Tarek S Arab

It’s time we were honest about obesity and Covid-19

It’s time we were honest about obesity and Covid-19
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Difficult facts can be conveyed in a sensitive, non-judgemental and compassionate manner; indeed, this describes the daily practise of medicine. When obesity rears its head, however, a significant number of my colleagues in the health professions display a cognitive dissonance and determination to deprive patients of the unvarnished facts that they would not dare hide with conditions such as cancer.

Prioritising their own “feelings”, they patronise the obese by taking offence on their behalf, preferring to virtue-signal, accusing those “ insensitive “ enough to want to state the facts of “fat shaming” or victim-blaming. Then, in an apparent coup de grace, they triumphantly declare that obesity is complex and multifactorial, as though such a declaration signalled that the discussion was over.

Normalising obesity does nothing to lessen its impact on our health; it is not desirable that 67 per cent of the UK adult population is obese or overweight. Obesity is a risk factor for coronary heart disease, diabetes, hypertension, heart attack, stroke, 11 forms of cancer, adverse pregnancy outcomes and complications from routine surgery. I was shocked last year when Cancer Research UK was accused of fat shaming for telling the truth about obesity and cancer risk. Is it “cancer-shaming” to tell someone they have cancer and to advise them of their options?

True (not imagined) “fat shaming” is the deliberate denigration of a fat person on account of their appearance and should not be tolerated. The sensitive, empathetic communication of the reality of obesity and its implications, however, should be of the utmost priority for clinicians when treating their patients.

Two days ago a Twitter storm (on one hand, Dr. Aseem Malhotra, Cardiologist and outspoken advocate of a particular mode of eating, on the other hand, multiple members of the medical/nursing profession, with esteemed members of the public piling in on both sides) erupted after a large consignment of Krispy Kreme donuts was delivered to a hospital for the staff to enjoy.

Harmless enough one would think, until one remembers that 25 per cent of nurses and 15 per cent of other medical staff are obese.

Or that obese people are 2-6 times more likely to require hospitalisation if infected with Covid 19 and have a more severe course including need for intubation. Once intubated, they are more likely to experience complications.

Furthermore, higher blood sugars, particularly induced by eating refined sugars in collaboration with endocrine disruptor chemicals, most pronounced in people with insulin resistance (precursor to type 2 diabetes), not all of whom will be obese, is associated with disrupted activity of cells of the immune system responsible for fighting infection, something we would surely want to avoid at this time?

We have already lost 119 healthcare professionals to Covid-19 and front line staff are at highest risk of infection. Surely the priority should be to minimise their risk as much as possible? I found it odd that so many of the people opposing his message which admittedly was expressed in robust and strident manner but minus “fat-shaming”, deliberately forget this, or worse, are unaware of it. The complete disdain for the health of their own colleagues, already struggling with health issues that put them at risk for COVID 19 complications by, in some cases, disregarding their contribution to the statistics, was disturbing to behold, as was “ defiant” exhibitionism of the kind that could adversely affect anyone with an eating disorders.

In a free society, we should all be able to choose what we put in our mouths. I have no time for “sugar taxes” or any other manifestation of the nanny state. It is not choice however, when during a busy shift, you are surrounded by carefully designed, hyperpalatable, addictive, cheap processed foods, that take advantage of brain biochemistry to induce dependence that are injurious to human health.

We have a wonderful opportunity, during this pandemic, to support healthy behaviour in both healthcare workers and those at home, but this requires candour.

Insulin resistance, the precursor to diabetes, which is also associated with dysfunction of immune cells when infection is present, can be positively affected by eating the right foods and anecdotal evidence that evidence of benefit may begin to manifest itself within 21 days. Further weight gain and high blood sugar levels, especially in those with diabetes or insulin resistance, can be minimised, with the right foods. Do our NHS health workers deserve any less? Why is no one demanding that Trusts ensure the highest quality food be made available for those at the front line?

Are we really going to allow a politically-correct, perpetually offended, minority of individuals among the health professions, most of whom aren’t even obese, to stop the dissemination of the facts, just because their delicate sensibilities are hurt? I have never, in clinical practise, ever met an obese patient who objected to the facts, provided they were delivered with respect, courtesy and compassion. As an obese clinician myself, I have personal insight into this.

“First do no harm” is the first principle of medicine. Fifty years ago, cigarettes were designated harmless, their use defended by the medical profession, despite the health concerns, and patients paid the price; today, processed food is “part of a balanced lifestyle”. Why do people have to be harmed while we wait for the medical profession to catch up with the science? There are those who wish to suppress legitimate discussion, by calculated faux outrage. Facts, I’m afraid, don’t care about your feelings.