The stress, isolation and unpredictability of COVID-19 led to weight gain among many Americans, and a few silly memes (including a portly Kermit the Frog). But undesired weight gain is no cause for laughs, particularly among kids, of whom nearly one in six is considered obese.

A new report from the Robert Wood Johnson Foundation (RWJF) revealed that the pandemic exacerbated already alarming trends for children, particularly kids of color and those in low-income families. While Minnesota fared better than most states, we have hardly reached health parity. Kristine Igo, director of the Statewide Health Improvement Partnership (SHIP), shares ideas to ensure that all our kids grow up healthy.

Q: Please tell us about SHIP.

A: SHIP was launched in 2008 by a bipartisan group of Minnesota legislators to address rapidly accelerating and costly chronic diseases, specifically obesity and tobacco use, which are primary contributors to chronic disease. We operate in all 87 counties and within 10 of the 11 tribal nations, partnering with health care organizations, schools and day care settings, city and local municipalities, worksites and businesses. The goal is to create more opportunities and reduce barriers so all Minnesotans can be more physically active, eat healthier and live free from commercial tobacco.

Q: But we should note that some Minnesotans are thriving while others are struggling. The RWJF report found that, in Minnesota, 11.7% of youth ages 10-17 are obese, tied for the eighth-lowest rate in the nation. (The national rate is 16%.) Yet, even here we face sharp disparities among our children.

A: Many of Minnesota's young people with higher obesity rates live in food deserts, such as many rural and tribal communities, where they have no access to a nearby grocery store with healthy food options. But we are also challenged by food "swamps," which are communities inundated with fast food and too many unhealthy food choices. We see that most commonly in our urban communities that may have a lower socioeconomic threshold, lower wages and few job options. As much as we talk about how well Minnesota is doing, we have disparities perpetuated by structural and systemic inequities.

Q: How do you begin to fix that?

A: SHIP is hitting all corners of the state, working with community leaders and local public health teams to identify where there is the greatest need for support and resources. We work with schools to integrate more activity into their school day, purchasing more bicycles and teaching kids how to ride. We also work closely with city planners, managers and mayors on transportation planning to change the landscape where people live. That might mean introducing more bike lanes, more walking spaces, slowing down traffic. But this is also about understanding that community members have varying perceptions of what it means to feel safe. An African American man may not feel safe going out for a run. How do we address the notion of safety for all racial and ethnic communities?

Q: Preliminary research suggests that these issues were exacerbated by the pandemic. Help us make the connection.

A: Without one, or sometimes two, free meals at school, families were additionally challenged. To help address this, the emergency food infrastructure expanded throughout the state. A lot of our school districts worked hand-in-hand with public health partners to provide free meals to kids and their families that were distributed at schools and community rec centers or delivered to kids at home. And we thought creatively about how to provide guidance on how people could be active during the pandemic.

Q: What about the kid palate? How do you get kids to love kale?

A: School food services directors talk a lot about needing to introduce foods two to three times before kids will gravitate toward those foods. But with income inequality, you have limited funds, so what you can afford often means high fat, high salt products.

Q: So what you can afford to put on the table isn't the healthiest option?

A: Right. But it's hard to put the blame or burden on the parents. It's less about individual choice and more about what influences that choice. If you're working two jobs and taking the bus, that will additionally limit the time you have to cook a meal. Lean meats are more expensive and require time in the kitchen and they also require a kitchen. No wonder many people default to prepackaged foods that are widely available.

Q: How important is it to bring parents or other key adults into the conversation about the child's weight and overall well-being?

A: SHIP works across many settings, in schools, health care systems, workplaces and child care settings. You're often working with multigenerational families. In school, you can help change their taste preferences but you also want to send recipes home. With tribal kids, elders and families gather in community kitchens to reintroduce Indigenous food knowledge and prepare meals together. Parents need all the support they can get.

Q: How about a success story?

A: One of our biggest successes is changing food options in convenience stores. You can now stop at a gas station with sections offering whole and healthy food options. We're chipping away at the food desert issue, but if a grocery store closes down, you've got another desert.