As evidence mounts that overweight and obese people are at much greater risk of developing life threatening COVID-19 consequences, public health experts have called on manufacturers to stop promoting the consumption of calorie laden food and drinks.

Writing in the BMJ, scientists at the Wolfson Institute of Preventive Medicine, part of Queen Mary University of London in the United Kingdom, argue that COVID-19 is “yet one more health problem exacerbated by the obesity pandemic.”

In an editorial, they cite evidence that people who are overweight or obese are much more likely to develop severe infections of SARS-CoV-2, the virus that causes COVID-19.

One study found that even after taking into account factors such as age, sex, ethnicity, and social deprivation, being overweight increased the relative risk of developing a life threatening infection by 44%. Being obese increased the relative risk by 97%.

“It is now clear that the food industry shares the blame not only for the obesity pandemic but also for the severity of COVID-19 disease and its devastating consequences,” write Ph.D. researcher Monique Tan, and professors Feng J. He, and Graham A. MacGregor in the editorial.

Perfect storm

Worldwide, more than 1.9 billion adults were overweight or obese in 2016, and that number is increasing rapidly. Latest figures show that the prevalence of overweight and obesity among adults has reached 64% in the U.K. and 72% in the United States.

Health experts recognize obesity as a significant risk factor for high blood pressure, type 2 diabetes, heart disease, stroke, and cancer.

In their editorial, the scientists write that several different mechanisms could account for the increased severity of COVID-19 among overweight and obese people.

For example, people with obesity have more angiotensin converting enzyme-2 (ACE-2), the membrane-bound enzyme that the virus uses to gain entry to cells.

Whether this fact is due to their fat cells producing more of the enzyme, or simply due to having more adipose, or fat storage, tissue, is not yet clear.

“The adipose tissue of people with obesity may, therefore, be a potential target and viral reservoir for SARS-CoV-2 before it spreads to other organs, as has proved to be the case for other viruses,” the scientists write.

The high blood pressure, high cholesterol levels, and diabetes that doctors associate with obesity are also suspects in making people with COVID-19 more susceptible to the infection.

In addition, it could increase the likelihood of the excessive innate immune response or “cytokine storm” that causes damage to the lungs and other organs of critically ill patients.

On top of this, obesity creates greater resistance in patients’ airways, making it more difficult to expand their lungs and, thus, reducing lung function.

Call for action

The Wolfson Institute scientists demand that there is now tougher action to combat obesity.

“Food industries around the world must immediately stop promoting, and governments must force reformulation of unhealthy foods and drinks,” they write.

They accuse some food manufacturers of “thinly veiled tactics, using the outbreak as a marketing opportunity.”

As an example, they cite Krispy Kreme’s Serving Smiles initiative in the U.K., which involved donating half a million doughnuts to “the amazing heroes working so hard in the battle against COVID-19,” including those working in hospitals.

The authors claim governments have not done enough to tackle obesity in their populations, with the exception of taxes on sugary drinks that some countries, such as the U.K., have imposed.

“The obesity pandemic is the result of living in food environments where it is difficult not to overconsume calories. The global food industry produces and extensively promotes cheap, sugar sweetened beverages and ultraprocessed foods high in salt, sugar, and saturated fat that provide only a transient sensation of fullness.”

–Monique Tan et al., BMJ

Vicious circle

The authors are particularly concerned that the COVID-19 pandemic has limited some people’s access to fresh foods due to increased food poverty, disruptions to supply chains, and panic buying.

This may have increased their consumption of highly processed foods and those with long shelf lives, which are often high in salt, sugar, and saturated fat.

“Reducing salt, sugar, and saturated fat across the board would improve the diet of the entire population and bring even greater benefits for people who are most socially deprived,” they conclude.

“The toll of morbidity and mortality from COVID-19 has made this more apparent and more urgent than ever.”

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