Prime Minister Boris Johnson has launched a series of policy initiatives as part of the Government's new obesity strategy. The strategy aims to improve the health of the nation and offer greater protection against the impact of COVID-19 and, in addition, to protect the NHS from being overwhelmed should a second wave of the virus threaten society.
Background
Few readers would have imagined the utter carnage and chaos that would follow in the wake of the COVID-19 pandemic as it swept across Europe in the early months of 2020. In a television broadcast on Monday 23 March 2020, Johnson announced that, apart from key workers, UK citizens must stay at home, apart from brief periods for exercise and shopping for essentials, and that many businesses would have to suspend activities.
This start of the nation's lockdown was accompanied by nightly government public awareness broadcasts. At first there was a public swell of war-time spirt of pulling together against adversity, with the Prime Minister playing a similar role to that of Winston Churchill during the Blitz in the Second World War. On Friday 27 March, however, it was revealed that Johnson had tested positive for COVID-19 and that he had placed himself in self-isolation (Guardian, 2020). Public fear of the power and infectivity of this novel virus was exacerbated when it was further revealed that the Chief Medical Officer, Chris Whitty, the Secretary of State for Health and Social Care, Matt Hancock, and Prince Charles were all having to self-isolate after developing symptoms of COVID-19. The country was facing an alarming public health crisis with several of its public figures in quarantine.
On 5 April came the shocking news that the Prime Minister had been admitted to St Thomas' Hospital, London, for tests because his coronavirus symptoms were worsening. The following day Downing Street announced that the Prime Minister's condition had deteriorated and that he had been admitted to the hospital's intensive care unit. There were some who thought that he might succumb to the disease. What hope was there for ordinary members of the public if this disease could affect the Prime Minister so badly?
The news was a wake-up call for those who were treating lockdown as some kind of extended public holiday and, as the daily death rate grew, people began to feel more frightened for their own lives and those of their loved ones—especially the frail elderly. Although Downing Street was keen to put a positive spin on the health of the Prime Minister, health professionals understood the gravity of the situation. Fortunately, after several days in intensive care the Prime Minister was able to be discharged from hospital on 12 April (Guardian, 2020).
In addition to primarily affecting the frail elderly, COVID-19 also leads to worse outcomes for those who are obese. This is because, as suggested by Ryan and Caplice (2020), adipose tissue may act as a reservoir for more extensive viral spread, with increased shedding, immune activation, and with the potential of cytokine storm amplification.
Following his discharge from hospital, Johnson acknowledged that his deterioration was probably linked to his own excess body weight. When launching his policy initiative in a candid televised interview, the Prime Minister admitted that he had been ‘way overweight’ when he was admitted to intensive care. He conceded that he had wanted to lose weight for some time and had struggled to do so. However, following his recovery he has endeavoured to run every morning and has clearly lost weight (McGee, 2020). The interview was released to coincide with the publication of a Department of Health and Social Care (DHSC) policy paper (DHSC, 2020) and an NHS strategy entitled ‘Better Health’(NHS website, 2020). Johnson has spoken about the personal benefits of losing weight, as well as the bigger picture for the country as a whole in protecting the NHS during the current crisis.
Facts about obesity
The World Health Organization (WHO) defines adult obesity as when an individual has a body mass index (BMI) of 30 or greater and defines being overweight as a BMI of greater than 25. The WHO has described obesity as a global epidemic and levels around the world have tripled since 1975, with about 13% of adults being obese and about 39% of adults being overweight. Some 38 million children under the age of 5 years were overweight or obese in 2019 (WHO, 2020).
According to new government figures, 63% of adults are now above what would be considered a healthy weight, with around 50% of these people being obese (DHSC, 2020). Additionally, some 20% of children aged between 10 and 11 years of age are obese, with those living in deprived areas being twice as likely to be obese (DHSC, 2020). The Government has stressed the link between dying from COVID-19 and obesity and has highlighted that excessive tissue fat around vital organs increases mortality rates among individuals infected with coronavirus.
After Turkey and Malta, the UK is the third fattest country in Europe, with an overall obesity rate of 27.8% (The Week, 2018), which may explain some aspects of the UK's high mortality rate during the worst period of the pandemic.
The Better Health campaign
The Better Health campaign owes much to the Prime Minister's personal crusade to tackle obesity. The benefits of cycling are being highlighted, together with strategies to tackle the country's addiction to so-called junk food, filled with empty calories (NHS website, 2020).
Successive governments have introduced policies that aimed to address obesity in childhood, but their success in tackling the crisis has been limited. Celebrity chef Jamie Oliver has worked with five successive prime ministers over the years to help devise a workable obesity strategy. He has wholeheartedly endorsed the aspirations of the new campaign (https://www.jamieoliver.com/campaigns/).
The primary goal of the latest strategy is to reduce levels of obesity by promoting healthy eating and physical activity. Supported by a £10 million investment, the Government is encouraging people who are overweight to shed 2.5 kg, predicated on cost savings to the NHS amounting to £105 million over a 5-year period, plus lives saved in the event of a second phase of the COVID-19 pandemic (DHSC, 2020). This latest initiative operates in parallel with the ongoing efforts of Obesity UK, which runs online support groups (https://www.obesityuk.org.uk/support-groups).
The new campaign will adopt a wide range of measures to address societal obesity, such as ensuring that all restaurants indicate the calorie count on their menus and prohibiting the advertising and promotion of unhealthy food on television and in shops.
Cycling is a major plank in the campaign, which includes empowering GPs to prescribe cycling to overweight patients in deprived areas. Some 50 000 ‘Fix Your Bike’ vouchers worth up to £50 were made available, to be used for standard servicing and replacing components in England (Department for Transport, 2020).
Better Health will tackle obesity by:
The Better Health policy offers visitors to the website useful advice and a 12-week weight loss plan to help those who wish to shed weight. The plan helps people:
Frontline care workers
As a second wave of the coronavirus looms, and with no immediate availability of a vaccine, losing weight for some may be a life saver. Nearly 8% of critically ill patients with COVID-19 in intensive care units have been morbidly obese compared with 2.9% of the general population (Public Health England, 2020). It is worrying that the frontline staff who care for these patients are at increased risk of being infected and many are themselves overweight or obese. As long ago as 2009, a cross-government strategy to address obesity in England indicated that, of the 1.2 million staff in the NHS, it was likely that around 300 000 would be classified as obese and a further 400 000 as overweight (Cross-Government Obesity Unit, 2009).
Research on levels of obesity among cohorts of nurses, for example, shows that they have a higher prevalence of being overweight compared with the general population (Bogossian et al, 2012). Alterman et al (2013), who researched obesity in US healthcare workers, suggested that work-related factors may contribute to this. They suggested that employing institutions should consider workplace interventions to address obesity levels. However, giving advice to healthcare staff about weight management through exercise sometimes fails to appreciate the 12-hour shift working patterns that are now ubiquitous in many hospitals and where a walk in the park is probably the last thing on a busy nurse's mind at the end of the working day or night, especially after wearing full personal protective equipment. Despite this, in the face of a second wave of COVID-19, overweight NHS staff will remain vulnerable.