As Europe emerges from its coronavirus lockdown, public health experts point to an uncomfortable truth: Many of its citizens will need to shed some weight as part of a long-term prevention strategy.
The question for the EU is whether it’ll miss a key moment to intervene.
One clear finding from the pandemic is that people with pre-existing conditions — including obesity and related conditions such as type 2 diabetes and hypertension — face higher risks of severe illness and death.
And worse, this vulnerable population is growing. According to the World Health Organization, the share of adults in the EU who suffer from obesity or are overweight increased from 47 percent in 1990 to 60 percent in 2016.
Moreover, around 1 in 3 children aged between 6 and 9 in the EU are overweight or obese — a strong predictor for future weight problems — according to World Health Organization data.
“Obesity is a gateway disease to over 230 different complications,” explained Jacqueline Bowman-Busato, EU Policy Lead at the European Association for the Study of Obesity.
That list includes 20 percent of cancers, she noted, while 80 percent of people with uncontrolled or severe obesity go on to develop type 2 diabetes.
A raft of new findings shows just how much heightened risk obesity can bring.
For example, a recent report published by Public Health England (PHE) on Covid-19 risk disparities found that, when adjusting for age and gender, almost 8 percent of critically ill patients in intensive care units with Covid-19 suffer from morbid obesity, compared with around 3 percent of the general population.
The report also cited a study by the OpenSAFELY collaboration that examined 17 million adult electronic health records. It pointed to a relationship between the risk of death from Covid-19 and being overweight, as measured by body mass index (BMI).
In the U.S., meanwhile, two recent studies from NYU Langone Health suggested obesity is a key predictor for severe cases of Covid-19.
One study looked at data from more than 4,000 patients who sought treatment in March. In a statement, study author Leora Horwitz concluded that obesity was a more important factor for hospitalization than high blood pressure, diabetes, coronary disease, kidney disease or cancer — it even beat pulmonary disease.
The other suggested that patients with obesity were twice as likely to be hospitalized and faced a higher risk of needing critical care than the non-obese.
Recent studies out of China and France have come to similar conclusions.
But the exact reasons for this remain unclear.
“There may be mechanical issues,” said Chantal Mathieu, senior vice president of the European Association for the Study of Diabetes (EASD) and head of endocrinology at University Hospital of Leuven. “If you have 40 kilograms on top of you, it may be more difficult to ventilate the lungs,” she said.
What is certain, Mathieu explained, is that mortality in this group of patients, who have a host of interrelated issues like diabetes and heart problems, is higher.
The Commission said it’s taking the problem seriously, but it has yet to detail how many resources in the newly announced EU4Health program will go toward fighting obesity.
“It is clear that the diets of European consumers aren’t in line with dietary recommendations,” said Commission spokesperson Stefan De Keersmaecker. “This has a knock-on effect on general health, with a high prevalence of diet-related diseases, including various forms of cancer and cardiovascular diseases.”
On the immediate horizon, the European Centre for Disease Prevention and Control is drafting guidance on how to safeguard vulnerable groups — including the elderly and those suffering from hypertension, diabetes or obesity. This text will be published “soon,” according to De Keersmaecker.
But the Commission still has to decide how much EU4Health will play a role. A proposal document for the program leaves the obesity question open, mentioning only that EU4Health should “contribute to the reduction of … unhealthy dietary habits and physical inactivity … and foster supportive environments for healthy lifestyles.”
The program still needs to be finalized, with amendments likely to come before it goes to the European Parliament and Council for approval. And while the final document is likely to discuss tackling cancer, it remains to be seen how prominently other non-communicable diseases will feature in the plan, which has been presented as a response to the coronavirus emergency.
Portuguese MEP Sara Cerdas, S&D shadow rapporteur for EU4Health, said the program should address not just the biggest direct killers, but the main conditions that cause co-morbidities.
“It’s important that it tackles risk factors, and here obesity is quite important,” Cerdas said, noting that the Covid-19 pandemic couldn’t be disentangled from the broader topic of health.
Until now, the Commission’s efforts to tackle obesity have been channeled through its new Farm to Fork strategy, which seeks to green Europe’s food system and reverse the trend of rising obesity within 10 years.
There, De Keersmaecker points to several core proposals like requiring nutritional labels on food packaging and creating an EU code of conduct for responsible marketing.
More broadly, the Commission’s health program has invested more than €16 million into 26 projects related to nutrition since 2015. It’s also working with member countries to reach the United Nations‘ Sustainable Development Goal of reducing mortality caused by non-communicable diseases by a third by 2030.
Not everyone is satisfied with the pace of change in the EU.
The EASD’s Mathieu said she’s disappointed in its response to protecting vulnerable populations.
“We were a bit slow in Europe,” she said, adding that other health topics have taken a backseat to the COVID-19 response.
Since the virus is affecting a population that already has other diseases, the public health response to the pandemic “should be embedded in everything else,” she added.
For Bowman-Busato, a first step would be for the EU to acknowledge obesity as a chronic disease, something already done by the WHO. From there, it could produce a framework to harmonize obesity response plans in different member countries and help strengthen obesity centers of management.
Finnish MEP Sirpa Pietikäinen, of the European People’s Party, said she’s worried that the window of opportunity from the pandemic will quickly close.
She’s calling for prompt action on several fronts, for example, by expanding European Reference Networks — platforms where doctors and patients can exchange information and hold seminars — to include non-communicable diseases associated with obesity, such as diabetes and heart diseases.
While the coronavirus outbreak has been disruptive to those living with obesity and related conditions — like interrupting normal medical care and leading to canceled doctor’s appointments — it hasn’t been all bad news.
Niti Pall, the International Diabetes Federation Europe regional chair, points to the increased role of online communities that have helped fill the communication gap. Telemedicine has also helped circumvent some of the obstacles thrown up by the pandemic.
“All of a sudden insurers let us do teleconsultation when we couldn’t a couple of months ago,” agreed Mathieu. “[Those include] consultations with people with obesity, motivating them and doing exercise at home, coaching them for dietary advice.”
Generally, the lockdowns are changing Europeans’ eating habits, in some cases for the better. One YouGov survey in April found that 38 percent of Britons reported cooking more often from scratch, while 33 percent said they throw away less food.
The poll also showed a majority wanted at least some of the personal or social changes made under lockdown to continue.
Organic and sustainable foods are also increasingly popular, according to Ecovia Intelligence, a research company. In France, for example, some organic food shops are reporting sales increases of over 40 percent.
Meanwhile, governments in Europe are trying to make the most of the crisis in order to discourage car use in favor of greener and healthier forms of transport. Italy, for example, has introduced generous cash subsidies to encourage purchases of bicycles — which unlike public transport avoid close contact with other commuters.
Bowman-Busato cautions that there’s more to obesity management than healthy eating. Rather, obesity stems from a range of causes that run from hormonal balances and psychological issues to environmental factors, she said, adding that DG SANTE could do more to lead on this issue as a chronic, relapsing disease.
“If they actually want to not just stem the tide but make sure other vulnerable populations are decreasing, they’ll deal with obesity properly,” she said. “And that means expanding and extending the narrative [around the condition].”
Zosia Wanat and Jillian Deutsch contributed reporting.
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