On the occasion of 2021 World Obesity Day (4^th March), Johanna Ralston and Margot Neveux from World Obesity Federation share their views on the risks and the range of root causes surrounding obesity in the context of COVID-19.

If we have learned anything from the past 12 months, it’s that health – and its absence – is often shaped by the society we live in, and on factors far beyond our own front doors. In the case of obesity, we have also learned that when coupled with COVID-19, its presence can create significant risks. Solutions require new kinds of collaboration and breaking down of barriers, both seen and invisible.  On 4^th March 2021, the World Obesity Federation calls on everybody to help us move towards a world of greater understanding, support, and policies, building happier, healthier, longer lives for all of us. Because in the end, every body needs everybody.

One year into COVID-19

On 11 March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Early on, COVID-19 disrupted health and food systems. Lockdowns around the world led to sustained shifts in diets and levels of physical activity as well as worsening mental health, all of which may increase the risk of obesity and other noncommunicable diseases (NCDs).  Associated with the root causes of obesity, the measures taken to curb the pandemic substantially increased the risk of exacerbating an already devastating problem. It also became clear quite early in the pandemic that people with obesity were more likely to experience complications and death due to COVID-19, and at younger ages.

In light of the undeniable evidence, a group of experts, stakeholders and people living with obesity sent an open letter to WHO’s Director-General. Subsequently, WHO recognised obesity as a key independent risk factor for the worst outcomes of COVID-19. Obesity is a chronic relapsing disease as well as a major risk factor for other NCDs such as diabetes, some cancers and cardiovascular disease. With the prevalence fastest rising in low- and middle-income countries, urgent and concrete action to prevent, treat and manage the obesity pandemic is needed.

What does obesity mean for the Triple Billion Targets?

The global obesity targets are catastrophically off-track, putting other health targets in jeopardy. In addition to the Sustainable Development Goals (SDGs), WHO set the ambitious initiative of the Triple Billion Targets:

• 1 billion more people benefitting from universal health coverage (UHC)
• 1 billion more people better protected from health emergencies
• 1 billion more people enjoying better health and wellbeing

Obesity is a cross-cutting challenge across all three targets and unless the disease receives the attention it deserves, it is likely that none will be achieved. With 800 million people living with obesity and billions more at risk, obesity must be included as a priority in UHC efforts and as a vital pathway to meet many of the other health targets. As exemplified with COVID-19, people living with obesity need to be recognised as a vulnerable group prone to excess deaths during health emergencies.

In a survey conducted at the beginning of the pandemic, World Obesity asked its global membership to share their experiences and views on their governments’ responses: less than 10% of respondents thought their government had done enough to recognise the link between obesity and COVID-19 as part of its pandemic response. Providing specific guidance to countries on obesity will be vital to ensure it is sufficiently embedded in country responses, both now and to prepare for future health emergencies.

Our opportunity to act is now: revisiting the ROOTS approach

Obesity has been misrepresented as a simplistic condition that can be halted by reducing intake of a substance through willpower alone. World Obesity Federation however understands that a complex interplay of factors rather than absence of effort is responsible for the poor outcomes.

Acknowledging the lack of understanding around the disease and the urgency of the situation, the global obesity community came together at the Global Obesity Forum 2020 and revisited the ROOTS framework developed earlier in the year. Together, these stakeholders drafted a Declaration that sets out recommendations for immediate action across the obesity spectrum from prevention to treatment, within the context of COVID-19.

• Evolving evidence on the association between COVID-19 and underlying obesity provides a new urgency – and inspiration – for political and collective action. In the context of obesity, this means:
• Recognising obesity as a disease in its own right which significantly worsens the outcomes of COVID-19 infection;
• Enhancing our obesity monitoring and surveillance strategies;
• Enhancing our obesity prevention efforts while simultaneously recognising that treatment should be accessible to all;
• Adopting a holistic, systems-wide approach in the recovery from COVID-19.

Overcoming the policy inertia

Obesity is often considered in isolation of other major problems which are facing similar policy implementation challenges, leading to slow and inadequate responses (1). Obesity is also often approached in a siloed manner, rather than addressing obesity prevention and treatment simultaneously, resulting in very few and dispersed interventions that lack a comprehensive approach. Political leadership and engagement are required to improve external environments, address the underlying social determinants of health and ensure the sustainability of obesity-oriented interventions.

The evidence on the close association between COVID-19 and underlying obesity provides a new urgency, and opportunity, for global action. Our window of opportunity to fund and implement actions to ensure better, more resilient, and sustainable health for all is now. This World Obesity Day, World Obesity Federation is calling on everybody to work together and help transform this moment of crisis into an opportunity for action on obesity.

Authors:

Johanna Ralston, CEO of World Obesity Federation: Johanna is a global leader in NCD advocacy, with over 20 years of experience. Johanna has served on a number of advisory boards and expert groups for WHO, the World Economic Forum, and others, and has written for a wide range of publications on health issues.

Margot Neveux, Senior Policy Manager of World Obesity Federation: Margot has a Master’s Degree in Public Health, joining World Obesity Federation in 2018. She is currently involved in the Organization’s global childhood obesity and advocacy activities, including two EU Horizon-2020 projects: STOP and CO-CREATE.

Additional reference:

(1) Hawkes C. From What to How. The role of double-duty actions in addressing the double burden. Sight life. 2018;32(2):82-85. Available at https://sightandlife.org/wp-content/uploads/2018/12/17_SALMZ_0218_ Perspectives_04.pdf   

 The views expressed in this blog are solely the authors' own and do not necessarily represent the views of the NCD Alliance.