“A key point is that we want to make sure that people know that as your numbers of underlying medical conditions increase, your risk of severe illness from COVID also increases.”—CDC Director, Dr. Robert Redfield.
Recently, we learned from the CDC that, for 6% of the deaths in the U.S. involving COVID-19, the virus was the only cause listed. They reported that “on average, there were 2.6 additional conditions or causes per death.”1 This presented an opportunity for many to discount the efforts to curtail the spread of the virus. Moreover, it fueled political finger-pointing. I found interest in the disclosure because it supported the narrative I have been proposing for some time. I don’t see this as discounting the impact of the virus (though I do think the response has been largely mismanaged). Instead, I think it directs attention to the importance of preexisting conditions. I especially think it highlights the impact of obesity on the health and welfare of the U.S. population.
Of the 161,392 reported COVID-19 deaths (as of 8/22/2020), 5,614 (3.5%) included obesity as a contributing cause.1 Obesity is a central factor in metabolic syndrome (the concurrence of high triglycerides, hypertension, and hyperlipidemia). In addition, roughly 1/3rd of Americans are obese (2/3rds are overfat). Diabetes is listed as a contributing cause of death in 25,936 (16.1%) of COVID-19 cases. In addition, circulatory diseases such as hypertension, ischemic heart disease, cardiac arrest, cardiac arrhythmia, heart failure, cerebrovascular diseases, and other diseases of the circulatory system, were listed as contributing factors in 35,272 (22%), 18,103 (11.2%), 20,210 (12.5%), 9,812 (6.1%), 10,562 (6.5%), 7,653 (4.7%), 8,743 (5.4%) cases, respectively. It is well known that obesity and inactivity are risk factors for these, as well as numerous other conditions.
While COVID-19 is, indeed, serious, and age and other non-hypokinetic diseases are contributing to deaths and the severity of the illness, I, personally, think that the response to COVID-19 has be mismanaged (maybe too harsh a term, but…). The approach has largely been to shut down schools and businesses, issue stay-at-home orders, require masks, and demand social distancing (defined as 6 feet). While these were well-intended efforts to “flatten the curve”, to lessen the burden on hospitals during the initial spread of the virus, and, moreover, to protect the health of the most vulnerable, they were arguably ineffective compared to the disruptions they caused. Moreover, the emphasis was always on the virus—treatment and finding a cure/vaccine. Billions are being spent in this arena.
I believe it is unfortunate that health care in the U.S. tends to be focused on the treatment of symptoms rather than the underlying causes. Of course, there is far more money to be made in pharmaceuticals than in preventative health care—e.g., diet and exercise. I believe, however, that there can be billions of dollars saved in health care, if on average the American adult lost (and maintained the loss) an average of 20 pounds of body fat. This should not be construed as “fat-shaming”. Rather, it should be a plea for a healthier America. It is not about appearances. It is life and death.
COVID-19 is serious. It is the third beta-coronavirus (beta-CoV) in 20 years (Severe Acute Respiratory Syndrome (SARS-CoV) in 2003 and Middle East Respiratory Syndrome (MERS-CoV) in 2012). It is not unlikely that we will see other novel beta-CoVs in coming years. It was important to take action early in the COVID-19 outbreak. Lives were (and still are) at stake. At this point, however, it is time to shift the focus to the most pressing health issues. I believe the recent CDC revelations support this. As the CDC Director, Dr. Robert Renfield, suggests, as the “numbers of underlying medical conditions increase, (the) risk of severe illness from COVID also increases.” I believe it is important, then, to focus on these underlying medical conditions.
While we cannot ignore that there are many chronically-ill who suffer from conditions outside of their control. Thus, the need for proper control of viral spread is warranted. (And it should be noted that these do not end with COVID-19.) Hand-hygiene and surface cleaning are at the forefront of these efforts—and, frankly, it is disturbing that it took a pandemic to awaken people to this. Masks and social distancing have, arguably, been taken to extremes in this pandemic. Hopefully, we have at least learned that, while masks need not become permanent additions to our daily attire, they do have a place, and we should be responsible to take the necessary precautionary care when we are ill—especially around those who are most vulnerable (and the most vulnerable are going to have to maintain some level of self-protection).
We all need to step-up our level of self-care. We all need to take some personal responsibility for our health. Genetics and chronic disease, as well as environmental issues, may contribute to the obesity pandemic, however, they are not the cause of obesity. Obesity is an issue of hypokinetics (inactivity) and hypercalorics (excessive eating). Obesity and inactivity are societal issues. Unfortunately, we have too long considered them to be individual problems. Societal issues require societal solutions.
In my humble opinion, obesity and inactivity have not received the attention warranted in combating the impact of COVID-19. Indeed, it has long been ignored as a health crisis. Only recently has attention been drawn to it (and seemingly much greater awareness has been noted in the United Kingdom).
Why was I excited to share the CDC’s statement? Because it has opened the door to exploring the conditions that are contributing to the severity of COVID-19 and the deaths it has caused. We have politicized COVID-19 and grown increasingly polarized over the virus, yet we continue to ignore the underlying issues affecting our health. I believe health should be universal. I believe it can be universal. We must care for the sick—this has to be a priority—but we have to demand that efforts be taken on the preventative side of health care. We have to take personal responsibility, but we can’t deny our responsibility to help those who are struggling to help themselves.
In the wake of COVID-19, we have to make changes—personally and collectively. We cannot take health for granted. We can’t make excuses. It will not be an easy task. We must, however, direct some attention away from masks, social distancing, and politics; and have the difficult conversations about change.
Yes, “only” 5,614 deaths can be attributed to solely COVID-19; and, yes, 161,392 can be associated with COVID-19. We can argue the statistics and the importance of the numbers, or we can see that our unhealthy behaviors are putting us at greater risk for early death. Let’s put politics and opinions aside and act to combat the preventable health issues that are leading to premature deaths in the U.S. Let’s focus on enabling Americans to be active and have access to healthy diets. Let’s let love and other-centeredness, rather than perceptions of body image, be the driving force behind encouraging one another to get more fit. We can’t do it alone.
Be your best today; be better tomorrow.
Carpe momento!
1https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm
