On an average day last month, about 30 COVID-19 patients moved through the emergency room at Mercy Medical Center Hospital in Springfield, according to Miah DiGregorio, a physician assistant who helps staff the ER. The ones sent home with mild symptoms were in general good health. But few of the patients who were admitted were metabolically healthy, normal weight, or without a preexisting condition.
Doctors and scientists are discovering two common characteristics among many of those who are losing their battle with COVID-19 — they are overweight or obese and suffer from a chronic disease. Ninety four percent of deaths from COVID-19 are in those with an underlying age-related chronic disease, mostly caused by excess body fat.
COVID-19 has pulled back the curtain to reveal just how unhealthy we are as a nation. Only about 12 percent of Americans are metabolically healthy, without a large waist, high blood pressure, high blood sugar, or high cholesterol. The major driver of poor metabolic health, which increases the risk of hospitalization and death from COVID-19, is the nation’s diet — rich in starch, sugar, and processed foods and low in unprocessed food, vegetables, fruits, whole grains, beans, good fats, seafood, nuts, and seeds.
While some otherwise healthy individuals with COVID-19 are hospitalized, the vast majority of hospitalized patients are overweight or suffer from a diet-related chronic disease such as diabetes, heart disease, lung disease, or cancer. Adjusting for other risk factors, Americans with obesity have a more than four times higher risk of hospitalization, while those with severe obesity (a body mass index of over 40 versus 30 for obesity) have a more than six times higher risk.
But how many COVID-19 hospitalizations, ICU admissions, and deaths could be prevented if the United States, and the world, had a better diet and better metabolic health?
The sad reality is that 75 percent of Americans are overweight, and more than 42 percent are obese. Chronic disease affects 6 out of 10 Americans. Also 20 percent of normal-weight people have prediabetes. These shocking rates of poor metabolic health — with nearly 9 out of 10 American adults unhealthy — is a major reason the COVID-19 crisis is so much greater than it needs to be.
Poor metabolic health from unhealthy food, the result of our toxic food environment, probably also explains much of the disproportionate burden, hospitalization, and death from COVID-19 in low-income and minority populations. In Chicago and Louisiana, Black people account for 70 percent of COVID-19 deaths while making up only about 30 percent of the population in those communities. Deaths in predominately Black counties are six times higher than in white counties.
What do most chronic diseases and obesity have in common? They are diet-related diseases. Our modern diet — rich in processed starchy, sugary foods and low in protective health-promoting foods — globally kills 11 million people a year, making it the single biggest cause of death, and it is preventable. In America, 60 percent of our calories come from ultra-processed products, which contribute to the rates of obesity, diabetes, hypertension, heart disease, some cancers, unhealthy aging, and more.
All of these conditions cause inflammation.
When COVID-19 lands in a pre-inflamed person, it is like putting gasoline on a fire. The inflammatory explosion, known as the “cytokine storm” (when the body attacks its own tissues and cells), is a major driver of the need for hospitalization, admission to ICUs, ventilator use, and death.
It is not the virus itself that kills us, but the overwhelming inflammation that results from an immune system already on high alert. Obesity and poor metabolic health cause both increased levels of inflammation and immune suppression, escalating the risk of severe illness and death from COVID-19. Obesity is linked to an impaired ability to fight viral infections, increased viral shedding and death from seasonal flu, and reduced effectiveness of vaccines.
In medicine, we call this an “acute on chronic problem." When a smoker with emphysema gets pneumonia, the outcomes are far worse than a pneumonia in someone with healthy lungs. In the case of COVID-19, the pandemic is an acute on chronic problem relating to our tragically poor metabolic health. It reveals the vulnerability of our population to disease and death. This is a major reason why COVID-19 is ravaging our population and our economy.
We’ve created the perfect environment for COVID-19 to thrive, thanks to our broken food system that grows, processes, markets, and distributes an abundance of cheap, inflammatory, nutrient-depleted, and immune-suppressing ultra-processed foods without sufficient healthy, minimally processed foods like nuts, fruits, beans, vegetables, whole grains, healthy fats, seafood, and more.
Pre-pandemic, we failed to effectively address the crisis of diet-related obesity and chronic disease. Hundreds of millions of people were afflicted and trillions of dollars consumed by health care spending and lost productivity for this population.
Our food system makes healthy food the hard choice and toxic food the easy choice.
COVID-19 has now connected the dots. It has revealed the enormity of chronic disease in America and the devastating costs to the nation’s health, economy, and health care system, especially during a pandemic.
If most patients, like the metabolically healthy emergency room patients seen at Mercy Medical Center, had mild, non-life-threatening symptoms, there would be less risk for all of us. We could then focus our attention on, and additional precautions for, the at-risk in our communities.
If we want to flatten the curve, protect our economy, and be more resistant to future pandemics, it is imperative we reduce diet-related chronic disease and obesity in America.
To do so, we need policy change in Washington that will reshape our food system from field to fork, resulting in the production and consumption of healthier whole foods. Only then, can we transform the health of our nation, truly flatten the curve, and be more immune to future pandemics.
Dr. Mark Hyman is head of strategy and innovation at the Cleveland Clinic Center for Functional Medicine and author of “Food Fix: How to Save Our Health, Our Economy, Our Communities and Our Planet — One Bite at a Time." Dr. Dariush Mozaffarian is dean of the Friedman School of Nutrition Science and Policy at Tufts University.