Covid-19 has made the obesity epidemic worse, but failed to ignite enough action

Dear Editor

Senthilingam describes the growing problem of the obesity epidemic and rightly identifies that the COVID-19 pandemic has highlighted this issue and provided an opportunity for change.[1] Their discussion briefly mentions the link between health inequalities and childhood obesity but could go further in exploring the impact of the COVID19 pandemic on the well-established childhood obesity epidemic.[1]

The most recent UK National Child Measurement Programme (data collected prior to March 2020) demonstrates that in children aged 10-11, childhood obesity rates are 21%.[2] In the most deprived areas, this number increases to 27.5% of children.[2] The impact of COVID19 restrictions is likely to have worsened this. For example, the link between weight gain and out of school time in the school holidays is already well demonstrated, and worse amongst those from deprived backgrounds.[3] This is likely to have been the case during COVID19 lockdowns, which have affected 75% of school children around the world.[4] Combined with added food insecurity, with over 20% of UK households worse off financially now than before the pandemic began, families are more likely to buy cheaper and more calorie dense foods.[5]

Physical activity has also decreased, although prior to the pandemic over 50% of children were already not achieving physical activity guidelines.[6] Despite lockdown restrictions allowing 60 minutes of exercise in a local area, nearly 30% of children report not leaving the home during a typical day of lockdown.[7] With parks, recreational areas and gyms closed and an increase in screen time over the pandemic, there has been a further reduction in physical activity in children and young people; these changes are more pronounced among ethnic minority communities.[7-9]

The UK government had already been slow and weak tackling the growing childhood obesity epidemic.[10] COVID19 is worsening the situation and the consequences on children must be recognised; the direct health consequences of obesity must not be ignored, however just as worrying are the links between childhood obesity and poor mental health, low self-esteem and marginalisation.[11] The July 2020 Obesity Strategy measures targeted at obesity in the UK do not go far enough.[1] The policy is also weak in comparison with other countries, for example Chile have introduced a wider range of more restrictive measures.[12 13] It also contains many strategies which have already been proposed – but never implemented – by the Westminster government.[10] With the convergence of the childhood obesity epidemic and the COVID19 pandemic the time is now for urgent and decisive action by the government, to protect the wellbeing of children and the future health of the UK population.

References
1. Senthilingam M. Covid-19 has made the obesity epidemic worse, but failed to ignite enough action. BMJ 2021;372:n411. doi: 10.1136/bmj.n411
2. NHS Digital. National Child Measurement Programme, England 2019/20 School Year: NHS Digital; 2020 [Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nat....
3. Franckle R, Adler R, Davison K. Peer reviewed: accelerated weight gain among children during summer versus school year and related racial/ethnic disparities: a systematic review. Preventing chronic disease 2014;11 doi: 10.5888/pcd11.130355
4. Di Pietro G, Biagi F, Costa P, et al. The likely impact of COVID-19 on education: Reflections based on the existing literature and recent international datasets: Publications Office of the European Union; 2020 [Available from: https://ec.europa.eu/jrc/en/publication/likely-impact-covid-19-education...
5. Handscomb K, Judge L. Caught in a (Covid) trap: Incomes, savings and spending through the coronavirus crisis: Resolution Foundation 2020 [Available from: https://www.resolutionfoundation.org/publications/caught-in-a-covid-trap/.
6. Sport England. Active Lives Children and Young People Survey: Academic year 2018/19: Sport England; 2019 [Available from: https://sportengland-production-files.s3.eu-west-2.amazonaws.com/s3fs-pu....
7. Bingham DD, Daly-Smith A, Hall J, et al. Covid-19 lockdown: Ethnic differences in children’s self-reported physical activity and the importance of leaving the home environment. A longitudinal and cross-sectional. medRxiv 2021 doi: 10.1101/2021.02.26.21252543
8. Stockwell S, Trott M, Tully M, et al. Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review. BMJ Open Sport & Exercise Medicine 2021;7(1):e000960. doi: 10.1136/bmjsem-2020-000960
9. Kovacs VA, Starc G, Brandes M, et al. Physical activity, screen time and the COVID-19 school closures in Europe – An observational study in 10 countries. European Journal of Sport Science 2021:1-10. doi: 10.1080/17461391.2021.1897166
10. Theis D, White M. Is obesity policy in England fit for purpose? Analysis of government strategies and policies, 1992-2020. Milbank Q 2020;99(1):126-70. doi: 10.1111/1468-0009.12498
11. Pizzi MA, Vroman K. Childhood Obesity: Effects on Children's Participation, Mental Health, and Psychosocial Development. Occupational Therapy In Health Care 2013;27(2):99-112. doi: 10.3109/07380577.2013.784839
12. Department of Health Social Care. Tackling obesity: empowering adults and children to live healthier lives 2020 [Available from: https://www.gov.uk/government/publications/tackling-obesity-government-s....
13. Organisation for Economic Co-operation and Development. OECD reviews of public health: Chile. Chapter 2: Tackling obesity, unhealthy diet and physical inactivity: OECD; 2019 [Available from: http://www.oecd.org/publications/oecd-reviews-of-public-health-chile-978....