The Centers for Disease Control (CDC) – our national public health watchdog – tells us that the best way to avoid problems with COVID-19 is to avoid being exposed to it in the first place. This includes social distancing, washing hands frequently, not touching our face, disinfecting high-touch surfaces, wearing face masks in public and around people who might be sick, and staying home. Many of us have followed this script carefully. Amazingly, as we did once before in the aftermath of 9/11, we have suddenly and dramatically shifted our group behavior to focus on safety first and taking care of the collective. Our individual motivation for change is high, and our collective focus on defeating this new enemy is laser-like.
How COVID-19 is taking advantage of the epidemic levels of obesity and chronic disease in the U.S.
COVID-19 is highly contagious and fast-moving. It is capable of causing direct lung and heart tissue damage and evokes an intense immune reaction (or “cytokine storm”) in some infected patients. COVID-19 clearly can affect people at any age, but it is most dangerous for the elderly (>65 years), and particularly those with chronic diseases such as hypertension, cardiovascular disease, diabetes, chronic kidney disease, chronic lung disease/asthma, dementia, and cancer. This puts the majority of our elderly at risk given that 85% of people over 65 have one or more chronic condition and 23% have three or more chronic conditions.
Why are our elderly so physically and mentally fragile?
Obesity-related chronic diseases have exploded in prevalence in the US since the 1970s, in large part due to a cultural shift towards highly processed foods; fast foods; sugar sweetened drinks; larger portions; eating and drinking becoming part of a wider range of social and recreational activities; cross-selling of junk foods in pharmacies, gas stations, school cafeterias, hospital cafes, airports, etc.; and sedentary living. Together, these factors promote obesity. Today, 60% of the American diet is highly processed. This has contributed to the rate of obesity in the United States reaching 39%, compared to 13% in the 1960s. Clearly the human body is not designed to process this new diet and lifestyle.
Obesity-related chronic diseases are now at epidemic levels. Type 2 diabetes has doubled among adults since 1970 and is now seriously affecting our youth. Also, our perceptions of aging have shifted to include the belief that getting old means experiencing poor physical health and mental frailty, conjuring up visions of nursing homes and assisted living facilities as the norm. But in fact, obesity and related chronic diseases were unheard of 100 years ago and are rare today among the elderly in areas of the world called “Blue Zones”. Blue Zones have been the focus of recent and promising research on aging. Blue Zone communities include Okinawa (Japan), Sardinia (Italy), Ikaria (Greece), Nicoya (Costa Rica), and Loma Linda (USA). Loma Linda is a clean-living Adventist church community in California that – like all Blue Zones – has a high number of centenarians and low rates of chronic disease. The Loma Linda residents are described as physically active, non-smokers, non-drinkers, and having close spiritual and community bonds. What exactly do they eat? The figure below shows that their typical diet looks nothing like the food that average Americans eat, including the food and drinks commonly served in nursing homes or available at corner stores, restaurants, or supermarkets.
Interestingly, the diet of the elderly living in Blue Zone regions of Italy and Greece look a lot like the healthy meal plans recommended by the American Diabetes Association in their evidence-based clinical guidelines (Mediterranean Diet and the DASH Diet). Blue Zone diets resemble those recommended by other national medical authorities for chronic condition management, which offer ways of eating that do allow for personal and local cultural preferences to be built into meal planning but involve consumption of mainly minimally processed plants, including vegetables, fruits, whole grains, nuts, seeds, mushrooms, and beans, with small amounts of added fish, meat and dairy.
What do obesity and chronic diseases in the elderly have to do with COVID-19?
When vulnerability from obesity and chronic conditions, including weakened hearts, lungs, kidneys, and other vital organs comes together with COVID19, the risks of contracting the virus in the first place, as well as experiencing life-threatening complications, go up sharply.
What is the take home message from all this?
Right now, the nation is facing a ferocious COVID-19 virus that can only be beaten with coordinated science, public health expertise, intensive medical care for those most affected, and a concerted and national focus on preventative health behaviors appropriate for containing infectious disease. The next take-home message is that there is a reason that our elderly population is suffering more with COVID-19. It is not aging that is the problem, but unhealthy aging.
“There is a reason that our elderly population is suffering more with COVID-19. It is not aging that is the problem, but unhealthy aging.”
Once the COVID-19 pandemic subsides, a smart and necessary national plan to prepare for the next viral epidemic that comes along is to leverage the collective commitment we’ve had to change our behavior in order to prevent infection, and redeploy that commitment to focus on the betterment of our long term individual and collective general health. Let us focus on our national food supply and our cultural eating habits, and while we are at it, let us reform the healthcare system to support that vision. Such a revolution would put primary care and community medicine at the center of the US healthcare system, not specialty medicine, and would prioritize chronic disease prevention to help citizens of all ages live safer and healthier lives.
Garry Welch, PhD is an expert in the area of behavior medicine for chronic disease care. He has extensive experience leading clinical research on behavior change strategies for people with diabetes and other chronic diseases. Dr. Welch’s 30+ years of clinical research led to co-founding Silver Fern Healthcare. He leads research and development at Silver Fern.