More bad news about the long-term effects of the pandemic has emerged from Nationwide Children’s Hospital and Ohio State University, and it isn’t about long-Covid.

It’s worse.

Publishing in peer-reviewed Clinical Obesity, the two institutions report that during the first summer of the pandemic “the proportion of youth with overweight or obesity increased from 37.8 percent to 44.6 percent” in Ohio with the “median weight gain…highest among those youth with severe obesity.”

The danger of obesity is now well-documented.

Long before the pandemic, it was implicated in helping drive heart disease and cancer, the long and still leading causes of death in the United States, and it has now been linked to the deaths of millions infected by the SARS-CoV-2 virus that causes Covid-19.

A metanalysis of deaths published in the peer-reviewed BMC journal Systematic Reviews concluded “obese individuals had 2.4 times the risk of being hospitalized compared to those without obesity,” and sadly too many people who end up hospitalized with Covid-19 die. 

A yet-to-be peer-reviewed study posted at MedRxiv in March concluded that “if the (global) obesity rate could have been reduced to less than 15 percent it is relatively certain that COVID deaths would have been less than 200 per million.”

The study was based on deaths through Feb. 25, 2021 in 167 countries where death and obesity rates were know. As of that date, the Worldometer Covid-19 tracker was reporting a global death rate of 321.6 per million, or about 61 percent more deaths than would have been expected with that less obese global population.

The global death rate is now up to about 750 per million, and despite the protection against the Covid-19-causing SARS-CoV-2 virus provided by vaccinations, bodyweight continues to be a big issue.

“An increase in fully vaccinated people, from 3 percent to 30 percent of world population, decreases new confirmed COVID-19 cases, although the dependence was not significant,” researchers reported in a peer-reviewed study in the Journal of Infection and Public Health in February.

What was significant in determining who died of the disease was a nation’s “GDP (gross domestic product), overweight, (and) obesity,” the researchers found. GDP popped up as an important link, the study noted, because “countries with higher GDP have a high overweight/obesity prevalence.”

These are nations, such as the U.S. and various European countries, now paying a high price for their success on a planet where for nearly 300,000 years the human species struggled daily to avoid death by starvation.

Curse of success

Americans, in particular, have been so successful at beating back the danger of starvation that for so long haunted human survival that the Ohio study of obesity among children found that the biggest weight gains came “in the first three to six months of the pandemic among low-income youth, reflecting the short-term effects of the pandemic.”

Simple translation?

Poor kids who were already sitting around too much eating too much high-calorie processed food were told to stay home where they sat around even more and ate too much high-calorie food. Or as the authors of the study put it:

Ohio “implemented full mitigation measures which included school closures, suspension of youth and afterschool activities, facility and restaurant closures, ban on social gatherings, scaled-down, in-person work hours except for emergency workers by the third week in March 2020. Remote learning and shelter-in-place orders – two of the mitigation efforts in response to the COVID-19 pandemic – affected youth disproportionately with decreased opportunities for physical activity, altered routines and sleep schedules, increased screen time, and consumption of non-nutritious foods.”

The consequences of this are not going to go away. It is well documented that obesity is easier to prevent than treat.

“Around 55 percent of obese children go on to be obese in adolescence,” a 2016 meta-analysis of studies on this subject found, “around 80 percent of obese adolescents will still be obese in adulthood and around 70 percent will be obese over age 30.”

The majority of people who grow obese in the U.S. do so as adults, but dooming children to obesity stacks the deck against their ever achieving a healthy weight. And healthy weights matter not just in terms of heart disease and cancer, but in terms of most infectious diseases.

Researchers writing in the peer-reviewed Annals of the American Thoracic Society in 2017 noted how “recent data highlight obesity’s association with a greater risk of infectious diseases. Following the first pandemic influenza outbreak of the 21st century, the 2009 H1N1 swine flu, obesity was identified as an independent risk factor for increased morbidity and mortality resulting from pandemic H1N1 (pH1N1) infection.”

“(The California Department of Public Health’s Janice) Louie and colleagues identified 51 percent of 534 adult cases of influenza in California during the 2009 H1N1 pandemic outbreak occurring in obese individuals, with 61 percent of influenza mortality cases happening in obese adults. Additionally, compared with healthy-weight adults, obese adults were found to have a higher risk of hospitalization for respiratory illness during seasonal influenza, with 1.45 times the odds of contracting seasonal influenza for adults with body mass indexes (BMIs) ranging from 30.0 to 34.9 kg/m² and 2.12 times the odds for adults with BMIs greater than or equal to 35.0 kg/m² .”

Someone standing 1.7 meters (5-feet, 7 inches tall) reaches a BMI of 30, which is the lower limit of obesity) at 87 kilograms (192 pounds), according to an online calculator of BMI for adults.

The U.S. Centers for Disease Control now estimates that 42.4 percent of Americans qualify as obese, but that number is based on 2017-18 data. The pandemic might have pushed the number a lot closer to 50 percent given the fuel it added to what was already a race to get fat.

“From 1999 – 2000 through 2017 – 2018, U.S. obesity prevalence increased from 30.5 percent to (the) 42.4 percent,” according to the CDC. “During the same time, the prevalence of severe obesity increased from 4.7 percent to 9.2 percent.” 

Severe obesity can best be described as frighteningly fat. To get there, a 6-foot-tall man must reach 295 pounds; a 5-foot, 6-inch woman, 245 pounds.

A serious problem

With one in 10 Americans having reached severe obesity, and more than four in ten charging toward it, maybe it’s time to accept that the country’s biggest health problem isn’t the pandemic.

The country’s biggest health problem is obesity, which significantly boosts the death rate for most of the life-ending diseases Americans now face, including Covid-19. But instead of trying to deal with this problem – an extremely difficult one given that eons of evolution have left us genetically programmed to try to put on weight to avoid starvation – America has embraced fat acceptance.

“Fat acceptance, which started in the 1960s as National Association to Advance Fat Acceptance, has been around through different waves and forms for about 50 years,” writes Amee Severson at Healthline.  “Currently, fat acceptance is a social justice movement aiming to make body culture more inclusive and diverse, in all its forms.”

She went on to argue that the “body positive” movement is doing a disservice to the obese by encouraging them to “preemptively respond to questions of ‘but health?’ In other words, despite body size or appearance not being good measures of health, society holds higher expectations for fat people to be a ‘good fatty.’

“A person actively doing the work to change their beliefs about their own body is doing amazing and healing work, but in a world that fosters a fatphobic culture, this journey can feel lonely.”

The message Severson is pushing is simple. That instead of working on weight loss, the obese should accept that it’s not their problem and that “it’s OK to be fat.”

Only the pandemic data says it is clearly not OK to be fat. The pandemic data says obesity is a serious threat to one’s health, like smoking a pack of cigarettes per day or regularly binge drinking or becoming addicted to drugs.

Nobody should be marginalized or shamed for being fat. Most people know how hard it is to keep their weight under control and even harder to lose it, and those who don’t should consider themselves blessed.

But neither should anyone ignore the very real health problems related to obesity.

“Dietary risk is now the leading risk factor related to death in the U.S.,” Dr. Anand Parekh, the medical director at the Bipartisan Policy Center, observed in a commentary at MedPage Today this week. “In fact, dietary risk, high body mass index, and low physical activity are all top 10 mortality risk factors.”

Parekh was lobbying for insurance companies to take a more active role in supporting nutritional counseling, pharmacotherapy, and even bariatric surgery, which has interestingly enough shown to reduce deaths from Covid-19.

A peer-reviewed study published in Surgery for Obesity and Related Diseases concluded that “a history of bariatric surgery significantly decreases the risk of emergency room admission, mechanical ventilation, prolonged ICU stay, and death in patients with COVID-19. Even when adjusted for BMI and the co-morbidities associated with obesity, patients with a history of bariatric surgery still have a significant decrease in the risk of emergency room admission.”

Changing behaviors

Diet and exercise can make a big difference, too, according to researchers at Harvard’s T.H. Chan School of Public Health researchers, who have discovered that obesity actually alters the architecture of liver cells, leading to what is now called “metabolic disease.”

Their peer-reviewed work was published in Nature in March. 

“Chronic metabolic disease, which includes obesity, diabetes, and cardiovascular and liver diseases, is the biggest global public health problem,” Gökhan Hotamışlıgil, the James Stevens Simmons Professor of Genetics and Metabolism at Harvard Chan School and the director of the Sabri Ülker Center for Nutrient, Genetic, and Metabolic Research was quoted observing in a subsequent press release from the university.

“The fundamental regulatory mechanism that we discovered can be used to evaluate the susceptibility – or resistance – of individuals to a disease state like obesity, and determine what steps, such as diet, nutrients, or fasting, will reduce, eliminate, or exacerbate these states. We can imagine a whole new array of therapeutic strategies targeting molecular architecture, similar to the restoration of an ailing building or preventing its deterioration.”

The restoration of buildings or the prevention of their deterioration, however, requires someone making the decision that they need to be fixed. And the biggest obesity problem in the U.S. today, as clearly indicated by the nation’s ever expanding waist lines, is that too few appear to think the problem needs a solution.

If anything, obesity is being normalized.

As Severson observed, “the shift has started with brands like Dove and Aerie, even stores like Madewell and Anthropologie, that are becoming more (fat) inclusive. Lizzo’s latest album debuted at No. 6 on the Billboard charts. The TV show ‘Shrill’ was just renewed for a second season on Hulu.”

Meanwhile, Covid-19 continues to claim the obese at an accelerated rate even among the vaccinated, and the other diseases that have long plagued those who’ve grow beyond healthy weight are not going away.

One would think that at some point the medical community would accept that the solution is not to continually try to treat the symptoms of ill health in this country, but to treat the biggest problem now driving ill health.

Oh if only sense were common.