Outlook: Newsletter of the Society of Behavorial Medicine

Winter 2020-21

Obesity in the COVID-19 Pandemic and Beyond: Exacerbation of Health Disparities Among Racial/Ethnic Minority Families

Marissa Kobayashi, MHS; Lindsay Stager, MA; and Melanie K. Bean, PhD; Child and Family Health SIG


Obesity is a major public health issue with alarming trends suggesting that the COVID-19 pandemic is exacerbating this crisis and widening health disparities among at-risk, low-income, ethnic minority families. Recent estimates suggest that 16.6% of children and 31.8% of adults have overweight and 18.5% and 42.4% have obesity. Moreover, 5.6% of children and 9.2% of adults have severe obesity, defined as body mass index (BMI) ≥120% of the 95th percentile and BMI ≥40kg/m2, respectively.1,2 Families from racial and ethnic minority backgrounds, specifically Hispanic/Latinx and Black/African American adults and children, have disproportionately higher rates of obesity.2 These inequities are especially concerning given the detrimental psychological (e.g., depression) and physical health sequelae (i.e., type 2 diabetes, hypertension) of obesity, and corresponding disparities in obesity-related comorbidities.3 The current COVID-19 pandemic is further compounding both obesity risk and existing racial and ethnic health disparities. Specifically: 1) obesity has emerged as a significant risk factor for COVID-19 complications; 2) COVID-19 sequelae are associated with increases in obesogenic behaviors; and 3) alarming increases in food insecurity, paradoxically associated with obesity, have been observed,4 with rates being disproportionately higher in ethnic minority households.5 Coordinated public health efforts are needed to reduce the deleterious impact of COVID-19 on obesity risk, with particular efforts needed among the most vulnerable families.

Obesity and obesity-related comorbidities are associated with increased risk of COVID-19 morbidity and mortality for both children and adults.6,7 Among children hospitalized for COVID-19, obesity is the most prevalent underlying condition.8  Similarly, adult obesity is frequently observed among those admitted to intensive care for COVID-19, with more severe obesity corresponding to more COVID-19 severity.9 Furthermore, the burden of COVID-19 has disproportionately fallen on individuals from lower income and racial and ethnic minority backgrounds due in part to greater exposure from employment (e.g., essential workers) and more frequent habitation in multigenerational households.10,11 Specifically, Black and Hispanic adults and children have significantly greater rates of cases, hospitalizations, and deaths when compared to their white counterparts.10  These disparities highlight systemic inequities, including those corresponding to higher rates of obesity, identifying the need for urgent action to reduce these trends and reverse other COVID-19 impacted obesogenic behaviors.

The pandemic has significantly disrupted many facets of family life and adversely impacted obesogenic behaviors. Stay-at-home mandates and the associated closures of schools, businesses, and other activities have disrupted routines and led to declines in child and adult physical activity,12,13 disruptions to sleep patterns, and increased screen time, all of which increase the risk of weight gain.13,14  Moreover, significant changes to eating patterns have been observed, with less dietary restraint,15 greater use of controlling feeding practices,4 decreased consumption of fruits and vegetables,16 and increased snacking and stress eating.14 Changes in the home food environment have become more salient with purchasing patterns associated with the pandemic suggesting greater prevalence of processed food in the home.4 Moreover, there are grave increases in food insecurity, with nearly 40% of Black and Hispanic households with children experiencing food insecurity.5 Taken together, these behavioral patterns are concerning, given their association with obesity, raising concern for long-standing obesity-related sequalae due to this pandemic. Thus, public health interventions and policies to address these behavioral trends are imperative, particularly for those most at risk due to these systemic disparities.

Given the increase in obesogenic behaviors, food insecurity and the COVID-19 health risks associated with obesity, timely intervention is critical. Innovative adaptations to evidence-based obesity interventions and targeted public health policies and legislative initiatives are urgently needed to address these widening health disparities. COVID-19 has exposed deep health inequities. These public health challenges will require commitment and coordination across multiple systems to avoid irreparable consequences to families’ health.

 

References

  1. Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, 360.
  2. Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2017). Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief, 288.
  3. Smith, J. D., Fu, E., & Kobayashi, M. A. (2020). Prevention and Management of Childhood Obesity and its Psychological and Health Comorbidities. Annual review of clinical psychology16, 351-378.
  4. Adams, E. L., Caccavale, L. J., Smith, D., & Bean, M. K. (2020). Food insecurity, the home food environment, and parent feeding practices in the era of COVID‐19. Obesity28(11), 2056-2063.
  5. Schanzenbach, D., Pitts, A. (2020). Food insecurity in the census household pulse survey data tables. Northwestern University Institute for Policy Research. Retrieved from:  https://www.ipr.northwestern.edu/documents/reports/ipr-rapid-research-reports-pulse-hh-data-1-june-2020.pdf
  6.  Centers for Disease Control and Prevention. (2020). “Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID-19. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/evidence-table.html
  7. Hussain, A., Mahawar, K., Xia, Z., Yang, W., & Shamsi, E. H. (2020). Obesity and mortality of COVID-19. Meta-analysis. Obesity research & clinical practice,14(4), 295-300.
  8. Kim, L., Whitaker, M., O’Halloran, A., Kambhampati, A., Chai, S. J., Reingold, A., ... & Anderson, E. J. (2020). Hospitalization rates and characteristics of children aged< 18 years hospitalized with laboratory-confirmed COVID-19—COVID-NET, 14 states, March 1–July 25, 2020. Morbidity and mortality weekly report69(32), 1081.
  9. Simonnet, A., Chetboun, M., Poissy, J., Raverdy, V., Noulette, J., Duhamel, A., ... & LICORN and the Lille COVID‐19 and Obesity study group. (2020). High prevalence of obesity in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) requiring invasive mechanical ventilation. Obesity. Doi: 10.1002/oby.22831
  10. Centers for Disease Control and Prevention. (2020). COVID-19 Hospitalization and Death by Race/Ethnicity. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html.
  11.  Substance Abuse and Mental Health Services Administration. (2020). Double jeopardy: COVID-19 and behavioral health disparities for black and Latino communities in the U.S. Retrieved from https://www.samhsa.gov/sites/default/files/covid19-behavioral-health-disparities-black-latino-communities.pdf
  12. Duncan, G. E., Avery, A. R., Seto, E., & Tsang, S. (2020). Perceived change in physical activity levels and mental health during COVID-19: Findings among adult twin pairs. PloS one15(8), e0237695.
  13. Dunton, G., Do, B., & Wang, S. (2020). Early Effects of the COVID-19 Pandemic on Physical Activity and Sedentary Behavior in US Children. BMC Public Health, 20, 1351.
  14. Zachary, Z., Brianna, F., Brianna, L., Garrett, P., Jade, W., Alyssa, D., & Mikayla, K. (2020). Self-quarantine and Weight Gain Related Risk Factors During the COVID-19 Pandemic. Obesity Research & Clinical Practice, 14(3), 210-216. doi:10.1016/j.orcp.2020.05.004
  15. Di Renzo, L., Gualtieri, P., Pivari, F., Soldati, L., Attinà, A., Cinelli, G., ... & Esposito, E. (2020). Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. Journal of Translational Medicine18(1), 1-15.
  16. Sidor, A., & Rzymski, P. (2020). Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients12(6), 1657.