Coronavirus Chronicles — Not Looking Good for Kids

All the comforting stories that people used to tell themselves about COVID-19 having a low impact on children have fallen apart. Kids are in terrible shape. The basic dilemma is that childhood obesity, already at an all-time high when the pandemic struck, is a prominent risk factor for catching the virus.

Although people are likely to lose weight when acutely ill, the effects of “long COVID” are totally designed to create more obesity in the future. When people suffer from circulatory and lung aftereffects, and are so physically depleted that a walk across the room is too much exercise, those who are unable to recover full function will not stay thin for long. The sedentary lifestyle forced onto people who are too weak to meet the demands of daily existence cannot help but lead to another wave of increased obesity.

Scary stories

Meanwhile, journalists report on individual cases that personalize the situation. Michael Daly wrote about a 16-year-old South Carolina boy who lost his appetite and vomited frequently, which are not typical COVID symptoms. He was taken to an urgent care facility and tested negative for COVID and positive for the flu. But over the next week, he just got sicker and was admitted to the hospital — still testing negative for COVID. Then he was airlifted to another hospital, where he tested negative once more — but was diagnosed with MIS-C. Daly writes,

They explained that the condition is a delayed inflammatory response to COVID that can come as if from nowhere weeks or even months after an infection — even an asymptomatic one… The syndrome had simultaneously attacked Branson’s heart, kidneys, and liver.

This led to five days on a ventilator and a 24-hour dialysis treatment. The young patient pulled through and was ultimately discharged from the hospital with eight different prescription medications. Incidentally, a study was in progress at the same time which ultimately pointed to the conclusion that MIS-C is preventable by vaccination against COVID-19.

Professionals and Social Media

Childhood Obesity News has mentioned several times how doctors and nurses are using informal channels like Twitter to quickly spread and collect information about what is going on in emergency rooms, intensive care units, hospital wards, and primary care practices, all over the country and the world.

Dr. Eric Feigl-Ding, for instance, notes that during a two-week period in Utah, 140 children were hospitalized with COVID. At the same time, in Britain, the hospital admissions for children ages 6-17 hit record totals, and the same thing has been happening in South Africa.

Especially for younger children, the notion that the Omicron variant is “mild” begins to appear ludicrous. Little kids struggle to breathe through massive secretions and need supplementary oxygen. A doctor’s wife wrote about a patient of her husband’s, 20 years old and otherwise completely healthy, on ECMO (the machine that does the work of the heart and lungs — in other words, total life-support).

One lung has just about disintegrated. Waiting on transplant but the other lung is going to be gone soon. STOP CALLING IT MILD.

Your responses and feedback are welcome!

Source: “Terrifying Post-COVID Syndrome Makes Comeback in South Carolina Kids,”,01/22/22
Source: “CDC: Vaccination effective against MIS-C,”, 01/11/22
Source: Dr. Eric Feigl-Ding (@DrEricDing), Twitter, 01/22/22
Image by Eden, Janine and Jim/CC BY 2.0

Coronavirus Chronicles — Closed for the Longest Summer Ever?

As Childhood Obesity News has mentioned before, summer vacation is what we call an “obesity villain” — a circumstance that gives kids a huge opportunity to pile on pounds in excess of the normal and healthy amount that children gain as they grow, pounds that do not magically disappear when school starts again in the fall.

This year, summer break has already been abnormally long, and lacking in any of the features we are accustomed to expecting from a summer. Sleep-away camps are closed, including those that specialize in treating child obesity. Day camps are closed. Municipal playgrounds and swimming pools are closed. Kids are discouraged from getting together with their peers to kick a ball around.

Food shortages and economic distress affect millions of families, and whenever that happens, disordered eating is not far behind. Doctor visits are curtailed except for dire emergencies. Kids are not getting their well-child checkups or being weighed.

Parents are impossibly burdened. If they have outside jobs, they have to figure out child-care arrangements. If they work from home, they have to somehow do their work with kids around. If they are unemployed, they have to find and visit food banks. If they are unhoused — let’s not even go into that nightmare just now. Parents have struggled through the non-existent “school year” trying to keep their kids academically current. Now they’re supposed to organize exercise programs that don’t involve mingling with other kids, using public facilities, or driving the downstairs neighbors insane.

Dimensions of the Problem

The American Academy of Pediatrics (AAP) offers painstakingly detailed guidance for schools. In the organization’s view, the prime desideratum is to have children physically present in school, for a variety of reasons:

Lengthy time away from school and associated interruption of supportive services often results in social isolation, making it difficult for schools to identify and address important learning deficits as well as child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation… Beyond the educational impact and social impact of school closures, there has been substantial impact on food security and physical activity for children and families.

The AAP is also concerned about particular genres of kids, those who are “medically fragile, live in poverty, have developmental challenges, or have special health care needs or disabilities.” The battles to include those populations in public education have been numerous and hard-fought, and to lose ground on those fronts is heartbreaking. On the other hand, the vulnerable are, well…. vulnerable, which in this instance means that compared to other groups, those children are at higher risk of contracting COVID-19.

A case in point

Emily Oster is a professor of economics, and a polymath who has published a formidable number of papers about all kinds of things. Based on her familiarity with a popular homeschool resource, she finds reason to suspect that online learning is nowhere near as productive as in-school learning.

For some kids, from ethnic minorities and lower income families, the experience can range from disastrous to nonexistent. Oster says,

There is every reason to believe, based on what we know from other data, that these kids will be less likely to complete high school, go to college, get good jobs and earn a living wage. They will be more likely to die sooner.

A skeptic might might say that it is not useful to extrapolate so much doom from one small batch of information. Also, the subject under examination was math, which is difficult and traditionally hated.

On the other hand, the online teaching of math has a big head start over many other academic subjects. The techniques and methodologies of online math instruction are not likely to improve much. If online math has not done so well, it seems unlikely that other subjects can do much better.

Your responses and feedback are welcome!

Source: “COVID-19 Planning Considerations: Guidance for School Re-entry,”, 06/25/20
Source: “COVID-19, Learning Loss and Inequality,”, 06/15/20
Image by Chris Ballance/CC BY 2.0

Investigating and Shopping

This post belongs to a compendium of hints and tips for parents that has spilled out of Childhood Obesity Awareness month into October. There are some things that everybody has heard a million times. Vegetables good; raw ones better. Fruit good; fruit juice bad. Whole grains good; grains in general, not so much.

There are things everyone has heard a million times that turn out to be no longer true, like the villainy of eggs. Like it or not, and strange as it may seem, the science of nutrition is constantly in flux.

Exploring the world of processed food labels, and even the tags on fresh produce, can be a productive family activity, especially if the kids aspire to be detectives. (Seriously, bring a magnifying glass.) Make a project of deciphering nutritional information, and all the different terminology behind which sugar and chemicals are hidden. How do we know if the veggies are truly organic? Does the grower conform to environmentally responsible best practices?

Other facets of factuality

How does unit pricing work, and can the consumer really save money by paying attention to it? A child’s willingness to consider these matters might cause astonishment. Once the mental connection is made between disposable income and a new bike, a child can become surprisingly interested in thrifty shopping.

What do the manufacturers mean by a “serving“? (Hint: The answer may turn out to be quite different from what you assume.) Health writer Maria Trimarchi gives an example:

Glancing at the calories in a 20-ounce bottle of Coca-Cola, you’ll see 100 calories. What your kids might miss, though, is that it’s 100 calories per serving, and there are 2.5 servings in that bottle. Drink the whole thing, and you’ve consumed 250 calories.

In the realm of labels, this bit of folk wisdom has been expressed by many people in many different ways: If you can’t pronounce the name of the ingredient, don’t eat the product.

Certified personal trainer Paul O’Brien likes health games, and speaks of “food and mood” charts, a learning aid that help families to figure things out. Here is his rationale:

This encourages children to recognize the association between what they eat and how they feel. You can make it a family game by designing your own charts and rules and discuss your progress at your monthly family meeting.

To enhance the shopping experience, a government website suggests encouraging little kids take along small pieces of construction paper to the market, and choose fruits and vegetables to match — yellow squash, purple cabbage, red peppers, and so on.

As always, not every idea works for every family, but they are worth seeking out. And of course no idea can ever be effective if it remains untried.

Your responses and feedback are welcome!

Source: “Big Kids: 10 Things Parents Can Do to Fight Childhood Obesity,”
Source: “Home is the childhood obesity battleground,”, 10/10/17
Photo credit: Trace Nietert on Visualhunt/CC BY

Everything That You Know Is Wrong About Losing Weight


In February, with the obesity epidemic still stubbornly present throughout the world, Weight Watchers in the United Kingdom offered a free summer program to teens from 13 to 17. Given the current climate of panic over the nightmare vision of an empire toppling due to the cost of diabetes treatment and other sequelae of obesity, this sounds like a public-spirited and civic-minded thing to do.

The outlines of the plan seem reasonable. To join, the child has to be accompanied by a legally responsible adult. Their doctor is supposed to set the target weight, and do a check up every six to nine months to reassure everybody that the weight loss isn’t getting out of hand. And here is the main clause: “The child must also be at or above the 95th percentile for their age and gender.” At that point on the obesity spectrum, a child is in serious need of help. How much harm could Weight Watchers do?

But no. Britain’s professional dieticians’ association is against the idea because it sends a negative message, and could cause the youth to become unhealthily fixated with dieting.

In the nearby Republic of Ireland, the Health Service Executive is the country’s largest employer and receives the most money of any public sector organization. It came up with a plan for 7-year-olds which the Irish Examiner‘s Catherine Shanahan describes as “designed to empower parents to tackle their child’s increasing weight.”

It apparently consists of six monthly conferences with a dietician. The pilot program started with 95 participants — the great majority (86) obese and 9 merely overweight. Shanahan writes:

Just 51 made an appointment with the service. Of those, only 37 actually showed up. At the end of the six months, just 18 had stayed the course.

This sadly relates to several topics familiar to Childhood Obesity News readers, such as patient compliance, and the fact that many people feel they have sufficient nutrition information.

According to an article in the Irish Medical Journal, the failure was partly the parents’ fault for telling the medical personnel that their children were chubby, fat, or heavy. Also, parents tend to feel defensive when somebody else tells them their children are obese, which makes them not want to become involved in the first place. Another suggestion is that parents suffer from blindness to the serious threats posed by obesity.

The reporter also mentions that there can be difficulty in “getting buy-in from the entire household,” which is a polite way of saying that parents are not always in harmonious agreement about which life circumstances negatively affect the kids, or how, or what should be done about it.

Unfortunately, a toxic percentage of parents use the children as weapons in complicated and bitter struggles between themselves. In many families, a child is the identified patient, but the whole family is sick.

These are all psychological issues, a coincidence which underscores Dr. Pretlow’s conviction that more mental health professionals need to get involved in curtailing obesity. (This program, incidentally, involved cognitive behavioral therapy techniques “to enhance parental motivation to introduce positive lifestyle changes.”)

Here is the rest of Shanahan’s disheartening summation:

Families who took part were encouraged to monitor dietary intake, screen time, and exercise. The dieticians running the programme had formal training and it was underpinned by evidence-based best practice. Yet, at the end of six months, for those who did stay the course […] couldn’t say the weight loss in children was “clinically significant”.

Your responses and feedback are welcome!

Source: “Weight Watchers free offer to teenagers could lead to them becoming ‘fixated’ with dieting,”, 02/15/18
Source: “Parents shun free scheme to tackle child obesity,”, 02/16/18
Photo credit: Counselman Collection on Visualhunt/CC BY-SA

What’s Up With the USDA?


About a year ago, Sonny Perdue became the U.S. Secretary of Agriculture and boss of an agency with a $140 billion yearly budget. Among many other matters, the Dept. of Agriculture runs the country’s nutrition safety net, in the form of 15 assistance programs including SNAP (aka food stamps); school breakfasts and lunches; and WIC, which feeds women, infants, and children.

Previously, Perdue spent eight years as governor of Georgia. He has also filled other posts, like board member for the National Grain & Feed Association, and president of both the Georgia Feed and Grain Association and the Southeastern Feed and Grain Association — all of which constitute what are politely called “close industry ties,” the kind that almost inevitably lead to conflicts of interest.

While serving as governor, he did not divest from four farm-related family businesses, refused to put them in a blind trust, and even continued to help run them. During his occupancy of Georgia’s highest office, over a dozen official ethics complaints were filed against him, and he was actually fined by the State Ethics Commission.

Perdue retaliated by firing the head of the Commission, who had served under four governors. Then Perdue went on to get a special law passed, just for him, to reduce his own state tax bill by $100,000, and got all the fine money back plus considerably more.

When he was appointed by the president to the cabinet post, his confirmation was delayed by the federal Office of Government Ethics, but eventually went through. As newly appointed Ag Sec, Perdue told the press:

If kids aren’t eating the food, and it’s ending up in the trash, they aren’t getting any nutrition — thus undermining the intent of the program… A perfect example is in the south, where the schools want to serve grits. But the whole grain variety has little black flakes in it, and the kids won’t eat it. The school is compliant with the whole grain requirements, but no one is eating the grits. That doesn’t make any sense.

It’s hard to argue with such an assertion, and right out of the gate, Perdue announced that school lunch rules would have “greater flexibility” which basically meant undoing the Michelle Obama-inspired menu changes by restoring to local control the guidelines concerning salt, milk, and whole grains.

Meanwhile, the headline in another publication read, “Sonny Perdue changes school lunch rules, but says Obama standards for milk, grains remain.” Well, which is it?

Basically both, through the miracle of time extensions, which means in practical terms that some things will never happen. Cornell policy expert David Pelletier is quoted as saying:

He is not changing the standards per se, but he is allowing schools to not follow them. It’s a bit like saying the posted speed limits on the roads remain the same, but you can go as fast as you want.

In reaction, Rachna Govani of Foodstand published a letter reminding readers that for many kids, school lunch might be the only meal they get all day, so it needs to be nutritious. She warned that the deficit of whole grains and the excessive salt in the American diet are two causes of cardiovascular disease, and noted that a bad diet greatly outweighs the ability of any exercise to compensate for it. She says:

Yet physical activity has been used by big food, big soda and now Perdue as a red herring. His message about exercise promotion mirrors the debunked propaganda big soda promoted.

Govani refers to the sugar-sweetened beverage industry’s doctrine of personal responsibility, which claims that people who consume its products only get fat because they do not perform enough exercise to negate the calories. A big fan of the Coca-Cola Company, Perdue has accepted tens of thousands of dollars worth of its contributions, which could indicate that favors are owed in return.

Perdue’s ongoing task is reorganizing the USDA to concentrate on production and trade, while reducing food safety measures and giving scant attention to areas like rural development. All his policies favor agribusiness over family farms. He was responsible for the universally hated “Harvest Box” idea to replace SNAP’s current method of allowing people to choose their own food.

At one point he visited an elementary school lunchroom to announce his new regime, and created what might be his finest media moment. Perdue told the kids, “I wouldn’t be as big as I am today without chocolate milk.” Since no one would regard his bulky physique as that of a role model, in some quarters this was regarded as shocking.

Your responses and feedback are welcome!

Source: “Ethics Questions Dogged Agriculture Nominee as Georgia Governor,”, 03/08/17
Source: “Sonny Perdue changes school lunch rules, but says Obama standards for milk, grains remain,”, 05/04/17
Source: “School lunches could lose nutritional value,”, 05/15/17
Source: “Sonny Perdue remakes USDA in Trump’s image,”, 03/16/18
Source: “Ag Secretary Perdue Moves to Make School Meals Great Again,”, 05/01/17
Photo credit: USDAgov on Visualhunt/CC BY

Scotland’s Ambition Leads U.K.


Scotland is part of the United Kingdom, but engages in a great deal of self-governance. Although the country boasts many hardy athletes, people don’t seem to pursue very much physical exertion. The weather is often vile, and many Scots enjoy sedentary indoor pursuits.

The national diet is notorious for sugar, salt and fat. And historically, according to Dr. Marisa Wilson of the University of Edinburgh, Scotland’s relationship with sugar has been “intense.”

The level of economic deprivation is high, which generally implies more exposure to fast food takeout joints, and less availability of healthful fresh produce. Journalist Vicky Allan writes:

Even today sugar-intake among children is higher amongst those in deprived areas. A 2008 study in Scotland found children in the most deprived areas of society ate 12 per cent more sugar than those in the least…

As previously mentioned, the Westminster Food and Nutrition Forum conference in April brought participants from all over the United Kingdom to discuss policy. Heather Peace, of Food Standards Scotland (FSS), divulged that her country’s obesity plan would hopefully include some healthy regulation of how supermarkets sell processed foods.

The group is very unhappy with in-store promotions that emphasize sugar- and salt-laden products. Professor Leigh Sparks, who authored a major FSS report, joins other academics in throwing shade on the industry’s half-hearted self-policing efforts. Apparently, while stores may go a little farther toward promoting healthful options, their good faith is called into question when promotion for unhealthful products still predominates.

The Scottish Grocers’ Federation points to the government-supported Healthy Living Programme in which more than 200 retail outlets participate. But the anti-obesity forces are not impressed by the examples of self-regulation they have seen so far, and, strangely, the Scottish Retail Consortium (the industry mouthpiece) agrees.

Spokesperson Ewan MacDonald-Russell told the press:

Any measures on pricing and promotions will have to be done through regulation or legislation; it’s not feasible, or legal, to ask retailers to voluntarily take collective measures in this area.

Scotland is aware that it has a serious obesity problem, and that education has not been effective. Vicky Allan consulted experts who see the need for a change in the food supply or “food culture,” and wrote:

By and large, it’s considered that since sugary drinks offer no nutritional value they represent a straightforward, fairly uncontroversial target. Where there is controversy however, is over whether they will result in any significant reduction in obesity, and whether, even, sugar really is the problem.

Of course the current trend is to absolve fat, especially since the discovery that, several decades ago, crooked science let sugar off the hook as the main obesity villain. But some experts still believe that sugar is unjustly demonized. Some do not even acknowledge any link between sugar and diabetes.

One quoted viewpoint is from the University of Glasgow’s Professor Mike Lean:

The problem linking sugar and overeating is not the sugar itself, or the calories in the sugar specifically, but the relentless exposure to extreme sweetness, which alters taste perceptions and leads to people to choose more sweet snacks between meals.

Many Scots are concerned that leaving the European Union will, because of different rules and new trade agreements, lead to the replacement of sugar with high fructose corn syrup, which is even worse. Meanwhile, Food Standards Scotland would like to see a reduction of portion sizes, and more extensive calorie information on menus.

There is also talk of extending the soda tax to cover sugary food products, without waiting for Great Britain to take the lead. Allan writes:

Some believe that the UK’s adoption of such a tax could be a tipping point, the start of a wave that spreads across the world, in the same way that the smoking ban did…

And Scotland could be the trim tab that affects the rudder that turns the ship.

Your responses and feedback are welcome!

Source: “Can a sugar tax help save us from obesity?,”, 04/08/17
Source: “UK sugar debate becoming more measured,”, 05/01/17
Source: “Scottish food watchdog wants ‘revolution’ on food sales,”, 06/16/17
Photo via Visualhunt

Informal Science Makes a Difference


A couple of years back, the Today show collaborated on an experiment with Brian Wansink, a Cornell University professor who had previously been executive director of the Center for Nutrition Policy and Promotion, a division of the U.S. Department of Agriculture. To prove his point that the sensation of fullness can be engineered, they offered a TV audience a free buffet.

The subjects of the experiment were divided into two groups of 12 each. Jeff Rossen and Josh Davis wrote:

For the first group, the buffet was laid out with fruit and salad first, then fatty pasta dishes at the end. The first group was given normal size plates and normal serving spoons.

[For the second group…] The order of the food was switched so that the healthy stuff went in back while the fatty stuff was placed at the beginning. In addition, group two was given slightly bigger plates and serving spoons. But the food itself was exactly the same.

The first group loaded up with the items they saw first, the healthful offerings, and left little space on their plates for high-calorie pasta. The second group, encountering the pasta first, took more of that.

Prof. Wansink summarized:

The first food you see in a buffet is a trigger food… What we find is, about 70 percent of what people are taking are the first three foods they see.

The second group of subjects, with the larger plates and spoons, averaged around 1,500 calories worth of pasta per person, while the smaller-plate group kept their pasta consumption down to around 890 calories. Also, the large-plate group ate about one and a half times as much total food as their small-plate counterparts. Apparently, humans are subconsciously imprinted with the conviction that a plate must be full.

The message is to use smaller plates and serve healthier foods first. By the time Today did their televised experiment, some American schools were already trying new methods of presenting and serving in their cafeterias.

By applying to school lunches the science of behavioral economics as advocated by Prof. Wansink, administrators were able to increase the consumption of salads. All they had to do was rearrange the physical environment so the salad bar was encountered first.

Fruit consumption was increased by placing it, rather than chips and desserts, in the checkout line. The researchers learned that keeping the lid of the ice cream freezer shut would cut ice-cream sales in half. Students still had a choice about what to eat, but making the high-calorie, low-nutrition items less visible and less convenient makes a noticeable difference in eating habits at school.

The take-home message

The obvious lesson for parents is to do the same at home. If the kitchen must contain snack items, put them away inside cabinets so the temptation doesn’t jump up, multiple times per day, and hit people in the face. At mealtime, serve the healthier items first, and, as for the rest, don’t leave serving dishes on the table.

Make it just a tiny bit inconvenient to take a second helping of high-calorie dishes. Use smaller dinner plates and spoons. Stash ice cream it the back of the freezer, behind and underneath other things, to make it just a bit harder to access. All these little “tricks” can add up, making the path to obesity avoidance a little smoother.

Your responses and feedback are welcome!

Source: “Experts say you can trick your mind into helping you lose weight,”, 04/22/14
Photo credit: Natalie Maynor via Visualhunt/CC BY

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources