing articles about the massive social and economic costs of these school closures without a hint of irony – as if they were not part of a media environment that dismissed parents’ and pediatricians’ fears about the impacts of school closures as silly and “anti-science”. Regardless, the time is ripe for a serious and open discussion about what we can do for children as the pandemic wanes. With two years of data to review, we can learn from the decisions we made and do better by our children in the future. In particular, we can address the disproportionate impact these policies have had on people of color and immigrants, who not only faced higher rates of COVID-19 during the pandemic but were also far more likely to suffer the social and economic consequences of lockdowns and school closures. Children in immigrant, Hispanic, and Black communities are at a much higher risk of developing obesity as well, and this requires urgent action. The American Psychological Association calls childhood obesity an epidemic in its own right, and ending it requires large-scale action.
