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      Food Insecurity and Pediatric Obesity: a Double Whammy in the Era of COVID-19

      review-article
      1 , 2 , , 3 , 4
      Current Obesity Reports
      Springer US
      Food insecurity, Pediatric obesity, Screening, COVID

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          Abstract

          Purpose of Review

          This review examines the current evidence about the ways in which food insecurity relates to obesity in children and adolescents, examining diet and diet-related behaviors, and taking into consideration the role of stress.

          Recent Findings

          While living with food insecurity impacts stress and diet-related behaviors in children and adolescents, it is not clear whether food insecurity is associated with obesity above and beyond the influence of poverty. However, strategies to mitigate food insecurity and obesity are inherently connected, and recent examples from clinical practice (e.g., screening for food insecurity among patients) and advocacy (e.g., policy considerations regarding federal food programs such as the Supplemental Nutrition Assistance Program, or SNAP) are discussed.

          Summary

          Food insecurity and obesity coexist in low-income children and adolescents in the USA. The COVID-19 pandemic exerts disproportionate burden on low-income children and families, magnifying their vulnerability to both food insecurity and pediatric obesity.

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          Most cited references97

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          COVID-19, school closures, and child poverty: a social crisis in the making

          While coronavirus disease 2019 (COVID-19) continues to spread across the globe, many countries have decided to close schools as part of a physical distancing policy to slow transmission and ease the burden on health systems. The UN Educational, Scientific and Cultural Organization estimates that 138 countries have closed schools nationwide, and several other countries have implemented regional or local closures. These school closures are affecting the education of 80% of children worldwide. Although scientific debate is ongoing with regard to the effectiveness of school closures on virus transmission, 1 the fact that schools are closed for a long period of time could have detrimental social and health consequences for children living in poverty, and are likely to exacerbate existing inequalities. We discuss two mechanisms through which school closures will affect poor children in the USA and Europe. First, school closures will exacerbate food insecurity. For many students living in poverty, schools are not only a place for learning but also for eating healthily. Research shows that school lunch is associated with improvements in academic performance, whereas food insecurity (including irregular or unhealthy diets) is associated with low educational attainment and substantial risks to the physical health and mental wellbeing of children.2, 3 The number of children facing food insecurity is substantial. According to Eurostat, 6·6% of households with children in the European Union—5·5% in the UK—cannot afford a meal with meat, fish, or a vegetarian equivalent every second day. Comparable estimates in the USA suggest that 14% of households with children had food insecurity in 2018. 4 Second, research suggests that non-school factors are a primary source of inequalities in educational outcomes. The gap in mathematical and literacy skills between children from lower and higher socioeconomic backgrounds often widens during school holiday periods. 5 The summer holiday in most American schools is estimated to contribute to a loss in academic achievement equivalent to one month of education for children with low socioeconomic status; however, this effect is not observed for children with higher socioeconomic status. 6 Summer holidays are also associated with a setback in mental health and wellbeing for children and adolescents. 7 Although the current school closures differ from summer holidays in that learning is expected to continue digitally, the closures are likely to widen the learning gap between children from lower-income and higher-income families. Children from low-income households live in conditions that make home schooling difficult. Online learning environments usually require computers and a reliable internet connection. In Europe, a substantial number of children live in homes in which they have no suitable place to do homework (5%) or have no access to the internet (6·9%). Furthermore, 10·2% of children live in homes that cannot be heated adequately, 7·2% have no access to outdoor leisure facilities, and 5% do not have access to books at the appropriate reading level. 8 In the USA, an estimated 2·5% of students in public schools do not live in a stable residence. In New York city, where a large proportion of COVID-19 cases in the USA have been observed, one in ten students were homeless or experienced severe housing instability during the previous school year. 9 While learning might continue unimpeded for children from higher income households, children from lower income households are likely to struggle to complete homework and online courses because of their precarious housing situations. Beyond the educational challenges, however, low-income families face an additional threat: the ongoing pandemic is expected to lead to a severe economic recession. Previous recessions have exacerbated levels of child poverty with long-lasting consequences for children's health, wellbeing, and learning outcomes. 10 Policy makers, school administrators, and other local officials thus face two challenges. First, the immediate nutrition and learning needs of poor students must continue to be addressed. The continuation of school-provided meals is essential in preventing widespread food insecurity. Teachers should also consider how to adapt their learning materials for students without access to wireless internet, a computer, or a place to study. Second, local and national legislators must prepare for the considerable challenges that await when the pandemic subsides. At the local level, an adequate response must include targeted education and material support for children from low-income households to begin to close the learning gap that is likely to have occurred. From a policy perspective, legislators should consider providing regular income support for households with children during the impending economic crisis to prevent a deepening and broadening of child poverty. Without such action, the current health crisis could become a social crisis that will have long-lasting consequences for children in low-income families.
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            COVID-19 Related School Closings and Risk of Weight Gain Among Children

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              Development and validity of a 2-item screen to identify families at risk for food insecurity.

              To develop a brief screen to identify families at risk for food insecurity (FI) and to evaluate the sensitivity, specificity, and convergent validity of the screen. Caregivers of children (age: birth through 3 years) from 7 urban medical centers completed the US Department of Agriculture 18-item Household Food Security Survey (HFSS), reports of child health, hospitalizations in their lifetime, and developmental risk. Children were weighed and measured. An FI screen was developed on the basis of affirmative HFSS responses among food-insecure families. Sensitivity and specificity were evaluated. Convergent validity (the correspondence between the FI screen and theoretically related variables) was assessed with logistic regression, adjusted for covariates including study site; the caregivers' race/ethnicity, US-born versus immigrant status, marital status, education, and employment; history of breastfeeding; child's gender; and the child's low birth weight status. The sample included 30,098 families, 23% of which were food insecure. HFSS questions 1 and 2 were most frequently endorsed among food-insecure families (92.5% and 81.9%, respectively). An affirmative response to either question 1 or 2 had a sensitivity of 97% and specificity of 83% and was associated with increased risk of reported poor/fair child health (adjusted odds ratio [aOR]: 1.56; P < .001), hospitalizations in their lifetime (aOR: 1.17; P < .001), and developmental risk (aOR: 1.60; P < .001). A 2-item FI screen was sensitive, specific, and valid among low-income families with young children. The FI screen rapidly identifies households at risk for FI, enabling providers to target services that ameliorate the health and developmental consequences associated with FI.
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                Author and article information

                Contributors
                june.tester@ucsf.edu
                Journal
                Curr Obes Rep
                Curr Obes Rep
                Current Obesity Reports
                Springer US (New York )
                2162-4968
                16 October 2020
                : 1-9
                Affiliations
                [1 ]GRID grid.414016.6, ISNI 0000 0004 0433 7727, Division of Pediatric Endocrinology, , UCSF Benioff Children’s Hospital Oakland, ; 744 52nd Street, Oakland, 94609 CA USA
                [2 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Department of Pediatrics, Division of Endocrinology, , University of California, San Francisco, ; 550 16th Street, 4th Floor Box 0110, San Francisco, CA USA
                [3 ]GRID grid.168010.e, ISNI 0000000419368956, Epidemiology and Population Health, , Stanford University, School of Medicine, ; Stanford, CA USA
                [4 ]GRID grid.214458.e, ISNI 0000000086837370, Department of Nutritional Sciences, , University of Michigan School of Public Health, ; Ann Arbor, MI USA
                Author information
                http://orcid.org/0000-0002-5460-5879
                Article
                413
                10.1007/s13679-020-00413-x
                7562757
                33064269
                09a37b72-98e3-40c5-8d5e-6d3681047d1e
                © Springer Science+Business Media, LLC, part of Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 7 October 2020
                Categories
                Childhood Obesity (A Kelly and C Fox, Section Editor)

                Health & Social care
                food insecurity,pediatric obesity,screening,covid
                Health & Social care
                food insecurity, pediatric obesity, screening, covid

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