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Obesity and Covid-19 - transcript

Aileen McGloin: Hello and welcome to safefood Nutrition podcast. I'm Dr. Aileen McGloin, Director of Marketing and Communications at safefood, the all-island agency promoting food safety and healthy eating.

On this podcast, we talk about nutrition. Issues like obesity, food poverty, sustainability, and health in the media. Today, we look at the link between COVID-19 and obesity and discuss the evidence that obesity increases the risk of poor health outcomes from COVID-19. We look at what this means for patients living with obesity, and question whether obesity has risen on the political agenda as a result.

I'm delighted to be joined by Professor Donal O'Shea, consultant endocrinologist based in St. Vincent's University Hospital and St. Columcille's Hospital. Donal works with the HSE, Healthy Eating Active Living Policy, in the implementation of early interventions and treatments for overweight and obesity - and that's across primary care and acute services for both children and adults.

I'm also joined by Professor Corinna Hawkes, Director for the Centre of Food Policy at City University of London. Corinna is a member of Public Health England's Obesity Reduction and Formulation Reference Group, and the Childhood Obesity Trailblazer Program Steering Group. She's also an advisor to The Food Foundation which advocates for a sustainable food system that delivers health and wellbeing for all. Welcome everybody.

Donal O’ Shea: Hi Aileen, delighted to be here.

Corinna Hawkes: Hello, Aileen, it's great to be here.

Aileen McGloin: You're very welcome. It's great to have you here to chat to us today. And Donal if I could just come to you initially, what evidence is there to suggest that there's a link between COVID-19 and obesity?

Donal O’Shea: Well, thanks for having me, Aileen and for discussing what has become, I think a really important space in our understanding of COVID-19 and our understanding of the effects of obesity. So, at the beginning of the pandemic, there was kind of an indication that there was a link to poor outcome and people who had diabetes or multiple comorbidities. And the initial hint that there was a strong link with obesity came from Wuhan, where the pandemic originated. But it was only when it hit Europe that the strength of the link became apparent and it became apparent from even the general public looking at photographs of people who'd died and you could clearly see the phenotype in a lot of the photographs was of people living with overweight or obesity and in some cases, severe obesity. And initially the thought was “well it's just because there is associated diabetes or associated heart disease”. And then there was a study that came out, it was a meta analysis, 75 studies that showed that obesity itself was associated with an increased likelihood of contracting COVID-19, more likely to go to hospital with this and much more likely to go to ICU with this and require supplemental oxygen and then finally more likely to die. And when you control for all the comorbidities, obesity was one of the strongest independent risk factors for a poor outcome with COVID-19. So, it's clear and it's no longer controversial. It was controversial at the outset.

Aileen McGloin: Absolutely. And beyond the disease severity itself, has the pandemic also impacted on people living with obesity in other ways? So, for example, from an anxiety or mental health perspective, or in their experience of weight bias, dietary behaviour, physical activity, other aspects of the disease.

Donal O’Shea: Certainly, I mean, when the initial association with COVID-19 and poorer common obesity was identified there was a massive, almost surge in fat shaming and certainly a number of the patients attending our service really felt this very personally. Because COVID-19 is like nothing we've ever experienced, as a population. The other risk factors are hidden in many ways, they're not visible. But people living with obesity experience enormous stigma, and this just added to it and their sense of shame, et cetera, was increased which is unfortunately more of the same for people who are living with obesity. And it's incredibly unfortunate.

Aileen McGloin: And did you find then that that maybe in turn impacted on the treatment or management of obesity? Or were there other effects on treatment and management in general?

Donal O’Shea: Yeah, what the lockdown did and kind of having to change behaviour because of COVID-19, what that did to our patients had actually split them in two. So, 50% of our patients found the lockdown helped them address their lifestyle behaviours, allowed them to walk more, allowed them the time to cook and prepare meals. And 50% found the opposite, with the stress they turned towards more comfort food, and motivating themselves to get active, more difficult. So, it was a kind of a 50-50 split in the patients attending our service. They're individuals living with extreme obesity.

I think the other issue that raised its head when it came to discussing the issue of obesity and COVID-19, was the issue of vaccination. And would individuals living with obesity respond to the vaccine the same way because there's evidence from other viral illnesses where that isn't the case. The good news is that from the studies published so far people with obesity are responding as well as people without obesity. And that's very positive. And the other thing I think is this kind of long post COVID syndrome and this tendency to represent with a pulmonary embolism or pericarditis, six, eight weeks down the line, we have yet to look in our cohort as to whether living with obesity is associated with that long COVID or that sting in the tail that we're seeing with COVID.

Aileen McGloin: And moving this to policy level Donal, what are the current challenges faced in addressing obesity at a policy level in Ireland?

Donal O’Shea: COVID is the greatest disruptor that I have seen in 25 years in the Irish health care system. I think COVID-19 will be responsible for an acceleration of all the policies in relation to preventing obesity in children, managing obesity in children and the same in adults. And we're, already seeing that. I've got to sit with the kind of key people more readily in processing the estimates for next year’s spending on obesity in the last three months than in the years leading up to it. And there is an appetite now for an end to end childhood obesity strategy and actively managing overweight and obesity in adults that was never there before. It's in the HSE corporate plan for the next few years and it got an advanced position, it’s kind of weaselled its way into the corporate plan, and I thought with COVID-19, it's going to disappear. Its time has not come. But actually the opposite has appears to have happened, I suppose time will tell, but I'm very optimistic that COVID-19 is going to be that unexpected lever for delivering policy change for the obesogenic environment and for individuals who are living with obesity.

Aileen McGloin: And Corinna, I'm going to bring you in here because there's been quite a lot of progress in the UK on this issue. Can you shed some light for us, for our audiences on the UK's approach to tackling obesity during the COVID-19 pandemic?

Corinna Hawkes: Sure, yes. It's wonderful to be here. Thanks so much for inviting me to be part of this conversation. In the UK, obesity has been taken a lot more seriously than it had been previously. Policy in obesity is often a very political area and measures which are associated with, how can I say, perhaps imposing or intervening in various ways are not traditionally associated with the political stripe of our current leadership. And so, it was an interesting development that because of the relationship between COVID and obesity had already been set out, that our current government started to take, I mean, the politicians started to take obesity much more seriously. There has been a longstanding effort in this country and by the civil servants, in the Department of Health and Social Care to deliver action on obesity. And suddenly they found their work and their own engagement being taken much more seriously by politicians and in July, 2020 an revised obesity strategy was released by the government.

Aileen McGloin: And can I ask, has Prime Minister Johnson's own experience with the virus influenced this change?

Corinna Hawkes: Yes, it has been the major reason for the change. Obviously, I haven't spoken to him personally but there is absolutely no question. And this has been stated, he believes that the fact that he had COVID much more seriously than others in a similar position, he believes that when he was told by his doctors that this could be because of his own weight status. And therefore, he kind of underwent a conversion of not really believing that this was anything other than a personal issue to something that he as a politician had a responsibility to address.

Aileen McGloin: And do you think that the new approach will have an impact on obesity and its associated outcomes?

Corinna Hawkes: I think this strategy that was released and the new policies that will be enacted as a result of that will do some good, they will have positive impacts. There's going to be calorie labelling on out-of-home. There's a new campaign that's going on at the moment through our broadcast channels and beyond. There's going to be some restrictions on online advertising, there's going to be more weight management programs. There's going to be fewer promotions in supermarkets. All of these things will collectively have some positive impact. However, it's still not going nearly far enough. So, for me, the question is, will the increased capacity of government to deal with this issue - will that make a difference? Because that's another thing that has happened - during COVID originally the obesity team was stripped back. I mean, there was like one person left and everybody was taken out, quite understandably for good reason. But even though COVID continues to be an extremely serious problem in this country at the moment they are loading up the obesity team in the civil service. So if that is maintained and if there is more capacity and more focus and more political support then I think gradually that could have the impact of this issue being taken much more seriously and more sustainably which will then build up to have impact.

Aileen McGloin: You wanted to come in there, Donal.

Donal O’Shea: You know, at the time that Prime Minister Johnson contracted COVID there was this very kind of powerful image of himself and I think Whitty the Chief Medical Officer and Hancock the Minister for Health all kind of tested positive within a couple of days. And the Prime Minister was the only one who ended up in hospital. And it was a very strong visual representation of what the papers were indicating. A lot of times politicians don't take a leadership stance based on a personal experience like that and that has been a big hindrance for obesity policy implementation over the years, and a lot of the healthcare systems. So, it was a really positive thing to come out of it, and it's lovely to see political leadership having an impact like that in a positive way at such a difficult time.

Corinna Hawkes: Yeah, I mean, it was an interesting development in the sense that politicians can either say, "Well, I was speaking to my daughter the other day, I was speaking to a friend and they said this and therefore, that's what I think." It becomes a very kind of a non-evidence-based situation of just having a view that isn’t particularly well-informed. Or on the other hand, you have politicians who experienced and are affected by obesity who’ll say, "Well don't look at me, you know, I'm a bad example. I can't do anything about it." And it was neither of those things. So, I think it was an interesting development for sure.

Aileen McGloin: And COVID has obviously had a severe social and economic impact, whether you're talking about mental health or poverty or unemployment. And do you feel, both of you, that current policies on obesity adequately address these issues? The social and economic issues surrounding obesity?

Corinna Hawkes: Well, if I can come to that, first the answer is absolutely not. I have made this point to our government and they don't disagree, but it's like they don't quite know what to do about it. But there is a complete disconnect between the very clear data showing that obesity is disproportionately experienced by those living in situations of deprivation and actually the policy response. So, the policy response we tend to see comes from our Department of Health. That's great, they should be doing that. But the work that needs to be also done by other departments responsible for supporting people who experienced poverty and deprivation - there's a complete disconnect. And what happens as a result of that and this has happened during COVID is that there was one response to deal with food insecurity. So it means that people have experienced food insecurity, their kids aren't getting access to food, they're missing meals, they're experiencing even worse situations because of joblessness, loss of income, working three jobs and not being able to serve your kids. All of these issues which have led to this enormous campaign spearheaded by the footballer Marcus Rashford here. And that is disconnected from the conversation going on about obesity. And I think that is a real problem because at the end of the day, healthy good food for all is very important for making sure that food insecurity isn't a problem. And it's very important to ensure that obesity is not a problem. So, I think there's a disconnect in government, but I also think there's a disconnect out of government on that too.

Donal O’Shea: You know I've heard discussions about the childhood obesity strategy should be kind of piloted in Ireland and they're targeting areas of socioeconomic deprivation to start in. But the people in those areas are saying, "We don't want a middle-class people coming in to tell us what to do right. You know, we need to make change from within and the environment needs to change above that to support it." But it's the same, the socioeconomic kind of distribution for childhood overweight and obesity is a postcode distribution that's entirely predictable. It's very hard to design a solution that will kind of fix that. It's a massive challenge.

Aileen McGloin: And if I could go back Donal to your description of the pandemic as kind of a trigger, was that the word you used? Or a kind of an impetus - a disruptor?

Donal O’Shea: Disruptor, a disruptor

Aileen McGloin: Yes exactly. And can any of that be harnessed to address the issues you've discussed there? Or other issues like how obesity is prevented or managed?

Donal O’Shea: Well I mean, I think it has to be because I think everyone is accepting that first of all there's going to be a tail longer than we anticipated in the COVID-19 situation. Secondly, we're not sure, is COVID-19 going to be like a flu and an annual thing? This year we did not have a flu season because of all the measures that were taken for COVID-19. And if we'd had a flu season plus COVID-19 in the last eight weeks in Ireland or in Britain, oh, that combination! And it would have been a tsunami as opposed to a wave that we’ve just about weathered in Ireland. So, I think we have to use the experience of the distribution of COVID-19 to redouble the efforts to address that socioeconomic divide. And you have to put a long-term lens on - it's not going to be a this year fix or a five-year time fix. If all went really well with the policy change it would be a 15-year turnaround and governments find that timeframe unappetising. They need to show a change in the next term. But short-term, they're not built to last.

Aileen McGloin: And, I suppose a blue-sky question just to finish off the interviews with you both. If you could change one thing in terms of policy now, what would that be? What would be the first thing? The most important thing that you think needs to happen?

Corinna Hawkes: Well, it's a hard one to answer and you're probably expecting me to say that. And I would love it if children could go back to school and be in a situation where everything about their school day promoted positive feelings about food and physical activity and health. And I'd love to see, I'm not saying one thing so I'm not answering your question, but I also am a strong advocate of comprehensive restrictions on the marketing of unhealthy foods to children. But in answer to your question if there's one thing that I'd like to see differently, I would actually like to see the policy-making process done differently. And by going into communities that are disproportionately affected by obesity and who are continuing to be so and even worsened by COVID-19. As was mentioned earlier there were some groups who have been affected much more detrimentally than others. And actually, talking to those communities about their experiences and from that identifying what will really work in those communities to address this problem.

Aileen McGloin: Donal, did you want to come in?

Donal O’Shea: Yeah, I mean, and just to add, and I know it was implicit in what Corinna was saying about the physical activity and health environment for children in school. I would name-check body image so that positivity would be around body image as well because that's such a source of discontent in that schoolgoing age group. And if we could move away from the body perfect, that is represented in all the magazines and the pop charts, it would be just a positive. For me the one thing that I'm going to say apart from enacting the entire obesity policy and action plan that the government have set out, but if there was one thing for me it would be treating obesity as the disease it is. In every other disease we've managed to start by treating the extreme end. So, you don't treat skin cancer by telling somebody to put on sun cream and wear a hat. You treat skin cancer by treating skin cancer. At the moment, we're still telling in Ireland people who are living with obesity to eat less and move more, that is not the treatment of obesity. And the minute we move to treating obesity as a disease, with medication and the surgery that will reverse their diabetes and save us money, the minute you do that, then everything in the preventive space will filter back from it. So, your smoking sensation programs filter back from your lung cancer treatment and heart bypass programs. And so for me, and I think we're within touching distance of getting our treatment of obesity, if you like, brought up to just a European norm, that's all we want, at the moment we're just not treating it almost at all. And if that happens, then I think the filter back things will happen and the policy change ultimately will happen. And we will be in a better place.

Aileen McGloin: Thank you. And thank you both so much for participating in this conversation this afternoon. Your insight has just been fascinating. Really appreciate your contribution. Thank you.

Corinna Hawkes: Thank you very much, great to be part of it, thank you.

Donal O’Shea: Aileen, I really enjoyed the chat, thank you.

Aileen McGloin: Well, I think we'll end it there. Thanks to our guests, Donal and Corinna for sharing their knowledge and experience.

And thanks to you for tuning in. Please do get in touch. Send us your questions or thoughts to [email protected]. And if you want to hear more from us search safefood podcasts, wherever you get your podcasts. You can also join the conversation on Twitter by following @safefoodnetwork and follow us on LinkedIn.

Until next time, goodbye and take care.

Relevant literature

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

Tackling obesity: empowering adults and children to live healthier lives 

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