Nearly one in six children between the ages of 10 and 17 are obese in Hawaii, marking a significant increase from four years ago and fueling concerns about the impact that COVID-19 restrictions and school closures have had on the health of the state’s youth.

The obesity rate for youth ages 10 to 17 stood at 11.1% for the years 2018 to 2019. That figure jumped to 15.5% for the years 2019 to 2020, according to a new report released Wednesday by the Robert Wood Johnson Foundation, a nonprofit focused on improving health and health equity in the United States. The data for 2020 was collected from June 2020 to January.

The increase in obesity places Hawaii 25th in the nation, up from 44th just a couple of years ago.

The report was released amid heightened concerns locally and nationally about the effect the pandemic has had on children’s health. A study released last month by the Centers for Disease Control and Prevention found that nationally children and teenagers have seen a significant increase in weight gain since the start of the COVID-19 pandemic. The study found that obesity among 432,302 youth between the ages of 2 and 19 rose to 22%, compared to 19% before the pandemic, among other findings. Dr. Alyson Goodman, one of the study’s authors, called the study’s findings “substantial and alarming.”

The report by the Robert Wood Johnson Foundation emphasised that the pandemic has exacerbated long-standing health inequities experienced by low-income youth and youth of color, while cautioning that more data is needed to better analyze the impact that the pandemic has had on childhood obesity throughout the country.

Sandra Hassink, medical director of the American Academy of Pediatrics Institute for Healthy Childhood Weight, said in a news release from the foundation that the pandemic had worsened the risk factors for childhood obesity.

“Economic stressors, food insecurity, less consistent access to healthy meals at school, combined with increased sedentary time, sleep dysregulation, reduced physical activity, and social isolation have made it harder for families to stay healthy,” she said.

The increase in obesity levels is particularly alarming due to its link to breathing problems, high blood pressure and diabetes, all of which increase the risk of becoming seriously ill from COVID-19.

In Hawaii, the disruptions to daily routines and economic security were particularly profound last year amid government-imposed lockdowns and restrictions and schools implementing distance learning. The state’s unemployment rate soared to 21.9% in April and remained high throughout the year. Many jobless families scrambled to get unemployment insurance, sign up for Medicaid and find supplements to their food budgets with the economic downturn affecting the state’s lower wage earners the hardest.

“In general, I think it is difficult to be healthy when your world is upended like that,” said Daniela Spoto, director of anti-hunger initiatives at the Hawaii Appleseed Center for Law and Economic Justice.

She said the financial strain on families is intertwined with obesity rates.

“Obesity and hunger everywhere in the developed world are two sides of the same coin because the cheapest foods that people can afford are also the foods that are highest in salt, fat and sugar, and lowest in nutrients,” said Spoto.

She said that many students last year also didn’t have the benefit of school meals, which became healthier under the Healthy, Hunger-Free Kids Act, which was championed by former first lady Michelle Obama and which increased nutrition standards.

This year, all public school children are receiving free school lunches, a policy that the Robert Wood Johnson Foundation urged all states to make permanent. Hawaii’s school children also returned full time to classrooms this school year even as COVID-19 cases soared with the delta variant.

“One thing we’ve learned is that in-person learning is, for most students, critical for their academic and social success, as well as their overall well-being,” Gov. David Ige said in August in outlining his plans for reopening schools.