COVID-19 and Childhood Obesity

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n the last decade, the COSI Portugal study, developed by the Department of Food and Nutrition of the National Institute of Health Doutor Ricardo Jorge and integrated in the Childhood Obesity Surveillance Initiative of the World Health Organization-Europe, has been showing an inverted trend in the prevalence of obesity and overweight children (-8.3% between 2008 and 2019). However, still one in three children is overweight and 10.6% childhood obesity.

It is also common to observe childhood obesity in families with obesity and other associated comorbidities. More than 60% of obese children will be obese adults, reducing the average age of the onset of non-communicable diseases, which, in itself, presents a greater risk of developing complications by Covid-19, which is a situation of particular concern among children from socioeconomic most unfavorable strata.

In view of the lack of knowledge about the treatment of this virus and its easy transmission, measures were introduced which inevitably led to changes in the usual daily routines. These restrictions included the closure of schools and daycare centers and the implementation of the telescope, forcing children to spend more time at home.

Challenges to obesity prevention
In Portugal, schools are not expected to open until the end of this school year, except for the last years of secondary and vocational education. These changes are possible challenges for the prevention of obesity, since the closure of schools can exacerbate the risk of weight gain, similar to that described in several studies during the summer vacation period.

The practice of physical activity (spontaneous and organized), often carried out in open spaces and at school, at these ages, was conditioned, especially in families who live in urban areas. It is expected that sedentary habits will increase, largely due to the time spent with electronic devices, not only due to play activities, but also due to the adaptation of the educational system.

The high screen time has been associated with the development of overweight and obesity in pediatric age, due to a greater consumption of snacks during this activity and by the very exposure to the marketing of products rich in sugar, salt and fat, as well as by the increase sedentary lifestyle. In addition, changing the routines of all family members can lead to greater stress and changes in sleep patterns, contributing to the preference for “comfort foods”.

On the other hand, the purchase of food also changed, with a less frequent trip to supermarkets, accompanied by a greater volume of purchased food and opting for less perishable foods, such as canned and processed foods. This change in routines and purchasing patterns can contribute to an increase in the energy intake of food by the whole family, mainly due to the more frequent consumption of foods rich in fat, sugar and salt.

These lifestyle changes caused by Covid-19 have recently been demonstrated in a study of children with obesity in Italy. During quarantine, there was a significant increase in consumption of less healthy foods (such as chips and sugary drinks), decreased physical activity and increased screen time.

In children with excess weight and obesity, isolation is of particular concern since the unfavorable environment compromises the maintenance of healthy lifestyles. In addition to maintaining pre-established healthy routines, the approach to childhood obesity presents other challenges, such as access to health services.

Childhood Obesity Prevention Measures

In view of the current scenario, it is crucial to adopt innovative measures to prevent the worsening prevalence of childhood obesity in Portugal. Opportunities to incorporate healthy behaviors into the daily routine, such as meals and family physical activity, as well as other playful and creative activities, should be maximized.

Some suggestions in this regard for families with children, include:

+ Organize your trip to the supermarket by drawing up a shopping list with what you need for your meals, giving priority to fruit and vegetables avoiding buying foods / snacks with a high content of sugar, salt and fat;

+ In the kitchen, children can assist in the preparation of meals, following the hygiene rules of the General Directorate of Health which include: frequent washing of hands and countertops, the use of aprons, using different utensils for different foods, not mixing raw and cooked food and washing very well vegetables and fruit that are to be eaten peeled;

+ Maintain your meal times and pay attention to the portions you serve – maintaining the same food routine that the child is used to at school contributes to a greater control of food consumption throughout the day;

+ More Fruit – Make Fruit the dessert of excellence and include it in breakfast and snacks. Be creative, try adding cinnamon / mint and spices, use it and serve it in different ways (skewered, balls, etc.);

+ More Vegetables and Legumes – Take the opportunity to recover the grain, beans and peas at your table and use the soup at the beginning of the meal as an easy way to increase the consumption of vegetables in children. The soup, in addition to adding nutritional value to the meal, also regulates appetite;

+ More Water – encourage children to consume water throughout the day and during meals, and avoid sugary drinks;

+ Promote 1-2 moments (30 to 60 minutes) of physical activity per day. Dancing, games, online tutorials with age-adjusted exercises are good examples.

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