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Open Letter to the Caribbean from the Caribbean Pediatricians, the Pediatric Association of Jamaica, and the Healthy Caribbean Coalition community including the Heart and Stroke Foundation of Barbados (HSFB), Heart Foundation of Jamaica (HFJ), and Healthy Caribbean Youth (HCY), as the region marks World Obesity Day.

We, Caribbean Pediatricians supported by the Healthy Caribbean Coalition community, are deeply concerned about the health and wellness of our region’s children and young people. Since the onset of the COVID-19 pandemic the lives of our children and young people have been turned upside down; the way that they learn, socialise, play, eat, move and sleep has changed, and these changes are having a substantial impact on their physical and mental health. We believe that we are on the cusp of a regional childhood obesity and mental health emergency.

Many children are consuming excessive empty calories while attending online school from home. In some cases, they are exposed to unstructured eating and oftentimes unrestricted access to foods, leading to overconsumption of foods high in salt, sugar, and fat. In addition, the shift to online schooling coupled with pandemic-related restrictions have resulted in the reduction or elimination of physical education, extracurricular activities, reduced recreational playtime and significant jumps in screen time .

Now more than ever, our children and young people are eating more and moving less. These behaviours have likely exacerbated the childhood overweight and obesity crisis. Since the pandemic, more and more children and young people are presenting with overweight and obesity and have been diagnosed with type 2 diabetes, hypertension, musculoskeletal issues, and other endocrine conditions.

Additionally, COVID-19 control measures and related economic and food security challenges, including interruptions in national school meal programmes, have resulted in childhood undernutrition across the region.

This pandemic’s exacerbation of poor diets and physical inactivity has also been accompanied by an alarming rise in mental health issues such as anxiety, depression, tic disorders, disrupted sleeping and disordered eating behaviours heralding potential eating disorders among children and young people. This silent mental health crisis can no longer be overlooked.

Children and young people are trying to cope and navigate this new reality and they need us, as a community, to create safe spaces to listen to their concerns and not disregard them. COVID-19 has shed a light on the need for more structured, school-based and community-based mental health services across the region, in particular, appropriate services to support the unique mental health needs of children and young people. The mental health of children and young people need to be a priority.

“…As we continue to navigate global changes, we must find the regional strength to address the impact of the Pandemic on our children and youth; specifically the adverse effects on their mental health, access to equitable education as well as nutrition and rates of physical activity. The opportunity is now, for us to be proactive and systematic to support child and adolescent health, to secure a resilience, productive and positive Caribbean future.”

Dr. Asha Pemberton, Pediatrician and Chair of the Planning Committee of the First Caribbean Congress on Adolescent Health (2019, Trinidad and Tobago)

For the past year we have been living in the surreal reality of this pandemic, doing our collective best to manage the sustained economic, social and mental stresses. The toll of this crisis on our most vulnerable – our children and young people – is yet to be fully understood. We cannot afford to wait until ‘things get back to normal’ and assume that our children and young people will emerge as ‘resilient’ creatures or that the damage caused to them during the pandemic can be undone.

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We must come together now to address this regional childhood obesity, undernutrition, and mental health emergency. If we allow levels of malnutrition to continue to rise unchecked, we are assigning an entire generation to a life living with NCDs and other health complications. If we do not address their mental health, we run the very real risk of developing lasting scars that could impact their growth, future productivity and quality of life.

We can and need to put measures in place to mitigate this crisis and a whole of society approach will be critical – everyone has to act now.

Governments – we need you to prioritise strong policies that protect the health of our children and young people including: front of package nutrition warning labelling that will help consumers make informed decisions about their foods; and banning the marketing and sale of unhealthy products in and around schools while simultaneously ensuring that children have ongoing access to fruits and vegetables. Access to these foods should be equitable and sustainable; the most vulnerable, specifically those suffering from malnutrition, should have ensured access.

We are also calling on governments to invest in school-based interventions that focus on ensuring that physical activity opportunities, good nutrition, specifically provision of uninterrupted nutritious school meals, and mental health support are cornerstones within a school environment. Within the community, there also needs to be a greater investment in mental health services and support for young people. Relatedly, parenting programmes need to be developed or expanded to ensure that children from vulnerable families get the appropriate support and protection needed.

“…Now more than ever, we need to act urgently. We have to move quickly to put people before profits and implement strong nutrition policies and mental health support systems to support our children and young people. As a society, it is our responsibility.”

Professor Anne St. John, Pediatrician and Medical Director for Youth Health Heart with the Heart and Stroke Foundation of Barbados (Barbados)

Private sector – should be partners in supporting ongoing efforts to shape healthy environments for our children and young people. This includes halting targeted marketing of unhealthy products on digital platforms especially now when children are spending inordinate amounts of times on screens.

Civil Society – is a critical actor and should continue to advocate for protective nutrition policies such as front of package nutrition warning labelling, banning the sale and marketing of unhealthy foods and beverages in schools, and community-based interventions (including school-based interventions) that will support safe physical activity opportunities, increased access and consumption of local fruits and vegetables. All efforts need to be made to destigmatize and prioritize mental health.

Youth advocates – remember, your voice is powerful. Continue to demand healthy environments for you and your peers. Among your peers, create spaces to discuss how you are feeling, normalise this. You have a right to these healthy environments and safe spaces.

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Parents and guardians – we acknowledge that your worlds have also been turned upside down, however, we need to do everything we can to protect our children; their health and wellness have to be our priority. With this, eat well together, be active and make memories together, and educate yourself about mental health and wellness and create open and supportive spaces for discussions on these issues.

Pediatricians and health care providers working with children and young people – we urge you to continue to educate your patients, parents and their children, about the importance of healthy, balanced eating, physical activity with less focus on weight only and rather on healthy lifestyles being adopted. Screening consistently for depressive and anxious symptoms and other mental health concerns is critical at this time; this screening will allow children and adolescents an opportunity to share how they are feeling especially if they are having difficult times coping. Remember, children and young people require unique care.

Lastly, next time any of us sees a child or young person, we need to ask them, how they’re doing and really listen to them. Ask them how we can help them be the healthiest version of themselves. Their voices are monumental in determining how we can create and ensure that sustainable change is implemented to mitigate this crisis.

We know what we need to do, let us work together and act now to protect our future.

Signed by Caribbean Pediatricians, the Pediatric Association of Jamaica, and the Healthy Caribbean Coalition community including the Heart and Stroke Foundation of Barbados (HSFB), Heart Foundation of Jamaica (HFJ), and Healthy Caribbean Youth (HCY).

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