World Obesity Federation President Professor John Wilding explores the mental and physical issues surrounding obesity and weight management and the links to COVID-19.
Obesity is considered a significant risk for COVID-19. Medically speaking, patients are considered to be affected by obesity if they have a body mass index (BMI) of 30 or higher. World Health Organization figures report around two billion people around the world are overweight, with around 650 million of those living with obesity; between 1975 and 2016, the proportion of the world’s population affected by obesity nearly tripled. By 2025, projections indicate, more than a billion people will be living with obesity.
HEQ speaks with Professor John Wilding, President of the World Obesity Federation, about the mental and physical health components of obesity and what can be done to address the issue.
Is there commonly a mental health component to obesity as a condition?
There is no question that obesity can be related to mental health issues, such as depression and anxiety. These are often exacerbated by the stigma experienced by some people with obesity as a result of their weight. There are also links to serious mental illness such as schizophrenia, severe depression and bipolar disorder; this is complex, but may be related to the medicines that are used to treat these conditions and which often cause significant weight gain. There is a growing body of research that shows that trauma and general adverse life experiences are a risk factor for developing obesity1.
Is gut health a key factor in weight management?
People with obesity seem to have a different profile of gut bacteria than people who are of healthy weight. It is not clear if this is due to a different diet or a direct consequence of obesity. Some research in animals suggests that the gut bacteria may contribute to altered appetite and therefore contribute to weight gain, but this has not been proven in people.
Obesity is considered a significant risk factor for COVID-19: is there a possibility this could be exacerbated by lockdown measures such as the closure of gyms and public parks, as well as the disruption to food supply chains caused by the pandemic?
This seems likely – many people have found lockdown to be stressful; and one response to that is ‘comfort eating’ and an increase in alcohol consumption, both of which can lead to weight gain. Although some people have started walking and cycling more, the overall impact of lockdowns on physical activity seems likely to be negative, especially with the closures of gyms, pools and other public leisure facilities. Limits on how far people can travel to exercise may have disproportional adverse effects in poorer communities, especially in cities where access to open space may be very limited.
It is still too early to determine if obesity is a risk factor for contracting COVID-19; what we do know so far is that obesity increases complications of coronavirus and is associated with a higher fatality rate2. Although physical activity plays a crucial role in overall physical and mental health and is highly encouraged, different studies show that its association with weight loss among adults is either very weak or inconclusive3, highlighting our food supply problem and the availability of healthy accessible food during this crisis as a key problem when these two pandemics – obesity and COVID-19 – are at play.
What measures could be taken at a policy level to better address the problem of obesity?
Obesity is a complex problem with roots in many aspects of our society. The ‘roots’ of obesity include genetic predisposition, but it is are still exacerbated by food policies and marketing approaches that encourage consumption of high energy dense diets that promote weight gain, together with limited opportunities for physical activity. These are compounded by few treatment options, which are often not supported or paid for by publicly funded healthcare systems. Policies need to change to address all of these concerns; and require imaginative thinking at all levels of government as well as internationally.
There are also important links with climate change, as our current pattern of food production is not sustainable. Shifts to more sustainable diets internationally would help global health and significantly reduce the threat of climate change4 and likely reduce the risk of obesity. Likewise, a shift to more active modes of transport would also be beneficial for both goals.
How could clinical treatment of obesity evolve in the future?
Although public health measures as described above are essential, they do not help the many millions of people worldwide who are already overweight or suffer from obesity. Simply asking people to eat less and exercise more does not work, as there are biological reasons why this is difficult and why weight regain is so common in people who have successfully lost weight.
For some people this may mean additional behavioural support, or the use of low energy diets or total diet replacements that have been shown to work; for others, medicines that help people lose weight have been shown to be effective. For those who have more serious obesity (that is, those with a BMI greater than 40 and some with a lower weight with complications such as diabetes), bariatric surgery may be very effective and has been shown to save money in the long run.
Are there any significant developments or current issues in the treatment of obesity which you would like to highlight?
I think it is particularly important to make clinical treatments such as those medicines which are proven to be effective and bariatric surgery more easily available to those that need them; this means expansion of clinical services, particularly to support people with severe obesity. There are emerging medicines (currently in research trials) that seem to be particularly effective for some rare genetic forms of obesity and others that are much more effective than those we have at the moment; these could transform the way obesity is treated in the future.
2 https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.047659; https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22818
3 https://www.nature.com/articles/0802548; https://www.sciencedirect.com/science/article/abs/pii/S0033062013001655; https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.12321
Professor John Wilding
World Obesity Federation
This article is from issue 14 of Health Europa. Click here to get your free subscription today.