Embed Size (px)
Citation preview
Jointly sponsored by World Obesity Federation (WOF),
European Association for the Study of Obesity (EASO) & The Obesity Society (TOS)
Children, Obesity and COVID-19:Risks and recommendations for the most vulnerable populations
Housekeeping
• Please use the Q&A function to post comments and questions
• There will be a chance to ask questions after each speaker
• The recording, slides and certificate of attendance will be circulated post-webinar
Agenda
13:00 – 13:03 Welcome and introductions Louise Baur & Johanna Ralston
13:03 – 13:15 The impact of COVID-19 on children: To what extent are children with obesity affected by the current pandemic?
Grace O’Malley
13:15 – 13:28 Treating children and adolescent obesity during the current COVID-19 crisis
Ania Jastreboff
13:28 – 13:53 Panel discussion:Childhood Obesity through an LMIC and equity lens
Simon Barquera, Jo Jewell, Paula Michele Lashley
13:53 – 13:55 Summary and key points Louise Baur
13:55 – 14:00 Final remarks Louise Baur & Johanna Ralston
Meet the speakers!
Louise Baur, Australia Paula Michele Lashley, BarbadosGrace O’Malley, Ireland
Johanna Ralston, UK Jo Jewell, USA
Ania Jastreboff, USA
Simon Barquera, Mexico
Welcome and introductions
Louis Baur, AM FAHMS
Professor and Head of Child & Adolescent Health
University of Sydney
Johanna Ralston
CEO, World Obesity Federation
An update on COVID-19 cases globallyJohn Hopkins University & Medicine: Coronavirus Resource Center
Why are children and adolescents important?
• Obesity in this age group is increasingly prevalent. Prediction of obesity globally in 5-19 year olds:*
2020: 158m 2025: 206m 2030: 254m
• For children & young people, the COVID-19 pandemic:
a) potentially makes obesity prevention more challenging
b) affects access to/ availability of treatment for obesity
c) especially affects the disadvantaged, incl. those from LMICs
• Children and young people are vulnerable in all cultures, and are our future
*Lobstein T, Brinsden H. Atlas of Childhood Obesity. World Obesity Federation 2019. www.worldobesity.org
Background on COVID-19 and Obesity
• Increasing evidence that PwO at high risk for severe complications
• “Likely that obesity shall be an independent risk factor for COVID‐19.”
• WHO statement on NCDs and COVID-19: People with pre-existing non-communicable diseases (NCDs) also appear to be more vulnerable to becoming severely ill with the virus.
• Obesity is not currently a separate independent risk factor for COVID-19 nor is data about BMI collected in a standardised manner. The World Obesity Federation, which is in official relations with WHO, considers that this is in part because obesity, though both risk factor and disease, is not classified across the WHO “five by five” main diseases and risk factors within NCD framework.
The impact of COVID-19 on children:
To what extent are children with obesity
affected by the current pandemic?
Grace O’Malley, PhD MSc BSc MISCP
Royal College of Surgeons in Ireland and
Children’s Health Ireland at Temple Street
EASO Secretary
The impact of COVID-19 on children: To what extent are children with obesity affected by the current pandemic?
• Less likely to develop fever, cough, or shortness of breath, 1-5% of positive cases with low mortality rate (0.18%), 5.7% of children are hospitalized(1-3)
• Infants and those with underlying conditions more likely to progress to severe disease (intussusception, leukemia Immunosuppression)(4,5)
• Adults with obesity at greater risk of complications of COVID19 and H1N1 flu…not known regarding children with obesity(6-10)
Impacts of societal response to pandemic
School/childcare closures for estimated 1.38b children: effects on food security and dietary quality, increased parental stress,
increased violence toward children.
Increased sedentary time, screen-time and less opportunity for play/activity
Increased weight gain and obesity progression
Progression of complications
Considerations for child health and obesity prevention/treatment• Impact on pre-pregnancy weight gain
• Access to maternal health interventions
• Impacts on gestational weight gain
• Access to breast-feeding and weaning support
• Parenting support from groups or family/friend network
• Increased tobacco exposure for those in homes with smokers
• Increased screen time and exposure to advertising
• Inequality related to access to space to play (parks within 2km)
• Altered routine and sleep impacts
• Access to online schooling
• Access to clinical support
• Opportunities for family cohesion, skill development
Redsell SA, Edmonds B, Swift JA, Siriwardena AN, Weng S, Nathan D, Glazebrook C. Systematic review of randomised controlled trials of interventions that aim
to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood. Matern Child Nutr. 2016 Jan;12(1):24-38. doi:
10.1111/mcn.12184. Epub 2015 Apr 20. Review. Erratum in: Matern Child Nutr. 2016 Jul;12(3):643
Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM. Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic
Review. Am J Prev Med. 2016 Jun;50(6):761-779. doi: 10.1016/j.amepre.2015.11.012. Epub 2016 Feb 22. Review.
https://www.covid19parenting.com
References
1) Ludvigsson JF. Systematic review of COVID-19 in children show milder cases and a better prognosis than adults. Acta Paediatr 2020 Mar 23. doi: 10.1111/apa.15270. [Epub ahead of print]
2) The Novel Coronavirus Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Weekly 2020;2:113–22.
3) Coronavirus disease 2019 (COVID-19) Situation Report – 64. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200324-sitrep- 64. Accessed March 25, 2020.
4) Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep 2020;69:422–426. DOI: http://dx.doi.org/10.15585/mmwr.mm6914e4
5) Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. Pediatrics 2020 Mar 16. pii: e20200702. doi: 10.1542/peds.2020-0702. [Epub ahead of print]
6) Centers for Disease Control and Prevention. People at high risk for flu complications. https://www.cdc.gov/flu/highr isk/index.htm. Updated August 27, 2018. Accessed March 19, 2020.
7) Kassir R. Risk of COVID-19 for patients with obesity Obes Rev. 2020 Apr 13. doi: 10.1111/obr.13034
8) Louie JK, Acosta M, Winter K, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA 2009;302:1896-1902.
9) Peng YD, Meng K, Guan HQ, et al. Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV.Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48(0):E004.
10) Liu M, He P, Liu HG, et al. Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia. Zhonghua Jie He, He Hu Xi Za Zhi. 2020;43:E016.
11) Kinsey EW, Hammer J, Dupuis R, Feuerstein-Simon R, Cannuscio CC. Planning for Food Access During Emergencies: Missed Meals in Philadelphia. Am J Public Health 2019;109: 781-783.
12) Rothe D, Gallinetti J, Lagaay M, Campbell L. Ebola: beyond the health emergency. Monrovia, Liberia: Plan International, 2015
13) Wilde T. Online gaming surge: Steam breaks concurrent user record amid socaildistancing mandates https://www.geekwire.com/2020/online-gaming-surge-steam-breaks-concurrent-user-record-amidsocial-distancing-mandates/ 2020.
14) Rundle AG, Park Y, Herbstman JB, Kinsey EW, Wang YC. COVID-19 Related School Closings and Risk of Weight Gain Among Children. Obesity (Silver Spring). 2020 Mar 30. doi: 10.1002/oby.22813.
15) Joob B, Wiwanitkit V. COVID-19 , School Closings and Weight Gain. Obesity (Silver Spring). 2020 Apr 10. doi: 10.1002/oby.22825
16) von Hippel PT, Workman J. From Kindergarten Through Second Grade, U.S. Children's Obesity. Prevalence Grows Only During Summer Vacations. Obesity (Silver Spring) 2016;24: 2296-2300.
17) Franckle R, Adler R, Davison K. Accelerated weight gain among children during summer versus school year and related racial/ethnic disparities: a systematic review. Prev Chronic Dis 2014;11: E101.
18) Wang YC, Vine S, Hsiao A, Rundle A, Goldsmith J. Weight-related behaviors when children are in school versus on summer breaks: does income matter? J Sch Health 2015;85: 458-466.
Treating children and adolescent obesity during the COVID-19 crisis
Ania Jastreboff, MD PhD
Assistant Professor, Yale University
Internal Medicine, Endocrinology & Metabolism
Pediatrics, Pediatric Endocrinology
American Board of Obesity Medicine, Diplomate
TeleHealth:
Clinical application during COVID-19
Positives
• Supports social distancing
• Patient show rate / preference
• Family focus – child/adolescent,
parents/caregivers
• Enables seeing the home
environment – living space,
cupboard, refrigerator
Negatives
• Access/availability
• Technology / internet hurdles
• (Only) visual exam, +/-vital signs
• Noise/distractions in the home
environment
Convert to phone visit
Telehealth: Patient Visits
• Family-based: includes parent(s) and child/adolescent
• Assess current needs: ask, listen, hear - let the patient and family tell you what they need, new context of social distancing
• Return Patients: encourage continuity of treatment, provide support, continue ongoing anti-obesity pharmacotherapy
• New Patients: evaluate, initiate discussion of long-term care/treatment, begin lifestyle/behavior change
Incorporating
Structure&
Daily Routines:Maximizing
opportunities for behavior change
during social distancing
Eating – planned meal times, advantages of meal prep at home, identifying healthy snacks
Physical Activity – build into daily routine, walks, going outside, dance-along videos, family activities
Sleep – structured wake time and bed time, no screen time before bed, bedtime routines
Education – include topics such as healthy food choices, nutrition, learning cooking! virtual visits with the dietitian
Stress reduction –hobbies, projects, continue seeing mental health professional virtually
During TeleHealth visits, discuss…
Life after social
distancing:
Goal to continue healthy routines
Social distancing is
bringing us together
Thank you!
Panel Discussion:Childhood obesity through an LMIC and Equity
Lens
Simon Barquera, MD MS PhD
National Institute of Public Health
Director, Nutrition Policy Research
Mexico
Jo Jewell
Nutrition Specialist
UNICEF
New York, USA
Paula Michele Lashley, MBSS DM FRCP MRCPCH
Consultant Paediatrician, Queen Elizabeth Hospital,
Lecturer in Child Health and Deputy Dean, University of the West Cave Hill Campus
Barbados
How can mitigation of risks for overweight and obesity be integrated in COVID19 response?
Source: UNICEF https://www.unicef.org/nutrition/food-systems.html
• Ensure evidence-based guidance, counselling and support on infant and young child feeding
• Promote access to nutritious food for children and women, including through continuity of school food programmes, cash-based and other safety-net programmes
• Ensure facility and (primarily) community-based programmes for the early detection and treatment of wasted children
Childhood and obesity in LMIC
• Mexico (as other LMIC) dominated by NCDs / Poor quality
diets major driver / Interacting with COVID19: Syndemic
• Lack of adequate resources for prevention and control
• Policies to improve food environment are crucial
Front-of-pack warning labels Enforcement of Codex guidelines to promote breast-feeding
Soda and junk-food tax Policies to incentive physical activity
Regulation of marketing directed to children Developing mechanisms to prevent industry interference
• Some promising results from these policy options in Latin America.
• Treating obesity seriously requires reinforcing health care with training for
health professionals and policy to improve the food environment
Childhood Obesity and COVID-19 in the Caribbean
• Pre-Pandemic• High levels of childhood obesity prior to pandemic fueled by obesogenic environments and lagging policy
• HCC has called for policy implementation at the highest levels and there have been successes
• During the Pandemic• Increased poverty due to financial shocks on already vulnerable tourism economies
• COVID-19 measures (lockdown, schools closed) threaten regional food security and may lead to increased overweight and obesity among children
• Decreased opportunity for physical activity may exacerbate unhealthy weights
• Poor mental health/ anxiety and overuse of ‘screens’ may trigger overeating
• Variable internet access creating challenges around access to nutrition/PA information
• HCC and the OECS Commission Joint Statement on on Strengthening Food and Nutrition Security in the Caribbean: A Legacy Response to the COVID-19 Pandemic
Questions?
Summary and key pointsChildren & young people must be prioritised. The COVID19 pandemic:
• especially affects the disadvantaged, particularly those from LMICs
• increases weight gain risk across the life-course (pre-pregnancy, pregnancy, childhood, adolescence & beyond …)
• makes obesity prevention more challenging: isolation, school/ childcare closures, food insecurity & poor diet quality, exposure to food marketing, sedentarism, family stress, increased child protection concerns …
• makes obesity treatment more challenging: goal is to continue healthy routines, tele-health opportunities, access issues (esp. for disadvantaged), technology hurdles/ internet issues
Final Remarks
Learn More:The World Obesity Federation (WOF) webinar series on COVID-19 & Obesity is available to watch‘on demand’ on our website!
We are exploring the potential for future webinars covering health systems, and the policyimplications of COVID-19.
SCOPE E-Learning: Childhood Obesity: From Diagnosis to Treatment is a six-module learning pathdeveloped in partnership with the European Childhood Obesity Group (ECOG).They are available in English on our online platform today (more languages coming soon)
COVID-19 Resources:WOF - https://www.worldobesity.org/resources/resource-library/covid-19-obesity-resourcesEASO - https://easo.org/covid-19-and-obesity/TOS - https://www.obesity.org/covid-19-and-obesity/
