Getting Britain in shape is a matter of life and death: As it emerges a quarter of Covid victims who die have diabetes, two experts urge people to shape up for their own sake
- Here’s how to help people impacted by Covid-19
For too long, many people — doctors included — have chosen to look the other way when there is any mention of weight and the threat that it poses the nation’s health.
But there can be no denying now that obesity and type 2 diabetes are a double epidemic that is blighting the UK, raising our risk of dying from heart disease, stroke and several different types of cancer — and now, we learn, also from Covid-19.
Being overweight doesn’t make you more likely to catch SARS CoV-2 (the strain of coronavirus that causes Covid-19), but mounting evidence suggests that it does significantly increase your chances of dying from it once infected.
Up to now, obesity has been an issue we’ve shied away from, partly out of fear of causing offence. Today, however, the nation’s waistline is firmly in the spotlight thanks to Boris Johnson’s new focus on tackling obesity as a key cause of many chronic health problems following his own battle with coronavirus.
It has been reported that Mr Johnson became convinced his weight was the reason he ended up seriously ill in intensive care — and he is now said to be planning a ‘much more interventionist’ strategy to encourage us to overhaul our weight, fitness and general health.
I understand that the Prime Minister’s weight was 17st 7lb before he was admitted to hospital — giving him, at 5ft 9in, a body mass index (BMI) score of 36, making him clinically ‘obese’.
For too long, many people — doctors included — have chosen to look the other way when there is any mention of weight and the threat that it poses the nation’s health
And obesity is emerging as a clear risk factor for severe Covid-19 infection. A New York University study involving 4,103 Covid-19 patients found that while age was the single biggest risk factor in determining whether someone needed to be admitted to hospital, obesity came a close second — ahead of heart disease or lung disease.
Meanwhile, a major analysis by the University of Oxford of the health records of 17.4 million people (the largest study of Covid-19 so far conducted worldwide) revealed that the most severely overweight people are three times more likely to die of Covid-19.
I now believe my own healthy BMI made a difference when I, too, developed dangerously low oxygen levels as a result of the virus.
I recently met the Secretary of State for Health, Matt Hancock, who’s had first-hand experience of the benefits of a healthy diet. He told me he’d lost two stone (going down to 11st 7lb) by cutting back on sugary and starchy foods.
I cannot help but wonder if that may have helped him recover from Covid-19 so rapidly after going down with it at the same time as the Prime Minister.
It’s not only obesity that has been identified as a new major risk factor for dying from Covid-19 once infected with the virus.
Obesity is closely linked to having type 2 diabetes — and every three minutes, someone in the UK is diagnosed with type 2, largely due to being overweight. The Prime Minister’s new initiative coincides with figures from the NHS showing that a quarter of Covid-19 patients who have died in hospitals in England had diabetes.
This is significant when you consider that 6 per cent of the population has type 2, so diabetics are disproportionately represented in the tragic number of deaths.
So what lies behind these findings about obesity and type 2?
Being overweight can make it mechanically harder to breathe, as a large belly makes it more difficult for the diaphragm and lungs to expand, reducing oxygen supply to vital organs. This helps explain why overweight people who contract Covid-19 are more likely to require extra help with breathing.
Obesity — or more precisely ‘central’ obesity (or a large tummy) — and type 2 diabetes also both affect the effectiveness of your immune system, making it less able to deal with new attacks. And as Good Health highlighted last week, obesity is known to trigger inflammation in the body. Overweight people have been shown to have higher levels of inflammatory messenger molecules called cytokines, which interfere with normal cell functions.
Dr David Unwin (pictured) has worked as a GP in Southport for more than 20 years. He is also an Ambassador for the All-Party Parliamentary Group on Diabetes and a Royal College of GPs National Champion for Collaborative Care and Support Planning in Obesity & Diabetes
A major research review, published in 2016 by the American Society for Nutrition, concluded that obesity and the health problems associated with it — including high blood pressure, raised blood sugar levels and tummy fat — have a ‘substantial impact’ on the health of the immune system and defence against disease.
Furthermore, overweight people have a problem with low levels of vitamin D, which is important for building and regulating our immune systems. Being overweight appears to cause the deficiency, according to a major study involving 42,000 people published in the journal PLOS Medicine in 2013.
Because vitamin D is fat-soluble and is stored in the fatty tissue, researchers believe it becomes dispersed in a greater volume of body fat, preventing it circulating effectively around the body.
And there’s no doubt that people carrying too much weight can be reluctant to shed their clothes outdoors — and so they miss out on the vitamin D our bodies naturally make when exposed to the sun’s rays.
All of this makes weight of critical importance as we look for ways to minimise our risks of succumbing to Covid-19. And I know from my own clinical experience just how scary infection with the new coronavirus can be. I have seen some of my patients with significant pneumonia, struggling to breathe and anxious; a few have been admitted to hospital, though thankfully none has died.
I also had my own brush with it — in the form of silent hypoxia, a dangerous condition where there is a severe drop in blood oxygen levels you’re unaware of because you’re not struggling to breathe.
As a 61-year-old man I was anxious about catching coronavirus, but I pride myself on being fit and healthy — I run four miles every other day — so I carried on working as normal and hoped I’d be safe.
But about a month ago, I started to feel tired and heavy-legged. I didn’t have a temperature, breathing difficulties, a cough or any other symptoms, though, so I just put it down to general anxiety about lockdown and the changes at work.
All the doctors in our practice have been issued with their own pulse oximeters — small devices that measure the oxygen in your blood and give an early warning of silent hypoxia.
There can be no denying now that obesity and type 2 diabetes are a double epidemic that is blighting the UK, raising our risk of dying from heart disease, stroke and several different types of cancer — and now, we learn, also from Covid-19
A healthy reading is considered to be an oxygen saturation of 96 per cent or above, but mine was consistently reading lower — sometimes as low as 91 per cent.
But as I had no other symptoms, I decided the device must be faulty and ordered a new one. Then, one day, I fainted while out running. One minute I was feeling tired, and the next I was on the ground with a bleeding arm.
My first feeling was relief that no one witnessed my fall. But when I got home and measured my blood oxygen levels with my new oximeter, I registered another low reading (91 per cent) and it all made sense. Although a Covid-19 test came back negative, I’m certain I had coronavirus — and it took me three or four weeks to feel properly well again. My wife, Jen, had a similar experience. But most worrying was my 19-year-old-son’s bout of coronavirus, which — again — I nearly didn’t discover.
A student home from university, Edward had been lying on the sofa for days on end. I’d started to give him grumpy pep talks about taking exercise when it occurred to me that he, like me, might also be ill. The oximeter revealed his blood oxygen levels were below 93 per cent and his pulse was terrifyingly high, at 150 beats per minute (normal is around 75 to 80). As he didn’t have any problems breathing, we decided he didn’t need to be hospitalised but we looked after him carefully at home.
Protect yourself at the supermarket by taking along antiseptic wipes to clean trolley and basket handles, says virologist Dr Simon Clarke.
His Covid-19 test came back positive; but, again, he had no other symptoms apart from extreme tiredness and low mood.
As a family, we’re all slim and fit — and I’m convinced this helped us to fight off Covid-19 without needing hospital treatment. But I remain in no doubt that in coronavirus we are dealing with a terrifying illness.
Yet today, a cure or a vaccine is still a far-off hope. In the meantime, what are the best options for protecting our health?
I think we need to start by spelling out — as Boris is suggesting (and I applaud him for being bold enough to say so) — that weight does matter.
We’d be failing in our duty as doctors if we didn’t tell people the simple facts and help them to make positive changes. And diets can work — as I’ve learned from running low-carb clinics. These are based on the principle that people with type 2 diabetes have a problem dealing with sugar, so it builds up in the bloodstream, causing problems.
Sugar isn’t just found in the obvious foods such as cakes and biscuits; it is also produced when the body breaks down starchy foods such as potatoes, pasta and bread — which can be a problem if you have type 2.
Low-carb involves cutting down or eliminating sugary or starchy foods and focusing on eating protein, good fats and vegetables.
This helps with weight loss — on average, my type 2 patients have lost 10.3kg (22lb) — and in turn tackles type 2. Last week I learned that my 73rd patient had put their diabetes into drug-free remission.
Nor is low-carb the only successful weight loss treatment. Very low calorie regimens such as the 800-calorie a day rapid weight loss programme pioneered by Professor Roy Taylor at Newcastle University have also had great success with putting type 2 into remission. Meanwhile, some patients benefit from bariatric surgery.
It’s up to the individual to find an approach that suits them, but the bottom line is this: significant weight loss is perfectly possible and can transform your body’s vulnerability to serious illnesses — of which Covid-19 is only one.
That’s why I think that for all its restrictions, anxieties and worries, lockdown, as well as helping to reduce the tragic deaths from this awful disease, also offers a real opportunity to achieve a lasting benefit for our health.
I read recently that 300,000 Britons have given up smoking with lockdown, and I believe we can make similarly inspiring transformations to our waistlines.
It’s vital that Boris now extends the current sugar tax on soft drinks to include confectionery such as chocolates, sweets and biscuits. Why not use the revenue to subsidise healthy whole foods to make them more affordable for poorer families?
But in the short term, we ourselves can start taking some positive action —perhaps with more exercise and looking hard at your diet. Whatever approach you adopt, it is essential to cut out highly processed food such as snack bars or biscuits. This sort of food adds calories, but with few nutrients.
When it comes to Covid-19, while there is much we cannot control, we can address vital lifestyle factors, such as weight — which could literally make a difference between life and death.
- Dr DAVID UNWIN has worked as a GP in Southport for more than 20 years. He is also an Ambassador for the All-Party Parliamentary Group on Diabetes and a Royal College of GPs National Champion for Collaborative Care and Support Planning in Obesity & Diabetes.
YES, OBESITY RAISES THE RISKS… BUT THERE IS A SIMPLE SOLUTION
By Professor Roy Taylor – Professor of Medicine and Metabolism at The University of Newcastle
My two sons are doctors working on the frontline of this pandemic. One is an anaesthetist in intensive care, and the other is an infectious diseases specialist.
The shocking statistics about the number of obese people with complications from Covid-19, and the fact that one in four of those who die have type 2 diabetes, is not lost on them. The truth is that their jobs would be a whole lot easier if so many of their patients weren’t overweight.
I’ve been working at the forefront of diabetes research for over 30 years and my team was the first to pinpoint the precise connection between eating too much food and developing type 2 diabetes.
When I heard that Covid-19 targets the respiratory system, I knew that overweight people would be at greater risk.
Any excess fat around the neck and airway, plus the extra weight on the chest, hinders breathing — making very heavy people more vulnerable to complications.
No single diet plan suits everyone, but anyone can lose weight — and our research shows that losing weight rapidly is far easier than a long drawn-out attempt
We also know that being overweight considerably increases your chances of developing type 2 diabetes — and if you’ve got diabetes, your liver will be pumping out dangerous fats, which accumulate inside the blood vessels that supply your important organs, causing multiple problems, including the risk of heart attack and stroke.
Covid-19 causes blood clots, particularly in those with elevated blood sugar levels; and those with poorly controlled type 2 diabetes are in the biggest trouble because their blood vessels are already damaged. If you’re overweight and you’ve got diabetic changes going on in your body, then Covid-19 presents a sinister foe.
But it doesn’t have to be this way!
As a man, I have twice the risk of dying from this awful virus as a woman, and at the age of 68 my immune system may not be as strong as that of a younger person (the over-70s have four times the risk of dying as those in their 50s).
But I work to stay slim because I know that’s the best way for me to live my life to the full.
The estimated two-thirds of the population who are overweight or obese, together with the estimated 4.8 million people with type 2 diabetes, should take comfort in the knowledge that they can take action to reduce their risk of death from Covid-19.
No single diet plan suits everyone, but anyone can lose weight — and our research shows that losing weight rapidly is far easier than a long drawn-out attempt.
We have shown that by losing weight you can reverse your type 2 diabetes. And our very latest research (just published in the journal Diabetes Care) shows that if you keep that weight off for a year, your insulin-producing cells will return to normal.
Having a Prime Minister who has had a near tragic brush with Covid-19 may turn out to be the best thing ever for the health of our nation.
Boris is the first to admit that although he was exercise-fit when he contracted the virus, he was also overweight.
Now he is promising to orchestrate a national drive against obesity after the coronavirus menace has passed.
But when Boris and his team sit down to thrash out plans for a slimmer future, I would urge him to stand strong against the persuasive forces of the food industry.
Yes, exercise is brilliant for overall health, and more bicycle lanes would certainly be a force for good. But you cannot cycle your way out of eating too much food.
The focus has to be on limiting food consumption. Legislation is essential to place modest restraints on the supply of ’empty calories’.
I’d like to see restrictions on fast-food outlets near schools, regulation of added sugar and fat in processed food, as well as super-sized and bargain meals; clear and visible calorie labelling on single-consumption items, and continued pressure for a sugar tax on sugar-sweetened drinks.
Together with many other experts, I have been calling for this action for many years. The difference now is that Covid-19 is shining a bright light on what we know should be done.
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