Being overweight puts you at greater risk of serious illness or death from Covid-19, experts say - and now new anti-obesity strategies have been launched around the UK. In Bradford, community schemes to promote healthy lifestyles offers a novel approach to the problem. Dr John Wright of the city's Royal Infirmary explains why radical thinking is necessary.
Our complete concentration on Covid-19 has concealed another global pandemic that has been more insidious but much more harmful: obesity. Early in the pandemic, we spotted common patterns in our sickest Covid-19 patients - they were more likely to have diabetes and heart disease and, in particular, to be obese. As the novel coronavirus makes a temporary retreat in the UK, obesity has become a focus of attention not just for the NHS but also the prime minister as he role-models weight loss for the nation.
The Covid-19 treatments that we are discovering through our research trials are making important, though small, improvements in survival. However, prevention is far better than cure, and if we are going to protect our citizens then we need to not only strengthen our public health prevention measures to stop transmission in the short term, but also reduce their risk from harm from infection by tackling obesity in the longer term.
Front line diary
Prof John Wright, a doctor and epidemiologist, is head of the Bradford Institute for Health Research, and a veteran of cholera, HIV and Ebola epidemics in sub-Saharan Africa. He is writing this diary for BBC News and recording from the hospital wards for BBC Radio.
At the hospital, we have been tracking the lives of 16,000 children from birth as part of the Born in Bradford project to understand how the complex interplay between our genes, lifestyles and environment affects our later risk of physical and mental ill health. It is like a huge Child of Our Time study, but with the best scientists from across the world working together to unravel the clues. The project has shown that our risk of obesity starts very early in life and is particularly high for children of South Asian heritage. The trail of breadcrumbs as to why South Asians have twice to four times the risk of diabetes and heart disease leads back to birth.
As these Bradford children grow up, they face very different futures if they live in Ilkley, one of the richest places in the country, or Manningham, one of the poorest. If they are growing up in inner-city Manningham then they will be surrounded by food swamps of fast-food outlets, and food deserts of healthy options. Poor-quality houses lack proper kitchens to prepare healthy meals. The roads are too busy and dangerous to cycle or even walk to school. Lack of parks and gardens hinder active play. Junk food advertising infects young minds and poor-quality food is all that some families can afford.
Our efforts to tackle obesity are depressingly futile and the girth of the world's population continues to expand. We focus too often on blaming people for bad choices rather than addressing the wider, interacting and complex conditions that lead to obesity. There is no simple behaviour change advice comparable to hand-washing or social distancing, no simple drugs such as dexamethasone or remdesivir to dispense.
Dr Mathew Mathai has worked in the paediatric diabetes clinic at St Luke's Hospital in Bradford for over a decade. When he first started, he says, children with type 2 diabetes were unheard of at the clinic - now there are 18 at any one time.
His clinic has been held virtually during the pandemic and he will soon be seeing his patients again, with a proper opportunity to weigh them and find out how social distancing restrictions have affected them.
"It will be really interesting to see what lockdown has done: for some it's been a useful period to think about exercise. And others have gone the other way and they've been in all the time, watching TV and eating more," he says.
Much of the work his clinic does is about motivation - and Dr Matai is keen to enlist people in the community who can help with that.
One such person is Tahira Amin, a registered dietitian, who was on maternity leave when she realised more could be done locally to help improve fitness, health and the whole feel of the inner-city area around Lister Mill in Bradford.
"I wanted to enjoy my pregnancy but still needed a challenge and investigated what I could do in the local community," she says. She'd already been involved in a programme to teach fencing to Muslim young women and girls and now she had an idea for another project - to promote good health by taking over allotments and turning derelict land into a community garden.
Amin believes that meeting others in an outdoor, active setting is a better way to learn about healthy lifestyles than sitting around in a classroom. "We can grow food, learn about diet and nutrition and get exercise that really helps in the fight against obesity," she says,
Sofia Rashid lives nearby and is pleased with the changes, particularly since it's made it so much easier for her seven-year-old disabled daughter to navigate her walker through the greener spaces.
"We have all looked after the allotment and helped grow things. All the women here are helping and we've been out walking through lockdown - it was encouraging to have someone thinking about health," she says.
Rashid says the response to Amin's project has been amazing. "She's also teaching us about healthy eating and she's set up a cycling group so some of us are planning to ride bikes for the first time," Rashid says. "Last weekend we had a street clean-up where all the ladies of the area got together, it was people of all ages."
Dr Mathai is convinced it's local schemes like this which will make a real difference, particularly for children who need help navigating the array of takeaway options on offer in the city.
"This isn't a medical problem, it's a social and community issue that needs to be addressed," he says. "It needs to be local parks, government and services taking the lead, with doctors there to support that community-driven approach."
In Bradford we are building on our work in Born in Bradford to establish the world's first "City Collaboratory" that recognises that we need a radically different approach to preventing obesity. It brings together policy makers, communities, schools, urban planners, transport experts, and researchers to help develop and test whole system approaches that will act across every aspect of the city to save lives.
Our local and national response to Covid-19 has shown what is possible with common purpose and collective endeavour. Let us put the same vigour and commitment to tackling the other pandemic.
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