The COVID pandemic has clearly underscored the consequences of another American health crisis: the obesity epidemic. And it further emphasizes the necessity for integrating sustainable lifestyle practices that promote general health and wellbeing.
In a sense, COVID tells a tale of two pandemics: one infectious, and one chronic and longstanding.
The SARS-CoV-2 virus has permeated our everyday life for two years now, and many of our patients have had drastic changes in their lifestyles as a result. Community activities shut down, gyms closed, and many people became more sedentary. A lot of people started working from home, thus reducing their already minimal daily walking and movement. Even shopping has shifted online, and many people need only walk from the couch to the front door or the curbside to pick up their deliveries.
Putting it simply, the pandemic has rendered many of us inactive, which is furthering our already alarming obesity rate. And we know that obesity and its related metabolic disorders are major COVID risk factors.
The CDC reports that in 16 of the 50 states, 35% or more of all residents are now obese. That’s up from 2018, when 9 states had a 35% prevalence. A CDC-sponsored study of more than 540,000 hospitalized patients hospitalized showed that COVID-19 was linked to underlying conditions such as obesity, diabetes with complications, and anxiety disorders were the strongest risk factors for severe COVID and death.
What we have here is a vicious cycle: Obesity predisposes people to a severe COVID, but strategies aimed at preventing transmission of infection (work from home, online shopping, shuttering of social and recreational activities) promotes obesity.
To help our patients navigate this tumultuous time, we need to address both of these pandemics, and teach people about lifestyle factors that can reduce the risk of both.
Here are five sustainable ways for your patients to transform their health, maintain a healthy weight, and support their immune system.
High-Protein Breakfast: Patients often come to us for dietary guidance. One of the best pieces of advice we can share is to eat a higher protein breakfast.
A 2015 study of 28 overweight but otherwise healthy adolescents showed that eating a daily breakfast containing at least 35 grams of protein, can reduce 24 hour glucose variability, daily glucose peaks, and post-prandial glucose fluctuations (Bauer LB, et al. Int J Obes. 2015). It improves overall glucose control, thereby helping people maintain or work toward health weight.
Of course it is also important to minimize fast foods, processed foods, and products laden with added sugars, artificial sweeteners, and trans fats.
Physical Activity: Working out is an excellent way to lower obesity in the population. I believe it is part of our job as physicians to make sure that our patients engage in a workout routine of some sort that they enjoy and that won’t lead to fatigue or injury.
The American Heart Association recommends that healthy adults get 150 minutes (30 minutes, five days a week) of aerobic activity. This is easily accomplished with a 30-minute walk after dinner. If someone can’t walk for 30 minutes straight, break it out into three 10-minute walks, or two 15-minute walks.
If a patient has been completely sedentary, it’s best to ease into physical activity rather than immediately jumping into an intensive routine. The main thing is to get people moving. Moderate exercise is crucial during this prolonged pandemic.
A recent Kaiser Permanente analysis of data from more than 48,000 COVID patients showed that those who were routinely inactive had significantly higher risk for severe Covid-19 outcomes (hospitalization, ICU admission, death) than those who consistently met basic physical activity guidelines (Sallis R, et al. Br J Sports Med. 2021).
Optimize Sleep: The CDC recommends that adults aged 18-60 years get seven or more hours of sleep per night. The reality is that our patients might be sacrificing sleep to accomplish other goals such as work, social or familial responsibilities.
Sleep is essential for physiological and neurological rest and repair. It also plays a central role in maintaining healthy weight and sleep deprivation impedes the ability to lose weight.
University of Chicago researchers showed that people sleeping 8.5 hours lost 55% more body fat than those sleeping an average of 5.5 hours, while following exact same moderately restrictive diet (Nedeltcheva AV, et al. Ann Intern Med. 2010).
Keep in mind that lack of sleep or burnout may increase risk of Covid-19 infection, so proper sleep is a key factor not only for reducing risk of obesity, but also for staving off SARS-CoV-2 and other viruses as well.
Reduce Exposure to Obesogens: Obesogens are synthetic chemicals that disrupt the endocrine system and lead to weight gain and obesity. Many of these compounds also hinder the body’s natural immune response. They are being let loose at astonishing rates into our environment. According to an excellent summary on the website Seeker.com, worldwide there are 10 million new chemicals released each year, which is more than 1,000 per hour. Only a tiny percentage of them have been studied in terms of their ecological and physiological impacts.
More than 20 chemicals have been identified as obesogens, many of which are estrogenic in that they easily bind to estrogen receptors. The five obesogens most commonly found in the home are Bisphenol-A (BPA), Phthalates, Atrazine, Organotins, and Perfluorooctanoic Acid (PFOA).
Reducing exposure to these chemicals is as simple –or as complex—as paying attention to the types of personal care, cosmetics, and household products one purchases. Choosing the ones that are free from some or all of these compounds. It is also wise to minimize the use of plastic containers for food storage or preparation, since plastics are a major source of obesogenic substances. Glass, stainless steel, and ceramic options abound, and they are much safer.
Optimize Vitamin D Levels: For overall health improvement, this is one of the easiest changes to implement. Taking a vitamin D supplement is a completely sustainable habit that can have a tremendous impact on patient health, especially for people living in northern latitudes that do not get as much sun exposure.
There’s ample evidence that low vitamin D correlates with high COVID risk. A study from the first year of the pandemic showed that vitamin D deficiency was associated with a six-fold increase in severe disease from COVID-19 and 15-fold risk of death, so this is a healthful, timely and easy resolution (Radujkovic A, et al. Nutrients. 2020). Since then, many other studies have been published, from all over the world, showing this inverse correlation.
Beyond vitamin D, many other nutrients can be helpful for immune system support. Getting a better snapshot of your patient’s immune system can help you to tailor your suggestions. Cyrex Laboratories, a clinical laboratory specializing in functional immunology and autoimmunity, has developed a test panel called the The Lymphocyte MAP™.
The Lymphocyte MAP screens the integrity of the immune system to define a patient’s immune status and immunotype(s) based on 29 key biomarkers and determinants. It tells you a lot about the current status of a patient’s immune system so that you can provide guidance on adjustments that will bolster immune response.
As the COVID-19 pandemic continues to surge, this can be vital information as we work to help our patients fight not only the virus, but the broader pandemic of obesity and metabolic dysregulation.
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Dr. Chad Larson, NMD, DC, CCN, CSCS, Advisor and Consultant on Clinical Consulting Team for Cyrex Laboratories. Dr. Larson holds a Doctor of Naturopathic Medicine degree from Southwest College of Naturopathic Medicine and a Doctor of Chiropractic degree from Southern California University of Health Sciences. He is a Certified Clinical Nutritionist and a Certified Strength and Conditioning Specialist. He particularly pursues advanced developments in the fields of endocrinology, orthopedics, sports medicine, and environmentally-induced chronic disease.
