AAP releases new guidance to address kids’ nutrition during pandemic

The AAP has expressed concern about poor nutrition and decreased physical activity among children in the United States during the pandemic.

In response, the academy released two sets of interim guidance for physicians to help children maintain a healthy lifestyle.

According to the AAP, the pandemic has focused attention on the epidemic of childhood obesity because there is an increased risk for severe COVID-19 disease in children and adolescents with obesity. The pandemic has also increased the number of children in the U.S. who do not have enough food to eat, while causing a spike in unhealthy food consumption and a decline in physical activity.

“Not all children can maintain healthy nutrition and physical activity during the pandemic,” Sandra Hassink, MD, FAAP, medical director of the AAP’s Institute for Healthy Childhood Weight, said in a statement. “Pediatricians need to assess for food insecurity, access to healthy foods, opportunities for safe physical activity and are encouraged to connect families with community resources to help with financial, housing or food needs and plan together to reduce family stress and find ways to improve children’s health.”

In its first guideline, titled “Supporting Healthy Nutrition and Physical Activity During the COVID-19 Pandemic,” the AAP recommended assessments across three different points — nutrition, physical activity and obesity.

• Nutrition — evaluate for food insecurities and access to fresh food; assess routines and patterns around eating; and assess for disordered eating related to the pandemic, including scarcity of food, stress and trauma.

• Physical activity — understand the amount and type of physical activity; assess barriers and challenges related to opportunities for physical activity; and assess recreational screen time and sedentary time.

• Obesity — conduct an obesity assessment at all visits because it is likely to increase throughout the pandemic; and identify at-risk children and adolescents through the assessment of nutrition, sedentary behavior, sleep and physical activity, review of systems, and physical and family history.

The AAP also recommended tailored counseling that uses positive strategies to build on family strengths and emphasizes maintaining a healthy lifestyle.

In the second guideline, titled “Obesity Management and Treatment During COVID-19,” the AAP made some of the following recommendations for obesity treatment:

• Continue regular follow-up for obesity, and address barriers to follow-up.

• Identify and treat obesity-related comorbidities, such as lipid disorders, hypertension, prediabetes and nonalcoholic fatty liver disease.

• Do not delay obesity treatment, including intensive lifestyle counseling, obesity-related pharmacotherapy or metabolic and bariatric surgery. These services should be accessible during the pandemic; they are not elective for patients with obesity.

The academy also recommended a tailored assessment and counseling to address obesity during the pandemic:

• Emphasize and continue healthy lifestyle counseling, including screening and counseling for smoking and vaping cessation, substance use and mental health concerns.

• Counsel patients about COVID-19 risk in a nonjudgmental way. Inform patients and their families of the increased risk for severe COVID-19 associated with obesity, and advise additional protections as recommended by the CDC.

• Address patient and family stress. Families affected by negative social determinants of health and parents of children and adolescents with disabilities may experience greater levels of stress. These factors may present barriers to obesity treatment.

• Screen patients for disordered eating, including binge eating, purging and restrictive eating.

• Address social determinants of health. Economic, housing and food security for families is dynamic and even more so during the pandemic. Families can be counseled and connected to federal and local resources to address social determinants.

The AAP also said that physicians can advocate for policy, systems and environmental changes to address health inequities and advance healthy eating and an active lifestyle.

“Obesity is a chronic disease that puts children’s current and long-term health at risk and is likely to worsen during the course of the pandemic,” Hassink said. “It is important for pediatricians to continue to assess all patients for onset of obesity during the pandemic and to maintain treatment of children and adolescents who already have obesity. We are especially concerned about children and adolescents who already are more at risk based on economic, social and geographic disadvantages.”

References:

AAP. AAP interim guidance addresses healthy lifestyles, obesity management during pandemic. https://www.aappublications.org/news/2020/12/09/covidobesityguidance120920. Accessed December 9, 2020.

AAP. Obesity management and treatment during COVID-19. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/obesity-management-and-treatment-during-covid-19/. Accessed December 9, 2020.

AAP. Supporting healthy nutrition and physical activity during the COVID-19 pandemic. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/supporting-healthy-nutrition-and-physical-activity-during-the-covid-19-pandemic/. Accessed December 9, 2020.