We are pleased to speak with Tim Lobstein, Senior Policy Advisor to the World Obesity Federation, visiting Professor at the University of Sydney, and former advisor to the WHO and Public Health England.
Tim, congratulations on the publication of the new WOF policy report, COVID-19 and Obesity: the 2021 Atlas. https://www.worldobesityday.org/assets/downloads/COVID-19-and-Obesity-The-2021-Atlas.pdf
This comprehensive document is aptly subtitled The cost of not addressing the global obesity crisis.
“Thank you, Sheree. We originally thought a more dramatic subtitle would be ‘How $6 trillion of the global cost of Covid-19 might have been avoided’ but we feared there would be confusion between the direct costs of Covid (medical staff, equipment, drugs etc) and the global economic costs (lost production etc). But I think the number is justified: based on an attributable fraction of around 30% of Covid-19 hospitalisations due to overweight, and the IMF’s anticipation that Covid-19 would lead to $22 trillion in lost global output 2020-2025, we can still make a first-order estimate that some $6 trillion losses to the global economy are attributable to overweight. We need to be clear that these costs are GDP, that is they can be seen as lost potential – lost employment, lost production, lost trade, increased poverty, children’s lost education, and increased social disparities and inequalities.
“I think we could be even stronger in our statement. In populations with a low prevalence of overweight, many fewer people needed hospitalisation and intensive treatment for Covid-19, and no significant pressure to lockdown society and damage their economies. If all the world had low levels of overweight, perhaps most of Covid-19’s costs could have been averted.”
Strong links between obesity and more serious consequences from COVID-19 infection have been evident since early in the pandemic. The Atlas presents compelling data around obesity prevalence and COVID-19 death rates, and shows that in countries where overweight affects a minority of the adult population, “…the rates of death from COVID-19 are typically less than one tenth the levels found in countries where overweight affects the majority of adults”.
“Yes, that’s exactly what I am talking about. Looking at the 163 countries for which we have data on Covid-19 deaths and overweight prevalence, then 89% of Covid-19 deaths have occurred in the 94 countries with more than 50% of adults classified as overweight, and just 11% of Covid-19 deaths have occurred in the 69 countries where less than 50% of adults are classified as overweight.
“This is not explained by differences in national age distribution, differences in economic prosperity, or differences in reporting of deaths from Covid-19, as far as we can tell. Relatively wealthy countries with low levels of overweight and long life expectancies, like Japan, Taiwan and South Korea have low Covid-19 death rates. Countries with high overweight, like Mexico and Brazil as well as Western Europe and North America, have terribly high levels of Covid mortality.
“There are exceptions of course. Some countries with higher levels of overweight have kept themselves well protected, including Australia, New Zealand, Iceland, Cuba and the Gulf States. With the success of vaccination programmes, the figures will change, and with them, I fear, the lessons will be forgotten: the story will focus on the success of science in defeating a virus, not the simple fact that an overweight population is an unhealthy population, and an unhealthy population is a sitting target for the next epidemic.”
Unhealthy overweight has become more prevalent across Europe and globally. What can you tell us about the data linking unhealthy overweight and higher national mortality rates?
“For decades we have talked about overweight and obesity being risk factors for non-communicable diseases, and we have focused on those causes of mortality. What Covid-19 has taught us is that overweight and obesity are also risk factors for communicable diseases.
“We could have been better prepared. Previous viral outbreaks, including various forms of influenza, have caused more serious consequences among people living with excess bodyweight. We have known this for a decade, and now we see what it means in the context of a major pandemic.”