Katrina Thoma may have spent most of her career in a pediatric intensive care unit, but upon becoming involved with Sadler Health Center in Carlisle, it was clear that childhood obesity was a significant issue.
That challenge only grew throughout the COVID-19 pandemic.
“I’ve seen a big jump in obesity since the pandemic,” said Thoma, who is currently the director of medical services at Sadler, which offers health care services to uninsured and underinsured patients. “Kids who had a steady weight suddenly gained 50 pounds. They weren’t going outside. They weren’t playing.”
What they were doing was snacking, she said. Just as adults working from home felt the lure of readily available food in their kitchens, Thoma said children who were bored or upset filled that time with food.
“In older kids and middle school kids, I saw a huge difference,” she said. “I heard from parents saying, ‘My refrigerator is empty on a constant basis and I need them out of the house.’”
Though local data collected and reported by school districts has yet to be released for years after the start of the pandemic, the Centers for Disease Control released a study in September 2021 that showed children ages 2 to 19 who were overweight or obese during the pre-pandemic period experienced significantly higher rates of BMI increase during the pandemic, compared to those who had healthy weights prior to March 2020.
The study reported that those with healthy weights, who were overweight and who had moderate or severe obesity all saw increases in rates of BMI, though those with weight challenges saw those rates double during the pandemic, which children ages 6 to 11 experiencing the largest increase in BMI changes.
“… Children and adolescents might have experienced circumstances that accelerated weight gain, including increased stress, irregular mealtimes, less access to nutritious food, increased screen time and fewer opportunities for physical activity,” the study reported. “These findings underscore the importance of efforts to prevent excess weight gain during and following the COVID-19 pandemic, as well as during future public health emergencies, including increased access to efforts that promote healthy behaviors.”
Childhood obesity data
The most recent comparable data offered publicly by national and state agencies doesn’t yet reach 2020, but previous data shows that Pennsylvania is about at the national average of childhood obesity rates, while Cumberland County sees lower rates than its neighbors.
According to CDC data from 2019, Pennsylvania saw 15.4% of its students in grades 9 to 12 battle obesity, while another 14.5% were in the overweight classification. The overweight rate was lower than the national average of 16.1% and lower than surrounding states, save for Ohio with 12.2%.
However, its lower overweight rate may be due to its higher obesity rate. Though the national average for childhood obesity is slightly higher than Pennsylvania’s at 15.5%, the commonwealth had a higher rate than all but two of the surrounding states — with West Virginia the highest at 22.9% and Ohio the second highest at 16.8%.
Data collected by school districts and reported by the Pennsylvania Department of Health does show that Cumberland County has more promising numbers than other counties in the southcentral region.
In the latest reporting data for 2017-18, Cumberland County had the lowest rate of obesity at 14.69% in children K-6 compared to all other counties in the region, and it had the third lowest rate of overweight children at 15.09%.
Among students in grades 7 to 12, Cumberland County had the highest rate of children with healthy weight (67.01%) in the region, and it had the second lowest rates in both overweight (16.19%) and obesity (17.44%).
Food insecurity
The school district data also illustrated how rural communities often struggle more with childhood obesity. In the region, Juniata County had the highest rates of obese children in both age groups, while Fulton County saw the highest rate of overweight children in both age groups. Huntingdon County and Bedford County also saw high obesity rates, while Franklin, Perry and Lebanon saw higher rates of overweight children.
According to Thoma, food insecurity is a major factor in rates of childhood obesity. While people may view “food insecurity” as a lack of food and equate it more toward hunger, Thoma said the definition is more akin to a lack of “healthy food” options. She pointed out that from her own research, she found that rural and low-income communities could see about seven to eight fast-food restaurants in a 5-square-mile radius compared to the one fast-food restaurant in an upper class neighborhood of equal size.
“For food deserts, it’s not about being able to find food, but not being able to get fresh food and vegetables,” she said. “You look at the price of a salad at those locations, and it’s way more expensive. When you have to choose between two cheeseburgers or one bag of apple slices, you choose the cheeseburgers.”
With the amount of money limited through the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), Thoma said parents will buy the cheaper meals they can find on dollar menus than what may be the healthiest. Other factors for low-income households also come into play when being able to get fresh food.
“Some people don’t have transportation,” she said. “In the U.S., we have Costco and Sam’s Club, and you can load up on 30,000 items, and stock up the refrigerator. The average American in a lower socioeconomic circle, though, they don’t have that capability.”
Thoma said people will buy what they can carry, what will stay fresh during the bus ride and what will stay in their cupboards longest without spoiling.
“Childhood obesity is hard if you don’t have money,” she said.
Battling obesity
At Sadler, Thoma is there to help parents and children understand what it is that they’re eating, choosing protein over carbohydrates and reducing the number of servings, but she added that what she’d like to see become a staple at Sadler is a resident dietitian — one who could do the work that Emma Witwer is doing at Project SHARE.
Witwer is the nutrition coordinator at the Carlisle food pantry, and while she has other duties in organizing the Summer Feeding Program for children, she also helps residents understand what they can do to plan healthy meals. Sometimes that means walking a family through a grocery store and showing them how to read the nutrition label, and it can include giving them a SHARE box that she equates to a HelloFresh meal kit, but one that includes healthy ingredients that could feed five to six people.
She also helps make sure Project SHARE offers the best food they can when it comes to food distribution and its appointment-only pantry where residents can “shop” for items and perishable goods they may need during the week.
In the pantry, items are designated as “choose often,” “choose sometimes” and “choose rarely,” with rarely items including products like pastries and high-sugar cereal. With food distribution, she estimates that most pre-packaged boxes have about 85% “often” and “sometimes” goods, and 15% “rarely” items.
“We’re trying to work in more healthy items,” she said. “Choose rarely isn’t choose never. It’s OK to have treats.”
While the nonprofit can control what items it gets when it purchases goods for distribution, Project SHARE also gets food donations. Witwer said she knows those who donate want to help, and she’s put together a guide of most wanted items that prove to be healthy options. Those include low-sodium canned beans and vegetables, canned fruit in 100% juice, canned meats like tuna and chicken, canned soup with less than 600 milligrams of sodium, peanut butter, whole grains like oatmeal and whole wheat pasta, and healthier snack foods like nuts, popcorn and whole wheat crackers.
The organization also requests pantry staples like cooking oils, vinegar and spices to help promote families cooking for themselves with food they get from Project SHARE’s pantry or from its Farmstand on Lincoln Street that is open two days a week and offers fresh food and vegetables.
Family support
Witwer also offers a cooking social every month for adults, as well as hands-on cooking classes for children that will restart in October and run through May. The Kids in the Kitchen Cooking Club offers in-person classes at Project SHARE on the first Thursday of every month, as well as virtual classes the fourth Thursday of every month where ingredient bags will be provided and Witwer will teach children how to create homemade, healthy meals.
Getting the child involved in cooking can make a considerable difference, especially for picky eaters, according to Witwer.
“Kids when they’re involved in the cooking process, they get more adventurous,” she said.
Thoma said it’s important the family be involved when it comes to helping a child with their weight. She noted the studies that have shown children with one or both parents who are overweight or obese tend to also have weight troubles since parents often make meal decisions in the home that will affect the child.
“You have to involve the family,” she said. “When you do, they have an even better chance [at getting a healthy weight].”
That can mean promoting two 10-minute walks a day where the family can walk together and have conversations, and Thoma would like to see family counseling with nutritionists and dietitians, though there aren’t many available and few who specialize in counseling an entire family. She added that mental health counseling is also important for children since depression or trauma may be the cause of weight gain in some cases.
For many, it’s simply about helping them understand what not to do – such as give juice to infants – and change the idea that healthy eating isn’t possible on a budget.
“The perception is making a healthy meal takes hours,” Thoma said. “But there are cookbooks on healthy meals that take 10 minutes. With fresh food, you can make a meal. I can have two different vegetables and a protein in 20 minutes after I get home from work.”