Last reviewed 28 August 2020
In this feature, Deborah Bellamy explores the impact of obesity during the coronavirus pandemic, and the current government campaign, proposed legislation and primary care interventions designed to tackle the issue.
Obesity presents one of the greatest long-term health challenges faced by this country and the NHS. It is acknowledged to be a complex issue caused by many inter-dependent factors. Ambitious targets of reducing the number of adults living with obesity, halving childhood obesity by 2030 and reducing inequalities mean a great deal needs to be done, as strategies so far have failed to have an enduring impact. Fortunately, the current response to the Covid-19 pandemic indicates public support and willingness to accept government direction in promoting good health, supporting the NHS and saving lives.
The obesity problem
Today, around 63% of adults are above a healthy weight and half of these obese. Prevalence is highest amongst deprived groups with 55–74 year-olds and members of Black, Asian and Minority Ethnic (BAME) communities most severely affected, resulting in reduced life expectancy and increased risk of chronic diseases. One in three children leave primary school overweight with one in five living with obesity, laying foundations for future health inequalities.
Covid-19 has focused the spotlight on these well-known issues and a disconcerting Public Health England (PHE) report stated those with a BMI between 35–40 could increase their risk of hospital admission, intensive care or death from Covid-19 by 40%, compared to those with a healthy BMI. A BMI greater than 40 could increase these risks by 90%.
As a result, the Government has announced an anti-obesity strategy for England, aiming to empower individuals to make healthier choices with interventions supported by the NHS, focusing on public health and prevention. The Better Health campaign aims to reduce what experts deem “the single most important modifiable risk factor” for coronavirus in anticipation of a potential second wave.
Risks posed by being overweight or obese with Covid-19 are high and cannot be explained by age, sex, race or other diseases. According to PHE, excess fat may affect inflammatory and immune function, consequently reducing response to infection and intensifying susceptibility to severe symptoms of Covid-19. Obesity increases risks of type 2 diabetes, heart disease and respiratory disease, compounding complications from the virus.
Though not a systematic review, PHE’s assessment of current literature on Covid-19 and weight suggests that whilst excess weight does not increase the likelihood of contracting the virus, obese people are significantly more likely to become seriously ill, admitted to hospital or intensive care, requiring advanced levels of treatment, such as mechanical ventilation, compared to those with a healthy BMI.
Covid-19 BAME and obesity
Covid-19 has had a disproportionate effect on older people, men, those living in deprived areas, people from BAME groups, as well as those with other long-term health conditions, reinforcing existing health inequalities.
BAME populations are susceptible to obesity-related diseases, such as type 2 diabetes, at a lower weight status compared to white populations. PHE warned the risk at BMI 35 was 2.56 times higher amongst BAME than white Europeans. At a BMI of 25, there was no difference.
Primary care interventions
Primary care is pivotal in providing health advice and support with a record of successful health promotion models, such as smoking cessation.
NHS weight management services will be increased with referral pathways, and GPs encouraged to prescribe exercise and social activities to support individuals attain and maintain fitness. Many GPs currently refer to weight management services and local authorities will be encouraged to extend provision. Where appropriate services are not available, healthcare professionals can signpost individuals towards the free NHS 12-week plan.
The NHS 12-week plan is an app designed to:
set weight loss goals
use the BMI calculator to customise individual plans
make healthier food choices
get more active and burn more calories
record activity and progress.
Primary Care Networks (PCNs) will be offered the opportunity to train staff to become healthy weight coaches supported by PHE.
From 2021, PHE will collaborate with the British Medical Association (BMA) and the National Institute for Health and Care Excellence (NICE) to implement incentives via the Quality Outcomes Framework to ensure targeted support.
PHE Better Health campaign
PHE’s Better Health campaign urges individuals to take stock in the aftermath of the pandemic, lose weight, eat better, and become active over the next nine months, using evidence-based tools and apps, such as the 12-week plan.
Discounts are available for WW (previously known as Weight Watchers), Slimming World, Get Slim and Man vs Fat, Second Nature and EFL fit fans, Couch to fitness, NHS Fitness Studio and Join the Movement, which includes free and pre-paid classes. Further details can be accessed at: www.nhs.uk/better-health/.
Individuals can also check risk scores to ascertain their likelihood of developing type 2 diabetes as part of the NHS Diabetes Prevention Programme, and flag up eligibility to access free NHS Healthier You at www.nhs.uk.
The Royal College of Physicians has urged the Government to address genetic, biological and social factors, as they feel the guidance lacks breadth. In addition, the Obesity Health Alliance has outlined key areas to ensure obesity is considered as part of a wider strategy to address health inequalities.
What legislation is the Government proposing?
The Government has announced a seven-point plan, five of which relate to food law. They include the following.
Publishing a four-nation public consultation which gathers evidence on the current “traffic light” labelling to review the current approach.
Consultation on making calorie labelling on alcohol compulsory by the end of the year.
Legislation requiring large out-of-home food businesses, restaurants, cafes and takeaways with more than 250 employees to add calorie labelling, enabling individuals to make ''informed choices''.
Cessation of promotion of foods high in fat, sugar, or salt, restricting volume promotions such as buy one get one free, and placement of such in prominent locations for purchasing, online and physical stores in England.
Intention to ban foods high in fat, salt, sugar and drink products on TV and online before 9pm and publish a full consultation response by year end.
Criticism of the Eat out to Help Out Scheme
There has been criticism that the Eat out to Help out scheme, launched in parallel with the PHE Better Health campaign, presents issues with fast-food chains participating, leading the National Obesity Forum to state that this has been a ''green light to promote junk food'' throughout August.
The NHS Long Term Plan will make weight management services available from 2021 for those most at risk with type 2 diabetes and/or hypertension and will extend to those living with obesity. Additionally, the current NHS Diabetes Prevention Programme will expand, including access to high-impact weight loss services. It will focus on areas of the country with the highest prevalence of Covid-19. There will be increased international collaboration ensuring companies reduce sugar content of commonly produced goods and lastly, there will be:
improvement on public sector procurement of food and drink as part of the forthcoming National Food Strategy
ways to support disabled people to move towards a healthier weight as part of the National Strategy for Disabled People
continued work with businesses and industries through the government’s reduction and reformulation programmes on sugar, calories, and salt
consultation on proposals to help parents of young children to make healthier choices via more honest marketing and labelling of infant foods
conversations with employers to better support people to be healthier at work.
The consultation responses should be forthcoming, together with draft legislation.