Sharp Obesity Increase Since Pandemic in Black Youth

A report comparing childhood obesity prevalence before the COVID pandemic and since the height of the pandemic shows a dramatic rise in the numbers for Black children and Black adolescents with obesity. Findings were published in the Annals of Internal Medicine.

Researchers, led by Michael Liu, MD, MPhil, with the Center for Outcomes Research at Beth Israel Deaconess Medical Center in Boston, found that overall, the prevalence of obesity didn’t change significantly. Prevalence was 20.3% from January 2011 to March 2020, when COVID shutdowns began, and rose to 22.0% from August 2021 to August 2023. But after accounting for secular trends, “no overall increase in obesity prevalence was seen during the pandemic relative to the pre-pandemic period (adjusted difference, 0.52 percentage points; 95% CI, 2.3-3.3 percentage points).

Pandemic-related increases in obesity prevalence were observed only in Black children and adolescents, the authors wrote, for whom rates were 22.4% in the decade before the pandemic and 35% in the 2 years after the height of COVID.

Racial Disparities Clear

Now, “In the US, more than in 1 in 3 Black youth, more than 1 in 4 Hispanic youth, nearly 1 in 5 White youth, and 1 in 10 Asian youth currently meet the criteria for obesity,” the authors reported.

Prevalence of severe obesity overall and across all subgroups remained stable between 2011 and August 2023.

Researchers used serial cross-sectional data from the 2011 to August 2023 survey cycles of the National Health and Nutrition Examination Survey and included 17,507 children aged 2-11 years and adolescents aged 12-19 years. Height and weight from in-person examinations were used to calculate BMI. Obesity in this study was defined as a BMI at or above the age- and sex-specific 95th percentile according to the CDC growth charts. Severe obesity was defined as a BMI of 120% or more of the 95th percentile.

Addressing Underlying Factors

The next step is to address the factors that have led to the disparities documented in this report through public health and policy interventions, Therese F. Anderson, MD, assistant professor of family medicine at Mayo College of Medicine in Jacksonville, Florida, told Medscape Medical News.

She pointed out the authors discuss multiple factors that have contributed to an increase in obesity during the COVID-19 pandemic and thereafter, including disruption in daily routines with school closures and reduced access to structured exercise and activity, leading to increased screen time and sedentary behaviors. Mealtimes were disrupted, and there was more reliance on ultraprocessed foods.

“Studies thus far have shown that Black and minority youth were disproportionately impacted due to higher rates of food insecurity, lower neighborhood resources — such as access to parks and safe spaces for exercise — as well as increased economic stress during the pandemic,” she noted.

Anderson said these new numbers add support for policies and funding in areas such as improvement of access to healthy foods, expansion of food assistance programs, incentives to build grocery stores in food deserts, and promotion of safe spaces for activity.

Medicaid Coverage for GLP-1s

“Additionally, expanding state Medicaid programs to fund weight management programs as well as medications like GLP-1s [glucagon-like peptide-1s], which are FDA approved for age 12 and up, are potential avenues for improvement. Currently, there are only 13 states with coverage for GLP-1s under Medicaid,” Anderson said.

Pediatricians have an important role in addressing childhood obesity, she said. First, she said, is promoting family-based approaches to lifestyle modifications, such as healthy meals and family exercise.

“Secondly, we need to continue to advocate for policy changes as they impact the health of Black and minority youth. For example, the American Academy of Pediatrics is urging lawmakers to reject funding cuts to Medicaid and the Children’s Health Insurance Program (CHIP),” she said. “Lastly, we need to familiarize ourselves with new interventions as they are emerging, such as telehealth and medications like GLP-1s.”

Financial disclosures for authors are available with the full article. Anderson reported having no relevant financial relationships.

Marcia Frellick is a Chicago-based, independent healthcare journalist.