Life in a global pandemic has been difficult for children and teens who struggle with their weight, according to experts at Stanford Children’s Health.

Whether they face anorexia nervosa or obesity, young people across the weight spectrum are finding that the restrictions of the pandemic make it harder to maintain a healthy weight. It’s an example of how, even as relatively few young people have been sickened by COVID-19, the ongoing pandemic hurts their health in other ways. Everything from lost routines to economic insecurity to grief have exacerbated the challenges of weight management. Fortunately, there are steps families can take to help.

“Everyone’s activity level has changed drastically,” said Elizabeth Shepard, MD, clinical associate professor of pediatrics and medical director of the pediatric weight clinic at Stanford Children’s Health’s Center for Healthy Weight. When stay-at-home orders and online school became widespread, many young people were no longer participating in sports or even walking the halls at school. “Overall, we’ve seen excessive weight gain during the pandemic. For some kids, that puts them suddenly into the range of overweight or obesity and that can be quite detrimental to their health over the long term.”

While some kids and teens have gained too much weight, others have lost dangerous amounts due to eating disorders.

“I’ve been in the field for over 35 years, and in 2020, I saw some of the sickest patients I’ve ever seen,” said Neville Golden, MD, chief of adolescent medicine and professor of pediatrics, who treats patients in Stanford Children’s Health’s Comprehensive Eating Disorders Program. The number of patients hospitalized for the medical complications of eating disorders has been at its highest level in decades, he said, adding that this trend has been reported by treatment centers around the world. “It’s not just those who were living with eating disorders before. Many people have developed eating disorders during this pandemic.”

Why more weight-related struggles?

The restrictions imposed by COVID-19 have led to eating disorders and weight gain in many ways.

Teens’ heightened anxiety, depression and feelings of loss have contributed to the rise in eating disorders, said Golden, the Marron and Mary Elizabeth Kendrick Professor in Pediatrics. Adults are experiencing these emotions, too, but are better equipped to handle them and may not feel as devastated as a teenager would about events they’ve missed.

“For instance, many of our patients have lamented the loss of their senior year of high school, prom and graduation,” Golden said. “Or they’re struggling because they can’t play their sport: Volleyball or rowing was canceled, so they became less active, gained 5 to 10 pounds, and then started dieting and exercising excessively to reduce their weight, launching a cycle that becomes very hard to control.”

Shepard’s patients have also described dealing with anxiety and depression, she said. And families have told her that they’re struggling financially: One or both parents may have lost their jobs, making it harder to afford healthy, fresh foods.

If families aren’t maintaining regular mealtimes—another common casualty in scrambled pandemic schedules—that can also make it harder for youth to manage any type of weight challenge.

Finally, in some cases, families have worried that going to the doctor about a weight problem could expose their child to COVID-19.

“I saw some patients between June and August who waited too long to seek medical attention because of fear of coming to the hospital,” Golden said. “They had very low weights and multiple medical complications, some of which required ICU admissions.” Untreated anorexia can cause a dangerous drop in patients’ heart rates and blood pressures.

“We need people to know that it’s safe to bring your child to the hospital or medical system to be evaluated,” he said, adding that this is true both for underweight and overweight individuals. “We’re very careful about preventing COVID-19 transmission, with frequent COVID testing, appropriate personal protective equipment, handwashing, social distancing and so on.”

What helps

The experts have several suggestions for families concerned about a child’s weight. Regular mealtimes are important: Shepard noted that, without regular meals, some of her patients are snacking too frequently, and Golden is seeing patients who hardly eat. Both experts also stress the importance of regular sleep, as disrupted sleep schedules can lead to a variety of unhealthy changes in eating.

Making healthy foods consistently available is key, Shepard said, noting that her team is giving out flyers about a program that helps low-income families purchase fruits and vegetables from farmers markets.

“One of the real decision points for healthy eating is what you bring into your house,” she said. “It’s very difficult to say ‘don’t eat it or don’t drink it’ about foods already in your home. You want to have healthy foods that you enjoy and that taste good. You can have some treats, but moderating how much you bring home is important.”

Parents should not restrict foods from one child while allowing them for other family members, she said, adding, “Healthy eating is for everyone, and treats are for everyone.”

For children and teens whose weight is low, Golden points to the findings of Stanford research on family-based treatment for anorexia nervosa. The treatment, which is now considered the first-choice method for most adolescents with anorexia nervosa, recommends that parents take charge of preparing three meals and two snacks a day, and sit with their child while they eat.

“Even that simple advice can really help a family in crisis until they get to see us,” he said.

That leads to the experts’ most important advice: They encourage families to call their child’s pediatrician with weight concerns. Many programs, including those at Stanford Children’s Health, are now offering some elements of weight management via telemedicine; for instance, the Stanford Children’s Health six-month Pediatric Weight Control Program is now offered via videoconference.

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