Calls for stricter junk food legislation as link between obesity and COVID-19 complications examined

29 May 2020 --- Mounting evidence is pointing to a connection between obesity in patients and worse COVID-19 outcomes. The UK government is imminently releasing a review of this connection, which comes as Prime Minister Boris Johnson declares “war on obesity” following his own COVID-19 hospitalization. In light of this, lobby group Action on Sugar/Salt (AoS) has proposed an evidence-based plan for supporting those living with obesity, while improving health for all in the long-term. Holly Gabriel, Nutritionist at AoS, tells NutritionInsight that the British government’s actions to improve access to healthy food and measures to improve the food environment have been put on hold at a time when they are “even more crucial.”

“Having a healthy balanced diet and being able to access healthy food plays a key role in keeping the immune system healthy. This pandemic has only demonstrated that importance further. More research is needed to see how quickly health outcomes from COVID-19 would benefit should a person improve their diet and become more active, but the evidence of the benefits of making small changes for overall health is well established. This is a major opportunity for the government and the food industry to improve the health of the nation,” details Gabriel.

At the start of this month, the UK government announced a review led by Public Health England (PHE) to analyze how various factors – including obesity, ethnicity and gender – can impact people’s health outcomes from COVID-19. The results are set to be released by the end of this month and use thousands of existing health records for people who have had COVID-19. The government says that this will establish more robust data on the factors impacting the number of cases and health outcomes for different groups within the population.

The review will also match laboratory records of COVID-19 cases to existing health records to draw down accurate data such as ethnicity and describe the association with COVID-19 cases alongside other factors such as sex, age and geographical location. The review will be led by Professor Kevin Fenton, Regional Director of Public Health at PHE and NHS London.

“Having an accurate understanding of how diseases affect different groups of people is a really important issue and a fundamental part of PHE’s role. Detailed and careful work is being done so that we can better understand this and explore the possible reasons for any disparities,” says Fenton. 

Shortly following the launch of this review, it was widely reported that Johnson told senior ministers and advisors that he is preparing a more interventionist drive to tackle obesity as part of the fight against COVID-19. 

“While we welcome the news that Johnson is planning a ‘war on obesity’ after his own battle with coronavirus was exacerbated by him being overweight, this particular public health crisis should have never been taken off the agenda in the first place. Being obese doubles the risk of needing hospital treatment for coronavirus,” says Professor Graham MacGregor from Queen Mary University and Chair of AoS.

A ten-step plan
In light of the imminent review, AoS has proposed a ten-step plan to treat and prevent COVID-19 as it relates to obesity. The treat aspect involves:

1. Providing guidance for identifying modifiable risk factors.
2. Improving understanding of the many causes of obesity.
3. Increasing access and funding for bariatric surgery.
4. Increasing access and funding for evidence-based weight loss support.

Meanwhile, the prevent aspect urges ministers to government commitments to tackle the obesity crisis that the nation faced prior to COVID-19. These include:

1. Ensuring only healthy products are advertised and promoted.
2. Adopting fiscal measures to promote healthy food, with income ring-fenced to subsidize treatments.
3. Making nutrition labeling mandatory.
4. Ensuring all food provided to key workers in their workplaces is healthy.
5. Improving the nutritional profile of processed food and drink.
6. Setting up a new, independent and transparent food watchdog.

“We have seen from the success of the soft drinks industry levy in reducing sugar intakes, that mandatory measures are essential to enforcing reformulation programs and other measures. A new, independent and transparent food watchdog, free from ministerial, industry and other vested-interest influences, should be immediately set up. This will enable them to make clear, independent, evidence-based information widely and freely available while working with technology companies and media outlets to halt the spread of misinformation,” notes Gabriel.

AoS also encourages that UK consumers are aware of their Body Mass Index (BMI) so that they may seek guidance if they are at an increased risk of poor health due to their weight. 

AoS is urging ministers to follow through its commitments to tackle the obesity crisis that the nation faced prior to COVID-19.Unpacking the obesity-mortality connection
According to Gabriel, increasing evidence demonstrates that obesity is an independent risk factor for more severe illness and death from COVID-19. “Data shows that 78 percent of those infected and 62 percent of hospital deaths caused by the virus are in those living with obesity. Linking UK COVID-19 data demonstrates that the more severe the obesity, the more likely people are to be hospitalized for COVID-19 or die from it.”

She continues that other risk factors include age, ethnicity, deprivation, and underlying conditions such as heart or kidney disease and type 1 and type 2 diabetes. “Obesity is the major risk factor that can potentially be modified, meaning millions of people are living with an increased, but preventable, risk from COVID-19,” she adds. 

Indeed, an ongoing prospective observational study – which as of May 22 had recruited over 43,000 UK patients – revealed obesity to be a key factor associated with the need for higher levels of care and higher risk of death in hospital. 

Meanwhile, researchers from Glasgow University – who analyzed data from 428,255 people – found that as BMI increases, so did the risk of having a severe case of COVID-19. “Once BMI or body fat was adjusted for, inflammatory markers were no longer associated with incident COVID-19. This suggests proinflammatory markers, arising from increased adipose deposition, are probably acting as a marker for body fat, which seems to be an adverse risk factor for severe COVID-19,” the scientists write. 

“Furthermore, obesity enhances thrombosis, which is relevant given the association between severe COVID-19 and pro-thrombotic disseminated intravascular coagulation and high rates of venous thromboembolism,” they add. 

To keep readers informed of these rapid developments, NutritionInsight is updating its daily news feed for the coronavirus-related information and insights you need to guide your business through this challenging period.

By Katherine Durrell