by Marion Nestle

Currently browsing posts about: Obesity

Mar 30 2021

One picture….

Mar 17 2021

Overweight is a major risk factor for Covid-19 hospitalization and death

I was struck by headlines last week stating that a CDC study found that 78% of people hospitalized with Covid-19 were overweight or obese.

78%?  That is an enormous percentage.

I looked up the study: Body “Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020.”

Summary

What is already known about this topic?

Obesity increases the risk for severe COVID-19–associated illness.

What is added by this report?

Among 148,494 U.S. adults with COVID-19, a nonlinear relationship was found between body mass index (BMI) and COVID-19 severity, with lowest risks at BMIs near the threshold between healthy weight and overweight in most instances, then increasing with higher BMI. Overweight and obesity were risk factors for invasive mechanical ventilation. Obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years.

What are the implications for public health practice?

These findings highlight clinical and public health implications of higher BMIs, including the need for intensive management of COVID-19–associated illness, continued vaccine prioritization and masking, and policies to support healthy behaviors.

The data supporting the headline are found in Table 1 in the paper.  This shows that overweight and obesity do indeed account for 78% of hospitalizations, but also close to that percentage for ICU visits and mechanical ventilation, but “only” 73% of deaths.

Overweight and obesity were especially risky for people under age 65, although they caused plenty of problems for people over age 65 too.

Why do they make Covid-19 worse?  The best guesses have to do with inflammation and mechanical pressure on lungs.

I found these figures shockingly high.

Shouldn’t we be doing all we can to reduce the risks for overweight and obesity?  Yes we should.

And what are those risks?

  • Poverty
  • Racial discrimination
  • Inadequate schools
  • Unemployment
  • Lack of adequate health care
  • Air pollution
  • And, of course, poor diets

If Covid-19 has taught us anything, it is that to prevent its bad effects, we need vaccinations and masking for sure, but we also need to change society.

 

Feb 19 2021

Weekend reading: Fat Justice

Aubrey Gordon.  What We Don’t Talk About When We Talk About Fat.  Beacon Press. 2020.

I didn’t think I’d want to read or write about this book but I couldn’t put it down and ended up doing a blurb for it:

In What We Talk About, Audrey Gordon gives us an authoritative, forceful, splendidly written, and deeply moving account of the shockingly personal hostility she and other fat people must endure on a daily basis.  You don’t have to agree with her interpretation of the research on fatness and its consequences to sign on to her thoroughly convincing demand for respect as a human being and for what she calls “fat justice.”  This book changed my thinking, and in the best possible way.

Here are two short excerpts:

While these [other fat activist] approaches work for many, I describe mine as work for fat justice.  Body positivity has shown me that our work for liberations must explicitly name fatness as its battlground—because when we don’t, each of us are likely to fall back on our deep-seated, faulty cultural beliefs about fatness and fat people, claiming to stand for “all bodies” while we implicitly and explicitly exclude the fattest among us.  I yearn for more than neutrality, acceptance, and tolerance—all of which strike me as a meek plea to simply stop harming us, rather than asking for help in healing that harm or requesting that each of us unearth and examine our existing biases against fat people (p. 6)

But the first step for all of us will be to let go of the magical thinking of thinness.  Stop believing that a thinner body will bring us better relationships, dream jobs, obedient children, beautiful homes.  Stop waiting to do the things we love until we’ve lost ten, twenty, fifty, one hundred pounds.  Come to truly believe what we already know, and what so much data tells us: the vast majority of us don’t lose significant amounts of weight and the few who do don’t maintain weight loss in the long term.  Nearly twenty years of dieting has shown me that I will never be thin….I also believe that my life is worth living, worth embracing, worth loving, and celebrating.  And it’s worth all of that now—not two hundred pounds from now (p. 161).

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Jan 14 2021

Pet Parents: Go easy on “Treat Love.”

I subscribe to Obesity and Energetics Offerings because it’s a great way to keep up with current research and commentary on just about anything related to diet and activity.

One of the things I particularly like about it is its section called “Headline vs Study.”

Here is its most recent example:

The headline, from Pet Food Industry magazine (an  unusually well written and edited source of information about this industry), refers to a survey of veterinarians done by Hill’s Pet Nutrition, a maker of pet foods.

According to veterinarians, more than 71% of pet professionals say the pandemic has impacted the way pets eat…Since the start of Covid-19, one third (33%) of pet parents with an overweight pet say their pet became overweight during the pandemic…veterinarians state that only 12% of pet parents proactively flag concerns with their pet’s weight. Moreover, nearly two in three veterinarians say pet parents act surprised (64%) or defensive (64%) upon learning about their pet’s weight issues.

Pet parents?  You know who you are.

What is this about?

IRONICALLY, TOO MUCH “TREAT LOVE” DURING THESE DIFFICULT TIMES IS THE MAIN CULPRIT.

Treats, as Mal Nesheim and I explain in our book about the pet food industry, Feed Your Pet Righthave calories, and those calories—just like the ones from any snack—add up.

Obesity in pets does just what it does in humans; it raises the risk of chronic disease, especially type-2 diabetes

A new study just out in the BMJ, which compared obesity in dogs to that of their owners, says:

Data indicated that owners of a dog with diabetes were more likely to develop type 2 diabetes during follow-up than owners of a dog without diabetes. It is possible that dogs with diabetes could serve as a sentinel for shared diabetogenic health behaviours and environmental exposures.

Pet parents: Walk those dogs!  Love them some other way!

 

Nov 25 2020

The State of Obesity, 2020: no downturn in prevalence

Trust for America’s Health has just issued its annual report on obesity in America.

The full report is here.

The results are truly alarming, especially because obesity—and the conditions for which it increases risk—also increase the risk of poor Covid-19 outcome.

The U.S. adult obesity rate stands at 42.4 percent, the first time the national rate has passed the 40 percent mark, and further evidence of the country’s obesity crisis. The national adult obesity rate has increased by 26 percent since 2008…Rates of childhood obesity are also increasing with the latest data showing that 19.3 percent of U.S. young people, ages 2 to 19, have obesity. In the mid-1970s, 5.5 percent of young people had obesity.

The report has a special section on the link between food insecurity and obesity.

Food insecurity and obesity have many of the same risk factors (e.g., income or race/ethnicity) and often coexist in populations. Researchers have hypothesized several mechanisms for how food insecurity might lead to obesity. These include the direct limitations to a healthy diet that come from inadequate food affordability and/or availability; stress and anxiety about food insecurity
that generate higher levels of stress hormones, which heighten appetite; and a physiological response in which the body stores higher fat amounts in response to reduced food availability.

As always, this is a terrific source of current information about America’s increasingly prevalent health problem and what’s being done—and needs to be done—to solve it.

Sep 11 2020

Weekend reading: Fat in the Fifties

Nicolas Rasmussen.  Fat in the Fifties: America’s First Obesity Crisis.  Johns Hopkins University Press, 2019.  

Fat in the Fifties: America's First Obesity Crisis: 9781421428710: Medicine  & Health Science Books @ Amazon.com

I wrote a blurb for this book:

Fat in the Fifties is a riveting analysis of the rise and fall of early concerns about the health consequences of obesity.  Rasmussen’s history is indispensable for understanding the social, psychological, political, and environmental origins of today’s obesity “crisis.”

Even though the prevalence of obesity was quite low—by current standards—in the 1950s, Rasmussen documents widespread professional and public concern.  These concerns drifted away in the 1960s and 1970s, overtaken by efforts to prevent coronary heart disease, the leading cause of death.   At the time, obesity did not seem to be an important coronary risk factor.  Rasmussen explains how all this happened, and does it well.

I had a personal interest in this book.  My father died of a heart attack in 1950—at age 47.  It was no coincidence that he was also an extremely overweight chain smoker.  Rasmussen’s book provides the context for this particularly tragic aspect of my family history and I found his analysis helpful.

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Apr 17 2020

Weekend reading: research on coronavirus and food

Research on this virus (officially SARS CoV-2, commonly COVID-19) is pouring out and filling every medical journal I typically read.  Here are a few recent articles on food-related aspects (some of these are not yet in print).

Obesity and its Implications for COVID-19 Mortality: The authors argue that the increased prevalence of obesity in Italy older adults as compared to its prevalence in China may account for the higher mortality observed in Italy.

Obesity is associated with decreased expiratory reserve volume, functional capacity and respiratory system compliance. In patients with increased abdominal obesity, pulmonary function is further compromised in supine patients by decreased aphragmatic excursion, making ventilation more difficult. Furthermore, increased inflammatory cytokines associated with obesity may contribute to the increased morbidity associated with obesity in COVID-19 infections.

Sudden and Complete Olfactory Loss Function as a Possible Symptom of COVID-19: This is a case study of a patient infected by SARS-CoV-2 whose presenting symptom was the sudden and complete loss of the ability to smell.

Loss of smell and taste in combination with other symptoms is a strong predictor of COVID-19 infection:  “Our study suggests that loss of taste and smell is a strong predictor of having been infected by the COVID-19 virus. Also, the combination of symptoms that could be used to identify and isolate individuals includes anosmia, fever, persistent cough, diarrhoea, fatigue, abdominal pain and loss of appetite.”

COVID‐19 Related School Closings and Risk of Weight Gain Among Children:  “In short, we anticipate that the COVID‐19 pandemic will likely double out‐of‐school time this year for many children in the U.S. and will exacerbate the risk factors for weight gain associated with summer recess.”

Should COVID-19 Concern Nephrologists?  Why and to What Extent? The Emerging Impasse of Angiotensin Blockade:  This is the easiest-to-understand review of the science of this extensively studied virus I have been able to find.  It covers the basics along with detailed explanations of what this virus does, how it works, and where vaccines might operate.    To penetrate human cells, this virus seems to hijack a particular enzyme in the complicated renin-angiotensin system that regulates body fluid balance and blood pressure.

Despite these differences, several studies have reported that SARS-CoV-2 exploits the same membrane-bound angiotensin-converting enzyme 2 (ACE2) as SARS-CoV to gain access to its target cells, although it has greater binding affinity. ACE2 is a carboxypeptidase that preferentially removes carboxy-terminal hydrophobic or basic amino acids. ACE2 cleaves a single residue from angiotensin I (Ang I), generating Ang 1–9, and a single residue from angiotensin II (Ang II) to generate Ang 1–7, whose vasodilator, anti-proliferative, and anti-fibrotic functional effects oppose those of the Ang II generated by angiotensin converting enzyme (ACE).

Oct 15 2019

World Obesity: Three More Reports

Friday October 11 was World Obesity Day, which explains why so many groups are issuing reports on obesity prevalence, risks, costs, and prevention strategies.

I wrote about the one from the Trust for America’s Health, The State of Obesity, a few weeks ago.

Here are three more, just in.

1.  The Heavy Burden of Obesity: The Economics of Prevention.

This one was produced by the OECD (Organisation for Economic Co-operation and Development).  It finds: “Almost one in four people in OECD countries is currently obese. This epidemic has far-reaching consequences for individuals, society and the economy. Using microsimulation modelling, this book analyses the burden of obesity and overweight in 52 countries (including OECD, European Union and G20 countries), showing how overweight reduces life expectancy, increases healthcare costs, decreases workers’ productivity and lowers GDP.”

2.  Time to Solve Childhood Obesity   This is “An Independent Report by the Chief Medical Officer, 2019, Professor Dame Sally Davies in the U.K.  The cover deals with both cause and effect:

3.  State of Childhood Obesity: Helping All Children Grow Up Healthy.  The Robert Wood Johnson produced this one.

Its key findings:

  • Obesity rates for youth ages 10 to 17 did not change much from 2016 (15%-16%).
  • Racial and ethnic disparities persist as do disparities by income.
  • Mississippi had the highest overall youth obesity rate (25.4%); Utah had the lowest (8.7%).

Comment:  Obesity is a global problem, not just one for the U.S.  Plenty of policies exist that could help make healthier food choices easier and less expensive.  But as the Lancet Global Syndemic report so clearly explained, doing something about obesity is hampered by weak (corporate-captured) government, food industry opposition, and weak civil society.  The first two are difficult to do anything about without attention to the third.  The clear need: strengthen civil society.  Let’s get to work on that.