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Obesity is the Biggest Risk Factor for COVID Complications in Children

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LEXINGTON, Ky. (Oct. 28, 2021) ­— Even though the latest wave of COVID-19 infections appears to be on the decline, the risk to children and adults is still significant. Of the number of risk factors associated with severe COVID-19, obesity appears to be one of the most prevalent.

According to a recent report from the Robert Wood Johnson Foundation, Kentucky ranks number one in childhood obesity. This puts a significant percentage of Kentucky’s children and adolescents at risk for severe COVID-19.

Aurelia Radulescu, M.D., of Kentucky Children’s Hospital Pediatric High BMI Clinic, talks about why obesity is a risk factor and what parents and caregivers can do to protect children.

UKNow: How does obesity affect a child's overall health?

Radulescu: Obesity is a new disease that we learned more about it in the last 20 years. We learned that obesity in children is associated with several medical complications that are also seen in adults. For example, children with obesity can develop prediabetes or diabetes. They can also have hypertension, dyslipidemia, sleep apnea and fatty liver disease. All these obesity-associated medical complications place them at high risk for severe health problems later in life.

UKNow: Why is obesity such a big problem in Kentucky?

Radulescu: One of the most important reasons is that children have limited resources. In Kentucky, we have a large population of children from low-income households who lack access to health care and healthy food. Many children are counting on the meals offered in school, and those meals are not always healthy. There is limited access to fruits and vegetables. If a child grows without eating a large variety of food and is exposed to unhealthy food over the years, it will be tough to change those taste preferences.

Another reason is that many communities lack resources for children to engage in physical activities. Many schools do not offer gym classes or offer them only once a week. Children may live somewhere where there are no sidewalks, or where it's not safe for them to go outside to play. A lot of children now interact with each other through screen time activities. Instead of playing outside together, they play video games, a sedentary behavior itself.

If we also look at data from the adult population, Kentucky ranks high in obesity there, too. Many children in Kentucky come from families with a strong history of obesity. So it's not just the child; parents and other siblings may have obesity as well. The combination of a genetic predisposition and an obesogenic environment plays a significant role in developing obesity. 

UKNow: How does obesity contribute to severe COVID-19?

Radulescu: We're still learning about COVID-19, but descriptive and observational studies show a strong link between obesity and severe COVID-19 infections in children. Obesity creates a proinflammatory state in the body. So the adipocytes, the fat cells of a child with obesity, are enlarged and become dysfunctional. They produce some inflammatory molecules, and those are toxic to the body. So people with obesity are in a chronic low inflammatory state. After it infects the host cell, SARS-CoV-2 causes an exaggerated inflammatory reaction. In combination with an already existing proinflammatory state, the hyperinflammatory reaction creates a perfect storm that damages the immune, cardiovascular and respiratory systems. So this is one of the theories that is postulated.

We also know that obesity produces inflammation of the endothelium, the thin membranes that lines the insides of blood vessels and the heart. When this membrane is inflamed, it becomes conducive to abnormal blood clotting perpetuating this chronic inflammation response. It's a vicious cycle.

Concerning the respiratory system, children with obesity are more likely to suffer from obstructive sleep apnea. They also may have decreased respiratory function due to mechanical forces related to obesity. Those forces don't allow the chest wall to expand well, resulting in impaired respiratory function and an increased need for ventilator assistance. This may be another reason why children with severe obesity are more likely to end up on ventilators.

UKNow: How has the pandemic affected children?

Radulescu: The relationship between the COVID pandemic and obesity, it's a two-way road. We are aware that obesity is a risk factor for severe COVID infection. But we’ve also learned that during the pandemic, the rate of obesity in children has increased. That is no surprise because the pandemic environment was very conducive to that. Children were more isolated. Access to healthy food was even more limited than before. The pandemic disrupted many children’s daily routines; their schedule became unstructured; children became more sedentary. And all of these behaviors led to an increase in the rate of obesity.

In a recent study published by the Center for Disease Control, the pediatric obesity rate in 2019 was 19%. Now it is 22%. That same study found that the rate at which body mass index (BMI) increased almost doubled in the first six months of the pandemic. 

UKNow: What can parents and caregivers do?

Radulescu: It's more important than ever that children with obesity adhere to preventative measures — wearing masks, washing hands and maintaining a social distance. Those who are qualified to receive the vaccine should get it.

If parents are concerned if their child has obesity, they should talk to their pediatrician. Parents should ask about the child's weight status, BMI, and what they can do to help the child achieve healthy body weight.

We are more knowledgeable now than we were years ago about obesity as a disease, and we have more guidelines and recommendations on how to take care of these children.

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The Pediatric High BMI Clinic accepts patients through physician referral.

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