Philadelphia pediatricians are seeing substantial weight gain in many young patients due to pandemic stress and lockdowns. Those extra pounds mean that if the children get COVID-19, they’re more like to get sicker than their leaner friends.

The city doesn’t keep data on children’s weight the way it does on COVID cases and hospitalizations. But pediatricians at three medical centers in the city are seeing a situation that matches national trends. Rates of pediatric weight gain doubled over the course of the pandemic, according to a Centers for Disease Control and Prevention study of more than 400,000 children between ages 2 and 19 released in September. That was similar to weight gain in adults. Children who were already obese or overweight when the pandemic started tended to see the biggest gains.

“These children have gained large amounts of weight,” said Stephan Myers, a pediatric bariatric surgeon at St. Christopher’s Hospital for Children. “I think it’s definitely underreported and underappreciated.”

In the last week of 2021, 280 children nationally were hospitalized with the virus, according to the CDC, the most since the pandemic started. Yet vaccination rates for children are worryingly low. In Philadelphia, about 30% of children aged 5 to 11 have received at least one shot, and 44% of those aged 12 to 17 are fully vaccinated. Vaccines are the best protection for all children, especially those with such risk factors as obesity.

At St. Christopher’s, the Healthy Kids, Healthy Teens Weight Clinic, which serves about 1,000 children, has some patients who have gained 40 to 100 pounds over the last two years. Before the pandemic, said Daniel Taylor, a Drexel University pediatrician, about 30% of his patients were overweight or obese. Now, he said, it’s 40% to 50%.

While obesity for adults is defined as a body mass index greater than 30, children are compared with others of their age and gender, and considered obese if their BMI is higher than that of 95% of others in their group, according to the CDC. For instance, A 10-year-old boy who is 56 inches tall and weighs 102 pounds would fall in that category.

Added weight is an independent risk factor for serious COVID, but it also is associated with other risk factors such as diabetes, hypertension, and asthma.

“When this [pandemic] started I didn’t want nobody in my house,” said Daisy Matos, whose daughter Jada Pacheco, 16, required bariatric surgery in May to help her lose the 80 to 90 pounds she gained during the first year of the pandemic. “She was a severe asthmatic, severe sleep apnea, severe diabetes. She had a lot of complications just for being so young.”

Despite those precautions, Pacheco did catch COVID-19 in July 2020, and the effect it had on her asthma was so serious that she spent a night in a hospital receiving oxygen.

“I don’t want to say it was scary because I knew I was going to be OK, but I was nervous because I had asthma, too,” Pacheco said. “I was coughing bad.”

The overwhelming majority of children with COVID-19 won’t require hospitalization, but those who do frequently are obese. Of children hospitalized with the virus, almost a third were obese, a December study from the CDC found, making it the most common comorbidity among that group. Among 12- to 17-year-olds hospitalized with the virus, 61% were obese.

That matches local doctors’ experiences. Two or three patients participating in the St. Christopher’s program have had to be hospitalized for COVID-19, said Vesta Salehi, the hospital’s chief of gastroenterology. At Children’s Hospital of Philadelphia, many hospitalized older children are obese, said Ron Keren, the hospital’s chief medical officer.

“Kids in our ICU, the older kids, I’m talking about the teenagers who don’t have other chronic medical conditions that would put them at risk of severe COVID,” he said, “often have obesity as a condition that is likely a risk factor that would set them up for severe COVID.”

There are a few factors that doctors think play a role in the COVID-obesity connection, Keren said. Baseline inflammation caused by obesity may be exacerbated by the virus. Excessive weight also can constrict breathing, Keren said, with fat adding pressure to airways and the diaphragm.

Poverty adds to the problem

CDC data from 2013 showed that, in Philadelphia, where roughly a quarter of residents live below the poverty line, 41% of children ages 6 to 17 are overweight or obese. Furthermore, in predominantly Black and Latino North Philadelphia, almost three-fourths of the children were overweight.

Poor access to healthy food and safe outdoor spaces for recreation are among the issues pediatricians identify as contributing to their patients’ weight problems.

The problems disproportionately affect the city’s Black and brown communities, with 45% of Black families living in areas with an overabundance of unhealthy food, a 2019 city study found.

The poorest Philadelphians, Taylor noted, typically have less access to health care, a legacy of systemic racism.

When supermarkets and healthy foods are out of reach, particularly for families without cars, they make do with what’s available at corner stores and bodegas, and buy calorie-dense foods that fill stomachs, but add on pounds, too. Harried parents also may struggle to find time to prepare healthy meals.

The pandemic’s school closings cut off a reliable source of health meals for many of his young patients, Taylor said. Some parents lost jobs during the pandemic, and those with jobs that didn’t allow them to work from home had to spend money on child care.

For youth such as Jada Pacheco, virtual school meant easy access to snacking.

“It was her eating habits due to being in the house, doing schooling in the house,” said Matos, who said her daughter gained 80 to 90 pounds from 2020 to 2021. “It was even more of a challenge to keep her out of the kitchen because they are home 24-7.”

On top of the food issue, there’s also inactivity borne of fear, Taylor pointed out. Parents in neighborhoods facing a historic gun violence crisis — more than 200 children under 18 last year were shot in the city — don’t want to send them out to play.

Addressing excess weight takes time, doctors acknowledged, and the best immediate step parents can take to protect their children is get them vaccinated.

Anyone who has tried to lose weight by changing eating habits and adding exercise knows how tough it is, especially if one has a lot to lose. Jada, who is 5-foot-4, weighed about 250 pounds before her surgery. Her weight-loss efforts only felt discouraging.

“I couldn’t keep up,” she said. “I’d see my weight go back up and I’d give up.”

Bariatric surgery, combined with habit change, changed the situation for Jada, who is among a growing number of pediatric patients resorting to a procedure once reserved for adults.

She has lost more than 100 pounds since May. The health problems associated with her weight have faded, too — not only does the surgery reduce one’s capacity for food, it also can improve diabetes dramatically, even reversing it.

“I thank God for this program,” Matos said. “My baby is right now healthy.”

Until Pacheco was diagnosed with diabetes, she said, she didn’t even acknowledge that her weight was unhealthy. That’s not uncommon, Salehi said. Society sends teens confusing messages about their bodies, sometimes suggesting they should be model-thin, sometimes urging them to embrace extra weight.

“Some of our adolescent patients go back and forth,” Salehi said. “They have insecurities with their bodies and other moments where they’re seeing positive body images from adolescents and adults who are overweight. We have some, they’re not worried about this. It isn’t even on their radar.”

Cutting through the complicated issues surrounding bodies and self-image, Salehi said, can be helped by focusing on weight not as a measure of pounds, but of health. Her program can emphasize recovery from type 2 diabetes, or lower cholesterol counts.

“In our conversations with them,” she said, “we really try to focus on the consequences of the obesity for their health.”