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The pandemic’s other public health crisis

The growing problem of childhood obesity

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How pediatricians can help combat the recent increase in childhood obesity

Childhood obesity is a serious concern that can set children up for long-term health problems. From 2017 to 2020, 19.7% of children and adolescents ages 2 to 19 had obesity. The prevalence is even higher among minority groups, affecting 26.2% of Hispanic children and 24.8% of non-Hispanic Black children. Childhood obesity increases the chances that children will later develop diabetes, high blood pressure and high cholesterol. It can also be a factor in low self-esteem and depression.

The COVID-19 pandemic worsened the problem, bringing school closures, changes to routines and reduced opportunities for exercise. Among children ages 2 to 19, the rate of body mass index increase almost doubled during the pandemic. Pediatricians can give a number of recommendations to children and their families to help stay healthy:

  • Encourage healthy eating habits, including eating lots of vegetables and opting for lean meats
  • Limiting the availability of high-calorie snacks
  • Avoiding the use of food as a reward
  • Cooking together as a family
  • Encouraging regular physical activity, including bone-strengthening and muscle-strengthening activities
  • Modeling an active lifestyle
  • Limiting the amount of time children are sedentary
  • Ensuring children get adequate sleep
  • Scheduling annual well-child visits.

To find out more about what pediatricians are doing, SmartBrief recently spoke to Neal Spears, Director of the Pediatric Clerkship for Texas A&M Medical School- Bryan Campus, about the increase in childhood obesity and how he addresses it at his practice.

What recent trends have you seen with respect to childhood obesity at your practice? 

Neal Spears
Neal Spears

At the beginning of the COVID-19 pandemic, when schools shut down for over a year, there was a dramatic and rapid increase in BMI for the majority of my patients.1 This seemed to affect a wide age range, from ages 5 to 18 roughly. It was most pronounced in children from families with lower socio-economic status, especially those whose parents were essential workers. These children often received day-to-day care from their grandparents. Most of the time, the job of the grandparents is not full-time schooling but to spoil the grandchildren, and that is what happened to many of my patients over those 15 months.

Are you seeing health consequences such as additional health problems in children affected by obesity?

I have diagnosed several with pre-diabetes and two with type 2 diabetes over this time frame.  There have also been several with obstructive sleep apnea as a new diagnosis.2

Can you talk about how you and your team approach patient care for children dealing with obesity?

Lately I have been trying to get Saxenda (liraglutide) covered for my 12-plus-year-old patients. The data is very exciting, but insurance coverage is lacking. Medicaid in particular will not cover any weight loss medication at all, despite proven safety and efficacy.

How do you talk to families about obesity?

I generally share the BMI-over-age graph with them and just talk about it as a fact, much like height, vision and hearing.3 I use motivational interviewing in the 4-plus-year-olds to try to help them understand healthful versus nonhealthful drinks and snacks. This often seems to be more effective than just lecturing to the child and parent as they shut off their brains.

I also emphasize data on lifetime obesity outcomes and the fact that if we can get a child to age 12 with a normal BMI, there is a 75% chance they will not be obese as an adult. There seems to be something that metabolically changes when we start puberty obese and, until the new GLP-1 medications, there has never been a good treatment. I believe these GLP-1 medications are going to change the entire approach to obesity treatment, at least for ages 12-plus.

What advice would you give to other pediatricians and practices to help address this?

Try to push for coverage of GLP-1s. Saxenda is the only one currently approved by the FDA for 12-plus years of age.  Use nonjudgmental, factual data and motivational interviewing during wellness visits. Give simple, clear advice and set reasonable, achievable goals as not everyone is meant to be at the ideal BMI.4 I generally advise my families to start with daily fun activities, snacking on fruits and veggies only, and no sugary drinks other than 8 to 16 ounces of milk a day.

Dr. Neal Spears joined CHI St. Joseph Health Pediatrics in early 2015. Dr. Spears attended Texas A&M University, Class of ’95, then went on to the University of Texas Health Science Center in San Antonio for his medical degree. He has a particular interest in treating children with ADHD and other chronic childhood diseases.

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April Hollis is a health care editor at SmartBrief. Connect with her on LinkedIn.


  1. Neuman, S. Children and teens gained weight at an alarming rate during the pandemic, the CDC says. NPR. Sept. 17, 2021.
  2. Holcombe, M. Prediabetes has more than doubled among American children. Here’s how to reduce your kids’ risk. CNN. March 28, 2022.
  3. BMI-for-age (5-19 years). World Health Organization.
  4. Bailey, E. Why childhood obesity rates are rising and what we can do. Healthline. July 4, 2022.