Science and Health Equity for Obesity and COVID-19

The interaction between COVID-19 and obesity is producing diverse responses. From some folks we hear denial. From elsewhere, we hear that concerns about obesity are expressions of racism. Still others will tell us that their favorite diet advice is the answer. Of course on Twitter, low-carb diets for COVID-19 are a hot topic today. But our modest proposal is this: let us focus on science and health equity in dealing with obesity and COVID-19.

Structural Disparities and Stigma

A new commentary in Metabolism today describes the effects of health disparities and stigma on people hit hard by COVID-19. Matt Townsend, Ted Kyle, and Fatima Cody Stanford write:

As obesity emerges as an independent risk factor for severe COVID-19 and is most prevalent among communities of color, it is another concerning layer of structural disadvantage.

The implications of weight stigma are particularly alarming in the context of COVID-19. Observed decreases in non-COVID hospitalizations indicate a general reluctance to seek even necessary medical care during this pandemic.

Recently, more than a 1,200 employees of CDC called upon the agency to name racism as a public health crisis.  Also, to clean up a “toxic culture” of racism within the agency. Plainly, we cannot continue to ignore the structural racism baked into health and obesity care in America and elsewhere.

Biological Vulnerability

Social and economic forces that shape a person’s vulnerability to COVID-19 are certainly powerful. But the biology of obesity is a critical factor to consider. That is because the systemic inflammation, immune dysfunction, and physiologic changes caused by obesity make people more vulnerable to COVID-19, say Townsend et al.

Pop Diet Nonsense

However, we should not let pop diet nonsense serve as a distraction. As a case in point, Altimetric tells us that an editorial about low-carb diets for COVID-19 is scoring in the top five percent of all research publications. Written by a health science journalist, it appears in BMJ Evidence-Based Medicine.

An authority on obesity medicine and clinical nutrition, Caroline Apovian, tells us:

It’s a complicated topic but I have several issues because the author makes some big leaps. Bottom line, a low-carb diet will not treat or prevent COVID-19.

Nonsense and pseudo-science will not help us cope with either obesity or COVID-19. Rather, we must follow sound biological science and work for health equity in populations at risk for obesity and COVID-19.

Click here for the commentary by Townsend et al, here for the BMJ editorial, and here for further perspective.

This Girl, photograph © JoLynne Martinez / flickr

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July 14, 2020