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Aug 22nd, 2020

I read with interest a recent Lancet article related to obesity, COVID19 and shaming. The authors state that there is no benefit to the approach that the UK government has taken in regards to obesity and its associated mortality risk with COVID19 other than to blame and shame a population. They rightfully state that the UK government's thoughts were: "The new obesity strategy, published alongside the 'Better Health' campaign, led by Public Health England, intends to restrict advertisements and promotions of unhealthy foods, improve nutritional labelling of foods and drinks in restaurants and stores, and expand weight management services."

The authors go on to state: "The ambition for a healthier nation, during and beyond COVID-19, is to be praised. However, at a time where our economies are fragile, bans on food promotions and advertisements could also result in higher prices and growing inequalities, which themselves contribute to obesity and poor health outcomes. Equally troubling, by targeting almost exclusively the obesogenic environment, and only a small part of it, the new policies fail to take into account the intricacy of biological, societal, and psychological factors that underpin obesity."

What is really at play here? Is the UK government really trying to blame and disenfranchise a group of individuals or are they trying to raise awareness and help these individuals recognize, rightly I would add, that choosing unhealthy food and lifestyle choices raises your risk of a bad outcome? This is just a fact.

Obesity is a major risk factor for increased disease burden and hospital admission with COVID19. (Hamer et. al. 2020) This is not about shaming but education. In a recent study in the Annals of Internal Medicine, Dr. Tartof and colleagues found that highest BMI conferred a 4 times increased risk of death. Elevated BMI in general was strongly associated with higher risk for death in graded fashion. They stated, "We detected a strongly monotonic increased risk for death with increasing age. Male patients had higher risk for death than female patients." (Tartof et. al. 2020)

Could the US or UK government do more for the disenfranchised to aid their health plight? Simple answer is of course. We should have clean air, water, food, cheaper prescription drugs, healthy school food, mental health benefits and much more that would have and could drastically reduce COVID19 death rates. We have the money. We gave away over 39 billion dollars in foreign aid last year alone. What I could do with that money for our collective health. Wow. Alas, we cannot change society's ills over night, but we darn sure can educate people that they have the right and can choose a better, healthier path.

Why are we as western societies so afraid to discuss these issues in the public forum? The news media continues to avoid the entire topic of how to personally avoid death by choosing to eat healthfully, exercise daily, manage stress, sleep adequately, and generally help your innate immune system surveil, find and kill the SARS2 virus before it can hurt or kill you. Why is this taboo?

It is so easy to claim that one is being singled out and blamed when what is really happening is that people are trying to help one see that there is a better way to live. I see it every day in clinic. Parents telling me not to discuss weight, habits or anything that could make a child feel badly. When what they really need is a loving individual to tell them that it is ok, we will work together to achieve health goals and we are a team. Children are neither as weak or sensitive as many parents believe. I have seen many a child cry when the topic brings itself to the forefront through discussion because they feel shame only to see them leave empowered with their head held high knowing that it is their body, their choice and their life. They can choose to be healthy. As a doctor and a parent it IS our responsibility to provide nourishing environments, education and love. Each of us has a right to choose to listen to good advice or not, choose to take on excess risk or not, choose to live healthfully or unhealthily, and all of the other choices in life. However, there are risks to all and we must as a society hold ourselves accountable for our behavior. It does no one any good to brush the antecedent triggers of COVID death under the table.

I repeat, we cannot change society's ills over night, but we darn sure can educate people that they have the right and can choose a better, healthier path.

We as a society need to take a page out of Jocko Willink's Extreme Ownership. We need to communicate clearly and lovingly what the goals are for our children. We need to help them make high quality choices. We need to lead.

Dr. M

Lancet Editorial
Tartof Annals of Internal Medicine
Hamer PNAS