Lessons from COVID-19 about the obesity epidemic

The COVID-19 pandemic has highlighted our ineffective approach to the obesity epidemic in the United States.

I believe COVID-19 would have claimed fewer lives if we had healthier patients and less obesity. According to the CDC, “obesity may triple the risk of hospitalization due to COVID-19 infection.” Additionally, they note that obesity can make intubation and ventilation more difficult for severely ill patients. While the attention currently is focused on COVID-19 vaccination, and rightfully so, I hope the nation does not lose sight of the work that awaits health care providers when the pandemic is controlled.

Traditionally, health care providers receive very little training on nutrition and weight control measures. The lack of training causes well-intentioned but severely simplified advice such as “exercise more, eat less.” This causes patients to have limited success with weight loss, and often the results are temporary. They are unable to achieve lasting results because they receive little to no education on hunger hormones, sex hormones, sleep, stress management, processed foods, sugar, their microbiome or the role of their mind in weight loss.

We focus on educating them about their risks of cardiovascular disease, diabetes, stroke, etc., in hopes that the consequences of not losing weight are enough to keep them motivated towards weight loss and healthier habits.

News flash: It is not working!

The nation needs to find ways patients can be supported through their weight loss journeys with a holistic approach to create long-term success. It will take providing patients with the accountability, encouragement, education, and community they need to be successful.

Consequently, if we take care of the obesity epidemic, we can almost guarantee the nation will see a drop in rates of heart disease, diabetes, stroke, kidney disease, hypertension, and liver disease — all of which are other risk factors for more severe COVID-19 infection.

There are several big culprits that can be addressed immediately to start impacting the obesity rates in the U.S. One of which is food addiction caused by hyper-palatable foods. Ice cream, pizza, fries, burgers, doughnuts, chips, and cookies are all prime examples of hyper-palatable foods. They have been highly processed, include high amounts of fat, sugar or salt, and create a hormonal response in the brain similar to that of illicit drugs. The feeling of pleasure a person receives after consuming hyper-palatable food causes them to come back for more despite harmful consequences.

Most people are simply unaware of what is happening in their body to create food addictions. When they try to lose weight but struggle with cravings and binging, they blame themselves for not having enough willpower when the issue is usually much more complicated. Would simple changes such as education and specific labeling impact the amount of hyper-palatable foods people consume? Maybe a label stating “could create food addiction” on a box of cookies would make some people second guess their choice.

A second issue that needs continued improvement is the presence of food deserts. Food deserts, as defined by the USDA, are “A census tract that meets both low-income and low-access criteria including: 1. poverty rate is greater than or equal to 20 percent OR median family income does not exceed 80 percent statewide (rural/urban) or metro-area (urban) median family income; 2. at least 500 people or 33 percent of the population located more than 1 mile (urban) or 10 miles (rural) from the nearest supermarket or large grocery store.” It is estimated that 23 million people in the U.S. live in a food desert. Since 2009 there has been an improvement in the number of food deserts, but this has yet to show a significant change in chronic disease and obesity rates. However, I still believe it to be an important part of a long-term solution.

Focusing only on food is part of what leaves us in this obesity epidemic. Other shortcomings in the health care system and the diet industry include a lack of education about the importance of sleep, stress management, and mindfulness while achieving and maintaining a healthy weight.

I think more medical professionals need to become health coaches. A big impact could be made on the obesity epidemic in the U.S. if health care providers would understand the physiology of the body, nutrition, and how to support behavior change. Health insurance companies have already caught onto the importance of health coaches and currently provide their own phone-based coaches. While they are on the right track, they are underutilizing the power of health coaches by far. They need to cover the costs of professional health coaches just like medical specialists are covered. Primary care providers should have the power to refer someone to a health coach for weight loss and behavior change just like they would refer someone to a specialist for treatment of diabetes or another serious medical condition.

We need to continue to focus on the COVID-19 pandemic. However, we need to also turn our attention towards preventing further disease and death due to obesity. Educating people about food addiction caused by hyper-palatable foods and addressing food deserts are a good start to impact change. However, real change will come when health care professionals are trained as health coaches and have the expertise to best support patients in their weight loss journeys.