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The obesity pandemic has made COVID much more deadly

Dr. Dariush Mozaffarian of Tufts University says 64 percent of all the hospitalizations from COVID-19 could have been prevented, if we had a metabolically healthy population.Suzanne Kreiter/Globe Staff

The Big Idea is a regular column exploring research that can change how you live your life and how you think about the world.

It was the jump ropes that got me.

Just about a year ago — November of 2020 — Dr. Mary Beth Miotto, the vice president of the Massachusetts chapter of the American Academy of Pediatrics, said she had noticed something strange happening to her young patients: Many were putting on a lot of weight. Quickly.

Only eight months after kids were sent home, some of the school-age children Miotto saw couldn’t fit into their clothes. And she was handing out jump ropes at doctor’s visits to encourage them to exercise.


“I’m seeing very disturbing trends,” she said at a press conference, alongside Governor Charlie Baker. “The long-term consequences of rapid weight gain and sedentary lifestyles will certainly be seen for years to come.”

Early on, researchers began to realize that obesity was a major risk factor for being admitted to the hospital with COVID-19.

By the summer of 2020, a study in Science revealed that “people with obesity who contracted SARS-CoV-2 were 113% more likely than people of healthy weight to land in the hospital, 74% more likely to be admitted to an ICU, and 48% more likely to die.”

Dariush Mozaffarian, dean of the Tufts Friedman School of Nutrition Science and Policy, and a cardiologist, knew the United States was in trouble. He has spent a career watching Americans gain weight — nearly three quarters of us are now overweight or obese — and he knew that we needed to eat more unprocessed foods, and exercise regularly.

But his message mostly went unheard.

In fact, his own recent research, he says, suggests that “64% of all the hospitalizations from COVID could have been prevented, if we had a metabolically healthy population, without the rates of obesity and diabetes and hypertension that we have now.”


Just take a minute to let that sink in.

Remember months of overcrowded hospitals? TV footage of packed ICUs, overworked medical staff, patients who couldn’t have their loved ones come visit them.

Now imagine that two out of every three patients could have avoided being hospitalized.

And Mozaffarian suspects that the death rate could have been similarly reduced.

Indeed, researchers at Johns Hopkins have found that the death rate from COVID-19 in the United States (230 per 100,000) is one of the highest in the world, about four times as high as the death rate in countries as diverse as El Salvador, Indonesia, Denmark, and Morocco.

Why is that? Mozaffarian believes we’ve been living through a slow-moving pandemic for decades, when it comes to weight gain and the complications that stem from it.

Then, in 2020, that slow-moving pandemic collided with a fast-moving pandemic: COVID-19.

If we had been healthier as a country, he argues, we may not have closed as many workplaces, businesses and schools.

But the collision of these two pandemics created yet another problem.

Not only did the slow-moving pandemic make the fast-moving pandemic worse, but the fast-moving pandemic also made the slow-moving pandemic worse. Both adults and kids who were stuck at home often found themselves snacking more and exercising less.

Which brings us back to jump ropes.

The weight gain that Dr. Miotto noticed in her patients, on a small scale, has now been borne out by large-scale data.


The CDC recently reported that the rate at which children normally gain weight just about doubled during the pandemic.

And children who were already obese gained weight five times as fast as they had before the pandemic — an incredible statistic.

Adults too seemed to have put on more weight than in non-pandemic times (unsurprising to many of us), but the impact of the pandemic’s disruption on kids will be felt for generations.

“Already, before the pandemic, one in four teens were obese,” says Dr. Mozaffarian. “One in four teens had pre-diabetes. One in six teens had non-alcoholic fatty liver disease.”

He notes that “we already had a tsunami of poor metabolic health in young people that has never been seen in human history before. And we don’t even know what that’s going to look like 30 years from now, because there have never been teenagers this sick.”

Estimates are that between 600,000 and 1.4 million Americans die each year from diet-related conditions. By contrast, about 375,000 Americans died of COVID in 2020, and another 375,000 have died so far this year.

What’s striking is just how little all of this has been discussed.

Mozaffarian says that people can make substantial improvements to their metabolic health with just 30 days of moderate exercise (including walking) and increased consumption of fruits, vegetables, and other unprocessed foods. But governors who made daily appearances in early 2020 rarely encouraged either healthier eating or daily exercise.


“It has been and continues to be a massive missed opportunity for the country,” he says.

So what’s the solution?

Over the summer, the Government Accountability Office proclaimed - in what felt like a cry for help — that there needs to be a national plan to deal with diet. There are all sorts of programs — from school lunches to SNAP to scientific research to nutrition labels and subsidies — that have no single point of oversight, or coordination.

Diet-related conditions are certainly as worthy of our attention as COVID-19, since they not only exact a greater yearly death toll, but have the potential to become deadlier still.

“While we and others have been trying to shout this from the rooftops, why it is that people are ignoring it is a very interesting question,” says Mozaffarian. “Part of it may just be our evolved human nature to respond to the saber-toothed tiger that’s about to kill us in the next second and to not respond the same way to the smoking volcano off on the horizon that may kill us tomorrow.”

You can follow Kara Miller on Twitter @karaemiller.

Follow Kara Miller on Twitter @karaemiller.