Report: Coronavirus-related expansions to federal programs should remain in place

One good thing may have come out of the pandemic. More children have access to healthy foods.

Whether that continues remains in question.

Because of the COVID-19 pandemic, U.S. policies changed, allowing more access to healthy foods for families that need it most.

The changes have the potential to move the needle on U.S. childhood obesity rates, something that has been challenging for communities, a Robert Wood Johnson Foundation report finds.

However, only if the changes stay in place for the long term.

The foundation is a nonprofit committed to improving health and equity in the United States. It strives to create a culture that provides every individual with a fair and just opportunity to thrive, no matter who they are, where they live or how much income they have, according to the report, "From Crisis to Opportunity: Reforming Our Nation's Policies to Help All Children Grow Up Healthy."

Jamie Bussel, an author of the report, pointed out the pandemic spurred governments to shift policies so revenue can support communities' health.

"Schools are providing all kids with healthy, free meals - whether they are open for in-person learning or operating virtually," she wrote in the report. "Families face fewer barriers to enrolling in nutrition assistance programs and using their benefits. Policymakers have increased monthly benefit levels in nutrition programs and are providing child tax credits to help families meet their kids' needs."

Kelsey Chrisman, who as the Jefferson City Healthy Schools coordinator helps children make healthy decisions about diet and activity, said the pandemic deeply challenged the district to keep children active and well-fed.

"We had to get a lot of online support," Chrisman said. "That's really hard whenever you're in this line of work."

Jefferson City has been able to keep students in classes. However, during the brunt of the pandemic, it had a large percentage of children who stayed home.

The separation took a toll on students, but also affected the adults who work with them, she said.

Federal changes, if left in place, can potentially decrease child hunger and poverty significantly, Bussel pointed out.

"We need to think bigger and bolder about permanent solutions that will strengthen our nation's policies and expand support for kids and families for the long term."

Experts, the report says, expected the pandemic to exacerbate food insecurity for some Americans. They predicted a surge in childhood obesity at its onset. Children remained home, and oftentimes didn't have access to healthy meals like those they'd receive in a school setting.

The pandemic also affected other determinants of health, such as families' income, housing and access to health care.

"As we continue to address the pandemic, we must ensure federal programs such as school meals, the Supplemental Nutrition Assistance Program (SNAP), and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), prioritize equity and health - and reach as many kids as are eligible," the report states. "We must also look upstream and approach this issue more broadly with far-reaching changes that make our food, housing , education, employment and health care systems more fair, just and sustainable."

Long-term efforts to reduce childhood obesity will require public-private partnerships, the report offers.

Latest available nationwide data (50 states, plus the District of Columbia) from 2019-20, show the obesity rate for children ages 10-17 was 16.2 percent. The rate has remained steady for about five years, according to the report.

Missouri's rate for the age group was 19.6 percent, which was the 11th highest.

The rates do not yet show significant changes associated with the pandemic; however, several studies indicate the pandemic may be contributing to rising obesity rates.

A study of 2019-20 clinical visits in the Philadelphia region found the obesity rate for children ages 12-17 climbed from 13.7 percent to 15.4 percent. A similar study in California found the rate of children there from 5-11 years old who were overweight or obese was 36.2 percent before the pandemic, but the rate climbed to 45.7 percent during the pandemic.

One hurdle for children, the report points out, is that beverage companies are marketing their sugary products for children in the same way the tobacco industry once marketed its products for tobacco users.

"For years, beverage companies have been marketing in schools, hiring athletes and music stars, and advertising in traditional and digital media to promote sugary drinks to kids," the report states. "Black and Latinx children have been disproportionately targeted. These efforts are strikingly similar to tactics used by tobacco companies to get young people hooked on their products."

Food and beverage companies have also engaged in activities that were "central to the tobacco industry's playbook" - funding research that favors their products, funding lobbying efforts, and securing contracts to prominently place marketing in locations like schools and sporting events.

The report offers a number of policy recommendations (concerning school meals) to improve childhood obesity outcomes.

- Among them are to make universal school meals (meaning all students qualify for free meals) permanent and provide resources that ensure every child has access to a consistent source of healthy meals. Data show during the fiscal year ending in 2020, 76.9 percent of meals schools in the United States served were free or reduced-price. And 30 million children participated in the National School Lunch Program. The report recommends the United States continue universal free school meals following the pandemic, when relaxed rules allowed schools to serve free meals (breakfast and lunch) to all children.

- The U.S. Department of Agriculture should continue to strengthen nutrition standards for school meals, particularly focusing on reducing added sugars in meals.

- The USDA should increase the reimbursement rate it provides for schools so they may afford healthier choices.

- Congress should increase funding for healthy meals.

- Local, state and federal governments should work together to assure safe drinking and cooking water are available in all schools, and include testing for lead in cafeteria water and tap water.

- Congress boosted its WIC program during the early stages of the pandemic. It committed about $1 billion of additional revenue to improve WIC participants' access to nutritious foods (while enabling them to avoid in-person clinic visits), according to the report.

"Federal relief laws have increased flexibility by allowing newly eligible mothers to enroll virtually, permitting food package substitutions when WIC-approved versions are not available, and enabling more widespread use of telehealth technology to deliver nutrition education and breastfeeding supports," the report said.

The American Rescue Plan Act boosted monthly fruit and vegetable benefits up to $35 per child and adult each month. The act sets aside another $390 million to modernize and promote the WIC program through Sept. 30, 2024.

Data show the program served 4.1 million children and 1.9 million infants in 2018.

The foundation recommends current waivers that enable more families to access WIC remain in place.