A Hard Weight

Long before Covid-19, obesity was a serious health concern, a major contributor to cardiovascular and cancer deaths. More than one in three adults in the United States are living with obesity, many more are overweight. The arrival of Covid-19 has shed a new light on this longstanding health risk. Unfortunately, the pandemic led many Americans—housebound, working fewer hours in the world, exercising less, drinking more, depressed—to gain weight.

It became clear early on that having excess weight worsened Covid-19 outcomes. Obesity tripled the risk of hospitalization, and increased intensive care unit admission and death from Covid-19, particularly for those under 65 in the US. Internationally, nearly 90% of deaths from the pandemic disease have been in countries with high levels of obesity. Only older age is a stronger risk factor for severe illness. Overweight, at least, may be reversible.

The interconnectedness of certain health conditions is unfortunately clearest when viewed through a lens of race. In the United States, Non-Hispanic Black adults have the highest prevalence of self-reported obesity (39.8%), followed by Hispanic adults, with non-Hispanic White adults reporting rates ten percent lower. Part of the reason that Hispanic and non-Hispanic Black adults have suffered worse outcomes from Covid-19 is obesity. And a good part of the obesity story is a poverty story: unhealthy foods are simply more available and affordable. Persistent food insecurity due to decreased affordability, particularly among those with low-incomes or who are out of work, leads to a diet of cheap and energy-dense foods and sugar-loaded drinks.

Of course, the causes and trajectories of obesity are complex. Neighborhood design matters, providing access to safe and convenient places for physical activity.  Campaigns for healthier eating matter. Food policies that work at scale in schools as well as supermarkets matter. To make societal headway, environmental and economic policies need to meet up with the psychology of food preferences; incentives for sellers and shoppers need to align with advertising and labelling edicts.

Our long record of societal pressures that induce many to gain weight, and the increased risk of severe Covid-19 that ensues, has been a lesson of the pandemic, one that has contributed to the stresses on our health systems. Fewer overweight Americans would have reduced the number of emergency room visits and hospitalizations. Is emphasizing the risks of Covid-19 going to be a new and effective approach to overweight reduction, as has been attempted in other countries? Not for long, as Covid-19 relents.

The power of the food and beverage industry is overwhelming and politically difficult to oppose, with meaningful change dependent on dirty words: taxes and bans. Yet modest taxes on sugary drinks produce only modest effects. Unhealthy foods are cheaper.

Obesity has many contributing factors, some that have clearly gotten worse in the past year. Yet it is worth remembering at this moment that respiratory viruses before Covid-19 produced worse consequences in persons living with excess bodyweight. Worse infectious disease effects will occur again with the next Covid-19 if we do not pay attention to the continuing obesity pandemic. To prevent the extent of pandemic death in the future requires action now. Health conditions are interconnected and their causes are as well. As our attention swivels from Covid-19, we should be reminded what made Covid-19 worse than it had to be.


Michael Stein & Sandro Galea

As we re-emerge from the pandemic, 2021 stands to be a turning point year for public health. In The Turning Point’s weekly essays, we reflect on what we learned during 2020, and what we are learning during 2021, that can guide us to the creation of a better, healthier world.

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