Evidence has shown that obesity is an independent risk factor for severe symptoms from COVID-19. Even after controlling for other health conditions and demographics, a person who is living with obesity is 44% more likely to be critically ill from COVID-19 compared to a healthy weight person, and the risk of dying increases by 27% if have Body Mass Index (BMI) 30-34.9 (hazard ratio 1.27, 95% CI 1.18-1.36), rising to more than twice the risk if have BMI greater than 40 (hazard ratio 2.27, 95% CI 1.99-2.58).
These statistics become even more concerning when one considers the population inequalities that the COVID-19 pandemic has exposed. For some time, we have known that obesity prevalence is much higher in people who live in more deprived areas, and in certain ethnic minority groups. The prevalence of childhood obesity is over twice as high in the most deprived areas relative to the least deprived areas and this gap is widening over time.
There is a clear economic case for preventing and treating obesity. Within the UK National Health Service (NHS), the direct annual costs from treating health complications associated with obesity is over £6bn, with wider costs to society of £27 bn. As well as the serious health consequences, obesity also leads to lower levels of quality of life, increased risk of social stigmatization, depression, low self-esteem and in some children lower levels of educational attainment.
So why is it so difficult to treat and prevent obesity? Obesity is a commonly misunderstood disease. It’s often suggested that it’s due to individuals making ‘bad’ choices over what and how much to eat, and not being physically active enough. This is made worse by media messages about personal responsibility alongside stigmatizing images. Rather, it is a complex condition caused by exposure to the ‘obesogenic’ environment, how we respond to that environment and a complex interaction of genetics, social, environmental and economic circumstances. This means that the policy response is not straightforward, it needs to be multi-faceted with strong leadership coordinating a response from all aspects of the ‘system’.
Across multi-disciplinary academic communities, lowering levels of obesity and in particular reducing population inequalities has been a long-standing priority. Millions of pounds worth of research money has been invested to identify clinical and cost-effective treatment and prevention strategies, yet population rates are still increasing, and inequalities are widening. In recognition of this, the UK Government has published two childhood obesity plans; the first, in August 2016 was widely criticized for not being bold enough with too much emphasis on voluntary action, and the second in June 2018, was improved with tighter controls promised on marketing and advertising of unhealthy foods, and an indication of extending the soft drinks levy to other foods. A prevention green paper and the NHS Long Term Plan also outlined the start of a process to reduce levels of obesity. But many feel this is still not enough, and the Government needs to be much bolder with legislative action to control the food industry.
The UK emergency response to COVID-19, like many other countries around the world was to do everything possible to ‘flatten the curve’ with enforced travel restrictions, the shutting of all but essential business, school closures and enforced home working for all but ‘frontline’ workers. A ‘rule of rescue’ strategy was adopted whereby all resources were diverted towards managing COVID-19 cases and preventing deaths. Various economic support packages were developed costing billions of pounds and sparking fears of an economic crisis and recession like never before. Now that we have passed this ‘first-peak’, and with lockdown restrictions easing, many feel a trade-off between the economy and health, but for the economy to ‘bounce back’ it needs a healthy, productive workforce that is resilient to future health threats.
Now that the emergency response has passed, routine NHS services are re-starting, and thoughts turning towards lessons learned. COVID-19 has highlighted the urgency of dealing with obesity as no longer a ‘cosmetic condition’ but a disease that brings considerable cost to society and health risks. Health economics can help with identifying cost-effective treatment options from providing dietary and physical activity advice right through to specialist weight management services. Bariatric surgery is a cost-effective treatment option for patients living with obesity, however in the UK only a very small proportion of eligible patients have access. More needs to be done to understand the reasons why and create a health care system that ensures equitable access for all. Analysis of funding structures between local authorities and NHS providers for the delivery of Tier 1 to 4 weight management services needs to be addressed; with consideration of financial incentives for health care professionals to address weight with patients; and a review of the length of funding contracts for weight management services. A comprehensive, bold prevention strategy is key, targeting the food and physical activity environments, and understanding the impact on health inequalities. In light of the COVID-19 pandemic, never before has obesity been such a health and economic priority.
*Professor Emma Frew sits on the strategic council advising the All-Party Parliamentary Group on Obesity. The views and opinions expressed in this perspective article represent those of the author and not necessarily the views of the APPG-obesity strategic council.