Mon, Apr-27-20, 00:22
Dr Aseem Malhotra's article on the front page of today's Telegraph in the UK:
Is it time for an honest conversation about the risks of excess weight?
There is a far higher risk of death from Covid-19 for those with obesity and its associated conditions says a leading cardiologist
No one chooses to be fat. Social scientists from The Organisation for Economic Co-operation and Development (OECD) conducted an international poll to find out what matters most to people for their general wellbeing.
Good health was revealed as the number one priority, so how can this be squared with the fact that 60% of the UK’s adult population is now overweight or obese?
As pointed out in the New England Journal of Medicine: “food choices are often automatic and made without full conscious awareness.” Despite wishing to lose weight, we’re still tempted to buy the chocolate bar at the checkout till.
Yet as the country is gripped by the Coronavirus crisis, being overweight and its associated health risks are being highlighted as never before.
There is a staggering ten-fold increased risk of death from COVID-19 for those with obesity and the conditions associated with metabolic syndrome such as type 2 diabetes.
Metabolic syndrome, which is caused by excess body fat, is defined as any three of a cluster of five conditions; increased blood pressure, excess body fat around the waist, high blood sugar and abnormal cholesterol levels.
Data from America reveals only 1 in 8 adults is metabolically healthy, including less than 1 in 3 with a normal BMI of under 25.
Those with obesity and metabolic diseases already have some degree of mild ongoing chronic inflammation in the body and appear to have an impaired immune response to coronavirus that ultimately causes the cytokine storm (an overreaction of the bodies immune system) leading to respiratory failure and death in a tragic minority.
This, by the way, might also be one of the most plausible explanations so far as to why those from BAME backgrounds are more at risk of COVID-19 complications as they have a three to fourfold increased prevalence of metabolic syndrome than Caucasians. Vitamin D deficiency may also play a role.
Excess body fat produces inflammatory molecules in the body which over time slowly damage organs. Chronically raised insulin, driven by regularly eating high glycaemic index products (typical of ultra-processed foods) also appears to be the driving force behind a series of conditions; type 2 diabetes, high blood pressure, heart disease and possibly even cancer and dementia.
As pointed out by Professor Robert Lustig, Paediatric endocrinologist at the University of California, San Francisco, “ultra-processed food sets you up for inflammation that COVID-19 is happy to exploit. Just another way ultra-processed food kills.”
The food industry has exploited people’s emotional urges by saturating the food environment to maximise sales opportunities. They have managed to make cheap junk food available to anyone, anywhere at any time. Not surprisingly more than 50% of the calories consumed in the British Diet is now classified as ultra-processed food or what obesity researcher Dr Zoe Harcombe more pertinently describes as “fake food”.
Coronavirus cases: a breakdown of the first critical care patients
Obesity: Almost 72 per cent of those admitted to critical care with coronavirus were overweight, including 40 per cent who were obese. Obesity can cause a range of health conditions, which may make the virus more deadly. In addition, it can exacerbate breathing problems, experts said. The study found that almost 28 per cent of those admitted to intensive care units with coronavirus were a healthy weight, while just 0.6 per cent were underweight.
Gender: The research found 70.9 per cent of patients in such units were male, while 29.1 per cent were female. This is in line with previous studies which found that the virus was far more deadly in men. These showed that of all suspected cases, 1.7 percent of women who contract the virus would die compared with 2.8 percent of men. Some experts believe the sex imbalance relates to a higher prevalence of smoking or chronic alcohol use among men, while others think men are more likely to have underlying health conditions such as heart disease and diabetes, making them more vulnerable to an infection.
Age: The average age of those being admitted to ITU units suffering from coronavirus was almost 63. Health experts have been most concerned about older patients, because international studies suggest a mortality rate of around 15 per cent in the over-80s, compared with a rate of less than 0.5 per cent in those under the age of 50. Medics in the UK have noted that many of those being treated in intensive care units seem younger than they would have expected, a point confirmed by the new data. The study also found most patients were living independent lives, in contrast to expectations that most of those admitted to intensive care would be frail.
Underlying conditions: The study examined the number of those in critical care who were suffering from “severe comorbidities” – conditions that might be expected to shorten their lives. Here, levels were low, with 4 per cent found to be suffering renal problems, 3.7 per cent found to be immunocompromised, and 3 per cent suffering from lung conditions. At the most, 18 of all 196 patients were classed as suffering from severe conditions, and even this number may be overestimated, as some patients may have been counted in more than one category. However, experts stress that a range of far more common health problems – such as diabetes – were not included in the audit.
Such items are usually mass-produced highly palatable packaged foods, devoid of nutrients and fibre, high in sugar, starch, unhealthy oils, additives and preservatives. As they don’t make us feel full, they encourage us to eat more. Numerous international observational studies have linked their consumption to obesity, type 2 diabetes, heart disease and even cancer.
Even our hospitals have become a branding opportunity for the junk food industry with three-quarters of food purchased in hospitals classified as unhealthy.
Just don’t eat it, I hear you say. Yet it’s not so easy. One study in the USA revealed that people who visited paediatric institutions which sold fast food on site were four times more likely to purchase such products when they left the hospital than those that didn’t visit the hospital in the first place.
The evidence is so clear of the harmful halo effect of these products that The BMA, the Academy of Medical Royal Colleges and even NHS England have made policy calls to stop the sale of junk food in hospitals.
Given the oversupply of cheap sugary foods exercising personal responsibility becomes an illusion. To practise it one needs knowledge, choice, access and affordability. And education is clearly ineffective when the food environment is working against you. As such it’s no surprise that a 2017 study published in the BMJ found more than 50% of the NHS’s 1.4 million employees are themselves overweight and one in four nurses are obese.
Until individual hospital chief executives act to sever contracts that ensure that crisps, chocolates and sugary drinks are delivered to the bedside of patients on the wards and make the default food healthy and nutritious, sickness will be continued to be sold in the hospital grounds.
The recent publicity of Krispy Creme Donuts and Dominoes Pizza giving away free items to NHS staff is another “cynical marketing ploy” according to a senior dietitian who prefers not to be named. Award-winning food writer Joanna Blythman told me: “we need to wise up and see this corporate philanthropy as the blatant marketing strategy that it is: an attempt to portray these brands’ unhealthy products as a reward for our real health heroes.”
But these dirty tricks are not new. In the 1950s under threat from public anxiety of the adverse health effects of smoking Big Tobacco used images of doctors in advertisements to assure consumers that their brands were safe.
One cigarette won’t kill you and neither will one doughnut. Yet poor diet is now responsible for 11 million deaths a year; more disease and death than smoking, alcohol and physical inactivity combined.
Some on social media argue that this is “not the time” to be stressing the importance of a healthy diet. But if not now when? “We know poor metabolic health increases the lethality of COVID-19, but what the profession doesn’t fully appreciate is how rapidly these risk markers improve from dietary changes. I regularly see in clinical practice massive improvements in blood glucose of my type 2 diabetic patients within two to three days of cutting starch and sugar,” says Royal College of General Practitioners clinical advisor on metabolic health Dr Campbell Murdoch.
Former MEP Alexandra Phillips noted that in just three weeks of cutting out starch and sugar her mum has lost 3kg and is close to coming off blood pressure pills she’s been taking for years.
These recoveries are well documented in the medical literature; 25-50% of those with type 2 diabetes are able to send their condition into remission within a few months of cutting out refined carbohydrates from their diet. But the overwhelming majority of doctors are either not aware or are not conditioned to pay much attention to diet; understandable when there’s little to no nutrition education in medical school.
In my view, Public Health England and the government are grossly negligent by not telling the public explicitly that they need to change their diet now to not just improve population health, but protect the NHS from potentially another viral pandemic in the next decade.
And backed with policies that address improving the food environment such as banning junk food advertising, taxing ultra-processed food and making healthier food more affordable and available it’s conceivable one would see marked improvements to population health within one electoral term.
Let’s also not forget the importance of regular physical activity for metabolic health. But remember you can’t outrun a bad diet.
Losing body fat could potentially reduce one’s risk of suffering the worst complications of Coronavirus in just a matter of weeks. Cutting out junk and just modest increases in whole fruit and veg, nuts and seeds and omega 3 fats could also potentially halve the death rates from heart attack and stroke, whilst simultaneously reducing obesity, type 2 diabetes and many cancers. Until then let’s make the message loud and clear. If we want to really fix our health, we need to fix the food.
Dr Aseem Malhotra is an Honorary Consultant Cardiologist at the Lister Hospital, Stevenage.
Last edited by Demi : Mon, Apr-27-20 at 01:52.