The UK government has announced its new obesity strategy linking it to “beating coronavirus”.
It includes plans on banning TV and online adverts and ending “buy one get one free” promotion deals for high salt, sugar and fat foods, and calorie labelling on restaurant menus.
These are important actions if implemented, several of which were listed in the 2018 Childhood Obesity Chapter 2 plan for action.
A new national campaign focusing on individual behaviour, called Better Health, has also just been launched by Public Health England (PHE) accompanying the government’s recent strategy, working with commercial partners such as Weight Watchers and Slimming World.
The campaign aims to support people to ”eat better, drink less alcohol and get active”, including access to mobile phone apps. I strongly welcome the fact that actions on obesity are back on the political agenda, particularly the system-based ones.
However, I am concerned about linking these actions to the fight against the viral pandemic.
Both the obesity strategy and the Better Health campaign use insights from the recently published PHE report to justify the link.
The report sights evidence that people who are obese are more likely to be hospitalised, get admitted to intensive care and die from Covid-19.
However, the available evidence establishes an association but falls short of confirming that obesity causes more severe Covid-19 disease.
It is understandable, given that we have only known the virus for a few months, that there is no available research on the impact of weight loss on the severity of the infection. We do know, however, that weight loss has many other proven health advantages and reduces the chance of premature death.
Obesity is much more common in people who suffer from multiple disadvantage and poverty. The same PHE report quotes an obesity prevalence of 35% (men) and 37% (women) in people living in the most deprived neighbourhoods, compared to around 20% in the least deprived. We already know that people in the most deprived groups are more than twice as likely to die from Covid-19 than those in the least deprived. We also know that people from ethnic minorities in the UK tend to suffer more from both poverty and obesity, and more likely to die from Covid-19, compared to people of white ethnicity.
“This narrative of losing weight to beat coronavirus can easily turn into victim-blaming.”
The type of data we have, and analysis done on them so far, limit our ability to establish causality of these various co-existing risk factors and ascertain which one contributes the most to the risk of severity and death from Covid-19.
Covid-19 is an infectious disease and the risk of getting it is determined by how much of the virus is circulating in the community more than anything else.
Therefore, fighting it primarily means controlling the spread and transmission of the virus, and very quickly detecting and isolating cases.
Obesity on the other hand is a structural problem in society. This basically means that it is largely determined by people’s environment and resources.
If you are poor, it is much harder to maintain a healthy weight due to the many barriers imposed by your environment and available resources.
Analysis by the Food Foundation found that over a quarter of UK households would need to spend more than a quarter of their disposable income after housing costs to meet the government’s healthy eating guide.
For the 10% lowest income households, almost three quarters of disposable income is needed to meet this guide. A health promotion campaign, a weight loss app or even banning adverts and promotion deals will not help these households afford a healthy diet. However initiatives such as subsidising the price of fruit and vegetables potentially can, and may lead to significant health benefits and healthcare cost savings.
Population-level action on obesity is very much needed, but it is a long haul of systems-wide change and must not be linked to the fight against Covid-19. This can potentially lead to further stigma of already disadvantaged people. This narrative of losing weight to beat coronavirus can easily turn into victim-blaming. If it is necessary to link it as a “wake-up call” then the same should apply for action on poverty right from the start of life, given the pre-pandemic status of almost one in three children in the UK living in poverty. Those who live with multiple disadvantage are most vulnerable to getting Covid-19 and getting it badly. These are the same groups vulnerable to many other health problems.
Singling out a consequence such as obesity as a solution to the pandemic is not the way to go. We must address the root of the problem; lifecourse inequalities in opportunity and resources. The PHE report on excess weight and Covid-19 concludes that “factors such as deprivation are complex to address”. I would argue that the time to start addressing this challenge is now, otherwise we are only just scratching the surface.
Dr Nisreen Alwan is an Associate Professor in Public Health at the University of Southampton.