When the Scales are Skewed: The Struggle for Equality in Child Weight Outcomes

Family & Community Health

As a pediatric obesity specialist, I work with families with children who are gaining weight too quickly. These children and adolescents often have serious co-occurring issues that are associated with extra weight, such as high cholesterol, metabolic disease or type II diabetes, depression or anxiety, and mobility issues, to name a few. In order to support these families, our treatment always starts in the home. At a family’s office visit, my team will inquire about dynamics around food, availability and accessibility of foods, and household patterns of eating, activity and sleep habits.

Over the last several months of the COVID-19 pandemic, however, I have a new perspective: Using telehealth visits, I have quite literally seen into the homes of hundreds of families. By seeing firsthand how a family engages together in their lived space, I have a better understanding of what caregivers have to work with at home to implement a management plan.

What I’ve seen has only reinforced what we’ve known all along, and what we as a nation are confronting: our endemic, systemic inequities are hurting our children in a way that deepens the divide. In short, the scales are skewed. The well-resourced families I see have been able to dust off old exercise bikes, purchase at-home gym equipment, and commit to home-cooked family meals. But for so many of my other families, the struggle is clear. There are no safe places to play, there is not enough space in overcrowded homes to do even simple energetic activities, and food resources are limited, with families turning to cheaper, less nutrient-dense meals and snacks.

Health care providers should acknowledge these struggles, and practice with a listening ear and the utmost empathy.

COVID-19 Has Exacerbated Barriers that Challenge Health

There is mounting evidence that the risk of obesity has worsened disproportionately for disadvantaged groups during the pandemic.

School closures and distanced learning cause more weight gain for families of lower socioeconomic status, largely due to the fact that students who rely on the structure and consistency of school breakfast and lunch programs no longer have those options. An estimated 30 million children in the U.S. are missing healthy meals during school closures. 

Additionally, studies have shown that parental stress and financial hardship have a direct impact on the prevalence of childhood obesity. As the pandemic progressed between March-July 2020, the prevalence of food insecurity increased from 32.6% to 36%, with Black and Hispanic families more effected than White families. This problem will only grow as many caregivers remain out of work and have less access to healthy foods.

Finally, many students with additional health challenges related to obesity are missing out on the reliable health care network found in our nation’s schools in the form of school nurses and counselors.

So what can we do to help nudge the scale toward equity and justice?

As we recognize Healthy Weight Week this week, I’ve put together just a few suggestions for health care providers.

When talking to families, encourage them to:

  1. Be kind to themselves and know that especially now, the obstacles are real and relentless. Too many parents blame themselves for letting unhealthy habits go unchecked in their kids, whether due to stress, financial issues, time or other competing priorities. Assure them there is no person at fault. Undue shame is emotionally distressing and unwarranted.
  2. Find balance. When times are stressful, remind families to build routines and structures that make life easier. This will look different for everyone, but encourage easy wins, starting small, and getting back to basics for keeping youth healthy, like:
    • Providing nutrient-dense foods when possible, such as fruits, vegetables and whole grains.
    • Keeping mental health in check with practices such as mindfulness, meditation or other stress-reducing activities. Guided relaxation exercises are a great way to start.
    • Making time for family meals and scheduled snacks, turning off electronics and focusing on building relationships as a family.
    • Creating habits for adequate sleep and daily physical activity—no matter how small! Walk and play outdoors when possible, or share our recommendations for many free activity apps and websites to help families get creative with indoor active play.
  3. Seek help when they need it. So many families are struggling, but luckily there are resources available to point families to in or around the Philadelphia region:

When communicating with policymakers, encourage them to:

  1. Improve policies that help to provide nutritious food for families, including school meal policies and U.S. Department of Agriculture food policies. Improve access to nutrient-dense foods when schools are not in session.
  2. Support programs that encourage physical activity for children, safe places to play and organized sports when safe to participate.
  3. Strengthen policies that address social determinants of health, such as minimum wage, child care, housing security and accessibility to health care. Make sure that the needs of immigrant communities and those with disabilities are included.
  4. Challenge the system whenever possible in a way that tackles systemic racism and related inequities.

Though the inequities may seem insurmountable at times, I challenge health care providers to engage with each patient using a sensitive, family-centered approach. As we continue to navigate the pandemic, we have the opportunity support families with simple tools and resources they can use at home to nurture the health and well-being of all children.

Jennifer Robbins, MD, MPH, is a former faculty member at PolicyLab at Children's Hospital of Philadelphia.