Covid-19 and obesity

The outbreak of Covid-19 started in late December 2019 in Wuhan, China. By April 20, 2020, the disease had spread to 210 countries of the world with over 2.3 million confirmed cases.

While researchers around the world are still trying to fully understand the epidemiology of this disease, by now we have enough data to draw at least some basic conclusions.

Most studies have shown that the risk factors, both for catching the disease and dying from it, are: age (the risk was higher in those aged 60 years and above) and underlying health conditions. The underlying conditions include cardiovascular and respiratory conditions, diabetes, diseases affecting the immune system and other chronic conditions.

These aspects of epidemiological research have also received widespread media attention. Yet, certain other confirmed risk factors have received little or no attention thus far. For instance, excess body weight and smoking.

A study on the hospitalised patients in the US during March, 2020 has highlighted obesity among the most prevalent underlying conditions for Covid-19. Excess weight not only predisposes a person to the other underlying conditions that independently increase one’s risk but also affects the body's response to deal with this infection. Moreover, doctors think that managing obese people on a ventilator (when a person’s respiration is externally supported) has added challenges and can lead to worse outcomes compared to those with normal body weight. Another confirmed risk factor for Covid-19 is smoking which is a known risk factor for many other diseases.

As the world finds itself in the grip of this unexpected pandemic, we also have a rare opportunity to seriously reflect on what we can do to reduce the health toll of such pandemics in the future. Many experts have pointed out the need for greater preparedness of the health systems, surveillance systems and maintaining supply chains for essential goods. But the issue towards which I want to draw attention is the need for countering non-communicable diseases like obesity. Right now, we must focus our energies on countering Covid-19. But in the longer run, the diseases which deserve our greatest attention are non-communicable diseases like obesity.

In Pakistan, is obesity even on anyone’s radar? Has any government made any serious effort whatsoever to tackle it?

In many countries, health surveys are carried out, every year or once every five years, to measure the distribution of risk factors like obesity, smoking and hypertension. In Pakistan, we do not have such health surveys conducted regularly. However, the existing data strongly suggests that nearly one third of all adults in Pakistan are by now obese or overweight.

For example, analysis based on the Pakistan Panel Household Survey (PPHS) conducted by the Pakistan Institute of Development Economics in 2010, showed that 30 percent of adults in Pakistan were either overweight or obese. More women (32 percent) than men (26 percent) had excess body weight. If we look at the distribution by age, it is striking that the proportion among the young and middle age (35-54 years) was even higher – 40 percent. The prevalence was higher in urban areas than rural areas pointing out the possible role of changing lifestyles that encourage sedentary habits and unhealthy eating including the changing culture of eating processed foods.

Findings of the Pakistan Demographic Health Survey (2017-18) painted an even more grim picture. Nearly one in two ever married women had excess body weight. It showed that among 15-49-year-old ever married women in Pakistan, 30 percent were overweight and 22 percent were obese. It is also striking that having unhealthy excess weight increased with increase in income and education among women in Pakistan. This is in contrast to many highincome countries where poor and under-educated women are more likely to be overweight or obese.

Obesity can be avoided by adopting a healthier lifestyle. This involves eating a healthy and balanced diet and doing regular exercise or physical activity. The WHO recommends at least 150 minutes of moderate physical activity a week for all healthy adults. How many Pakistanis are following this advice in order to maintain a healthy body and mind? Again, we do not have regular and up to date data. But the findings of a survey on stepwise surveillance of non-communicable disease risk factors conducted in Punjab and Sindh during 2013-14 showed that nearly half of the women and a quarter of the men were not meeting this recommended physical activity level.

A Gallup Pakistan nationwide survey of 1000 adults conducted in 2019 showed that 69 percent people said that they did very little or no exercise in their daily life. More than half (53 percent) people in the survey said that they never or very occasionally control the portions of food they eat and less than half (45 percent) were concerned about healthy living. There is little or no research on the perceptions of Pakistanis about healthy lifestyles and the challenges that keep them from doing more exercise or eating more health diets. Quite obviously, without such research, a successful public health intervention cannot be designed

To conclude, as we reflect on the causes and consequences of the Covid-19 pandemic, let us also think about what we can do to tackle the hidden and neglected issue of obesity. In the longer run, that’s a much, much bigger issue.

The writer is a researcher at theLondon School of Hygiene andTropical Medicine and teaches atUniversity of Essex Online.