Phil Nuttridge takes a break from his regular series of articles on specific aspects of food and nutrition, to look at the emotive issue of Obesity and its future management in the light of its correlation with poorer COVID-19 outcomes. More information can be found on Phil’s nutrition website cuttingcarbs.co.uk or by following him on Instagram: CuttingCarbsUK. He also has a daily blog on coronavirus (where this article was first published) at massagehealth.co.uk/covid
I think the question of obesity will always be an emotive one. It is very easy for those who are not over weight to condemn those who are on the basis of the ‘eat less, move more’ paradigm. This is the back door to allowing the ‘gluttony and sloth’ model of obesity which is judgemental on the individual.
No-one chooses to be over-weight or have type II diabetes, but if an individual wants instead to improve their health in these two regards, they will receive conflicting advice on how to manage those conditions depending where they look.
For fifty years we have been told to eat a low fat diet, but the gateway that creates to eating more carbohydrate is then probably the single greatest contributor to the obesity epidemic (and incidentally also the dietary pathway to metabolic syndrome). And yet, here in the UK, if they enter our health service, go to obesity or diabetes websites or open any conventional diet book, they will be told to continue with a low fat high carb diet. Short term gains become unsustainable in the longer term and the individual then struggles with their weight even more than before and feel the crushing sense of failure that creates. The judgement of the gluttony and sloth model then becomes even more unbearable.
The metabolic understanding of obesity has hugely changed in the last ten years. Obesity is now understood as a disease of hunger, it is not ‘simply’ a consequence of eating more calories than calories burned. An impaired physiological response to hunger (both from elevated insulin and leptin) is the driver of metabolic syndrome one consequence of which is obesity. Sleep, stress, nutritional profile and quality of the diet and the gut biome all contribute to the leptin/insulin axis and the neurological response to it. And yet many of the organisations trying to advise the overweight do not explain that new understanding, instead sticking to the old paradigm which has now been proven wrong.
[The elephant in the room here is that data shows as a population we have been following calorie-controlled low fat diet for the last fifty years and yet we are the fattest we have ever been. Regrettably for those following this approach, their impaired hunger mechanisms are further damaged by calorie restriction and the yo-yo diet is created.]
Understanding that impaired hunger is triggered by the two hormones leptin and insulin then creates another problem in that our health care systems are modelled on the pharmaceutical approach to resolving ill health. So we pump our bodies with synthetic insulin to manage things and that creates more obesity. Yet, robust clinical trials over the last ten years consistently show that dietary changes can reverse the hormone imbalances far more robustly than any currently available drug intervention. This message does not get to those who need it. Even websites trying to help diabetics and the obese do not get this message consistently right.
The modern paradigm of impaired hunger and metabolic health is where the keto, low carb, real food dietary movements are coming from but yet they are still seen as the heretical fringe. There is a new breed of clinician nutritionist out there (I have trained to be one of them) and we are trying to get this message out there, but while so ever our voices are drowned-out by proponents of the old paradigm, or we are called-out just because our message is different to the old and now failed model, we cannot make progress.
That is the thing I am fighting and it is the discussion to change the prevailing message that I want to be the meaningful and enduring legacy of coronavirus. Coronavirus has found our weakness. We need to change our weaknesses not the virus.
Our metabolic health is in our control; the virus is not.