University of Sydney academics respond to the relationship between obesity and COVID-19

A number of University of Sydney academics have responded to the UK government's Better Health campaign to address obesity following UK Prime Minister Boris Johnson's revelation of his own "wake up call" when told his weight may have impacted the severity of his COVID-19 symptoms.

Obesity and COVID-19
Professor Luigi Fontana from the University of Sydney’s Charles Perkins Centre and Sydney Medical School (Central Clinical School) says there is some data suggesting a link between obesity with poor COVID-19 outcomes.

Prof Fontana notes “Two in three Australians are overweight or obese, a condition that markedly increases the risk of being admitted to intensive care and having poorer outcomes, including higher mortality, when infected with COVID-19.

“Accumulating data strongly suggest that a reversible damage of the inner lining of the arteries (endothelial dysfunction), driven primarily by insulin resistance, and not obesity itself, is the main element linking being obesity with poor COVID outcomes.

“Our studies show that even small amount of caloric restriction, especially when combined with regular endurance exercise, can drastically and rapidly improve insulin sensitivity, lipid profile, blood pressure and reduce inflammation and oxidative stress.

“These simple interventions might provide a way forward for reducing risk of hospitalisation and death for the large number of at-risk overweight and obese men and women with insulin resistance and endothelial dysfunction.”

Masks and social-distancing more effective
Charles Perkins Centre Epidemiologist, Emeritus Professor Adrian Bauman says a social distancing and people wearing masks are a more effective method of COVID-19 prevention than an obesity campaign.

Emeritus Professor Bauman advises “Government mass media campaigns that are ‘suddenly’ launched to address long-term problems are seldom successful.

“The most useful approach for campaigns is being part of a well-developed system-wide (whole of society) approach to problems like obesity, with all relevant sectors partnering together, and having coordinated actions beyond just ‘awareness raising campaigns’.

“There are a few concerns with the current multi million-pound obesity campaign proposed for the UK:

• a campaign alone won’t achieve population weight loss

• effective weight loss is a slow process, not achievable for the whole community in a few months [we have been trying for years]

• COVID-19 prevention would be much better served by everyone wearing masks and social distancing, than by weight loss; even if infected with COVID-19, some risk is present for obesity or smoking, but even greater risk for those with established chronic disease or the immunocompromised or, above all, the elderly.”

Obesity and stigma
Professor William Bellew from the University of Sydney School of Public Health and Charles Perkins Centre says there needs to be more action to improve the consequences of weight stigmatisation.

Prof Bellew adds “mass media – including news, movies and television, and social media – can be part of the weight stigma problem. Media can increase weight stigmatisation through overrepresentation of thin and underweight individuals, underrepresentation of individuals with obesity, and by portraying people with obesity in a stigmatising or negative light.

“There needs to be more in-depth research on weight stigma and bias – but we need to take action now to improve understanding and prevent the consequences of weight stigmatisation on individuals.

“We recently reviewed existing research on weight bias and stigma and found:

• Children and adults who experience weight stigma are vulnerable to numerous consequences affecting their psychological and physical health

• Psychological consequences include increased risk of depression, anxiety, low self-esteem, poor body image, substance abuse, and suicidal thoughts and behaviours

• Adverse health outcomes which result from peoples experience of weight stigma can reduce quality of life and pose major obstacles to efforts to prevent and treat obesity effectively.”

The problem (and solution) lies in food environments
Professor David Raubenheimer, Leonard P Ullman Chair in Nutritional Ecology and Nutrition Theme Leader at the Charles Perkins Centre contributes “Obesity and associated metabolic disease are driven by unhealthy food environments.

“The common factor that links food environments to obesity globally is industrially manufactured ultra-processed foods, high in energy and low in nutrients.

“Now contributing 50% on average to Australian diets, ultra-processed foods have displaced healthy whole foods. These are designed to hijack human appetites causing over-consumption and the mechanisms through which they do this are understood.”   

Junk food and children
Professor Louise, Baur Head of Child & Adolescent Health at the University of Sydney advises “There’s a reason why so many junk food ads are directed towards children, young people and their families – they work in selling those products!

“It’s encouraging to see that the UK is planning to ban TV and online ads for junk food ads before 9pm. That way parents can have more control over what their children eat. It will take the unhelpful ‘third parent’ out of the house and give the children back to their own parents.

“People who struggle with excess weight know it can be very difficult to lose that extra weight on their own. Getting support from a well-trained health professional is vital for anyone seeking treatment for their obesity. The UK plans to ramp up clinical services for such people, a very welcome initiative.”

Coordinated and sustained investment and action to make a difference
Tiffany Petre, Director of the Obesity Collective, based at the University of Sydney Charles Perkins Centre notes “the new UK Obesity Strategy is a step in the right direction because it includes considerable investments into both prevention measures and expanded NHS treatment and care services for those already living with obesity.

“It is important to remember that obesity is a systems challenge where we will need coordinated and sustained action across society. It is not only about personal responsibility and behaviour change, there are also strong social, genetic, biological and environmental influences outside of people’s control.

“There is much more that needs to be done to take on the challenge of obesity on a community level, but the UK strategy is a good start. The developing Australian National Obesity Strategy is currently on hold but when finalised it will also need to have tangible action and investments in prevention and treatment of obesity to make a difference.”

The Obesity Collective is a charity platform for committed individuals and organisations from across the community to take on the obesity challenge together, with empathy and a whole of society perspective.