Linking Obesity and Severe COVID-19 in Children

Linking Obesity and Severe COVID-19 in Children

by Samantha Borenstein | Edited by Andrew Guo

Within the past two years, there has been a sharp increase in weight gain and obesity in US children between 2 and 19 years old.  It is natural for children to gain weight, especially as they are growing, but children have begun to gain too much weight too fast.  A study by the CDC found that rates of BMI increase doubled in this age group during the pandemic, largely due to the impact of COVID-19 on government policies that dictated school closures and loss of job opportunities for their parents.  

When our lives were flipped upside-down by the pandemic, many children were exposed to increased stress, irregular mealtimes, less access to nutritious food (especially if reliant on school meals), reduced physical activity, and little social interaction.  The aforementioned factors contributed to an environment that encouraged unhealthy eating, overeating, and stress eating, thus resulting in accelerated weight gain.  Children with preexisting obesity experienced the most acute unhealthy weight gain.  Ultimately, children previously reported obese gained an average of 7.3 pounds during the pandemic, while those with healthy weights gained an average of 2.7 pounds.  Another study reported that the most affected groups were Hispanic and black children, as these groups are disproportionately affected by poverty and obesity.

Obesity is the second leading cause of preventable death in the United States, so this increase in unhealthy weight gain is of great concern to pediatricians across the country.  Compared to people of lower weights, obese individuals have increased risk for conditions such as coronary heart disease, fatty liver disease, cancer, high blood pressure, breathing difficulties, and mental illnesses.  While these heath issues are all incredibly troubling, there is another illness for which obese people are at increased risk: COVID-19.

Obesity involves excessive fat accumulation (adipose tissue storage), so much so that it jeopardizes one’s health.  By resulting in enlarged fat cells, the disease essentially creates a chronic inflammatory state in the body, creating dysfunction.  Inflammatory molecules are then produced, which are toxic for the body.  When these patients are subsequently infected with COVID-19, the virus infects a host cell, causing hyperinflammation.  The combination of the two inflammatory states damages the immune system, the cardiovascular system, and the respiratory system.  

Inflammation of the respiratory system is incredibly dangerous, and increases risk of needing a ventilator.  Additionally, obesity can result in an inability for the chest wall to expand fully, thus making inhalation unnecessarily difficult, furthering severe disease and necessitating ventilator utilization.  After studying the progression of the disease in people under 18, researchers were able to link obesity to a 3.07 times higher chance of hospitalization in COVID-19 patients.  It was also linked to a 1.42 times higher chance of severe illness, meaning COVID-19 cases requiring ICU admission or ventilators.

The results of these studies have highlighted the two-way street between obesity and COVID-19 across all age groups.  As fat tissue in the body increases to the point of decreasing health, risk of severe illness and, ultimately, death also increases.  Though obesity increases risk of severe COVID-19, the lockdowns that were enacted to stop the spread of COVID-19 are directly linked to increased obesity.  What makes adolescents so significant is that these studies have demonstrated that obesity is the main background health condition behind COVID-19-related hospitalization in children, unlike people over 18, for whom COVID-19 severity can be linked to myriad health conditions.  Further, adolescents were the most impacted by COVID-19.  Their development was stunted in school, they suffered emotionally due to lack of social contact, their lives became less active and more sedentary, and they were increasingly unable to access healthy, regular meals.  They were not being supervised by teachers or parents because they were home alone to do virtual school while their parents worked.  They experienced a sharp increase in mental health issues, and their overall stress exponentially increased.  All of these factors are dangerous, and ultimately increased susceptibility to COVID-19.

Amid the Omicron variant, as cases spiked and child hospitalizations steadily rose, childhood obesity became more prevalent in the public eye.  We have been extremely aware that people with underlying conditions are more at risk for severe illness when infected with COVID-19.  Almost 90 percent of hospitalizations of children 5-17 involve two or more underlying conditions.  In all of these hospitalizations, 66 percent of COVID-19 patients between the ages of 12 and 17 were obese, making it the most significant underlying condition in COVID-19-related hospitalizations.  These obese patients were not only more likely to need advanced care, but they consistently needed longer durations of care as well.These statistics present a terrifying picture, but pediatricians have recommended multiple courses of action for parents with children that have obesity.  One of the most important things to do is to consult a primary care doctor about getting a COVID-19 vaccination.  After speaking with the doctor, assuming the child is not allergic to any of the ingredients in the vaccine, getting vaccinated is essential, as it has been proven incredibly effective at protecting against severe illness and death.  Another recommendation is to take preventative measures to reduce risk of infection.  This includes washing one’s hands, wearing a mask, and social distancing when possible.  Yet another important course of action is to consider changing some of the family’s habits; obesity is not just a result of lifestyle choices, as it is often linked to genetics and other factors, but changing some habits—such as making healthier food choices, getting adequate sleep, and limiting screen time—can help children lead healthier lives, and help reduce some of the excess adipose tissue that poses health risks.

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