Make America healthy again? The future is personal.

September 14, 2020

The COVID-19 pandemic is an opportunity to think about what health and nutrition look like for all

The ongoing coronavirus pandemic has focused the nation’s attention on health. With more than 2 million confirmed cases of COVID-19 and 120,000 deaths, the US is bearing a terrible burden from this unexpected new disease. At the same time, there is growing attention on the role that inequality plays in making life miserable for many Americans, highlighting the systemic economic and racial disparities that affect all aspects of life from healthcare to justice. 

Most people recover from COVID-19 fairly quickly, without any serious complications, and some show no symptoms at all. However, for others it can be a severe or even fatal disease and may leave long-term side effects that we are only just beginning to understand. Even for those who are less seriously ill, we don’t yet understand the long-term impacts that the virus may have on their health and wellbeing.

Understanding the complex mix of factors that impact our health

For many people, COVID-19 is little more than a nasty cold, fleeting rash or stomach upset, and maybe a quarter show no symptoms at all.  For others it can be a severe or even fatal disease, requiring hospitalization in the most serious cases and leaving long-term lingering side effects like fatigue, lack of smell, stomach problems, and strange rashes that we are only just starting to understand

Even for those who are less seriously ill, our research through the COVID Symptom Study using data on nearly 4 million participants suggests that around one in 10 people experiencing symptoms of COVID will suffer for a month or more. If this holds true across the US population, there are potentially a million people set to experience long term impacts on their health and wellbeing as a result of the virus over the coming months and years.

Good nutrition - or rather, the lack of it - is likely to be the thread that ties all these issues together, and why the US and the UK who eat the most ultra-processed foods in their regions are the worst-hit countries. While the elderly and frail are most at risk from coronavirus, data from more than 2.5 million US and UK users of the COVID Symptom Study app showed that people who were obese were much more likely to be hospitalized with COVID-19 compared with people with a lower body mass index (BMI), and also more likely to need respiratory support such as ventilation. This was true across all the age groups we looked at, including younger people. Social and economic deprivation was another major risk factor for hospitalization in both the UK and the US populations we studied, which also goes hand in hand with poor nutrition.

There is also a deep racial divide in how the COVID-19 pandemic is playing out in the UK and the US, with recent data showing that African Americans are dying from the disease at almost three times the rate of white people. This is also reflected in the underlying statistics about increased metabolic conditions such as obesity, type 2 diabetes, and heart disease, which also make people more vulnerable to the effects of coronavirus.

In the US, just over 40 percent of all adults are now classed as obese, rising to nearly half for non-Hispanic black people. It’s therefore no surprise that African Americans are also 60 percent more likely to be diagnosed with type 2 diabetes than non-Hispanic white people. The underlying reasons for this are a complex mix of social and economic factors - for example, the greater likelihood of black and ethnic minority folk living in so-called ‘food deserts’ without access to healthy food and fresh produce - along with a side order of systemic racism.

The coronavirus pandemic has led to a change in nutritional habits and weight for many, for better and for worse. When we surveyed nearly 1.5 million US and UK users of the COVID Symptom Study app, our preliminary results suggest that while most people report no change in their weight or eating habits, more than a quarter (28%) have gained weight while around 16% have lost weight during this time. And although one in four (24%) have been eating more healthily than usual, nearly one in five (18%) have had a less healthy diet.

COVID-19 has been a tragedy on a national and global scale, and it isn’t going away any time soon. Whether it’s the current ebb and flow of cases or the next major wave - or a new as-yet-unknown pandemic after this one - we must take this opportunity to make America healthy again, starting from the ground up.

Now is the time to reframe how we think about food

Obviously, the first thing to do is to try and control the spread of the virus. In the absence of a vaccine, which is far from certain, this means effective health policy interventions on a state and federal level including social distancing and personal practices like good hand hygiene or wearing a mask to protect others. After that, we must focus on improving everyone’s’ health to cope with both the short and long-term impacts of coronavirus.

Obesity is probably the biggest underlying health and inequality issue facing the United States today. But this is a global problem. British Prime Minister Boris Johnson’s own brush with COVID-19 has made him reconsider his views on tackling obesity, blaming his stay in intensive care firmly on his own weight. At the same time, it’s vital not to further stigmatize people who are overweight or obese, who are already likely to suffer from poorer healthcare due to medical bias about their weight or reinforce existing racial inequalities.

We know that people with obesity have high levels of chronic inflammation that permanently stresses the immune system, and could be one reason for the extra risks of coronavirus. The effects are likely worse in those with poor gut and microbiome health.  We have recently shown that unhealthy spikes in blood sugar and fat levels after meals are associated with increased inflammation. This further strengthens the idea that what you eat each day can influence your level of inflammation and immune system, regardless of your weight - a concept known as dietary inflammation. 

Moving beyond a 'one-size-fits-all' approach

The pandemic has been a great catalyst for change, although much of it has been difficult and distressing. We’ve seen seismic changes in attitudes towards home working, air travel, and more active forms of transport. We can now see this as a tipping point moving us towards a better future and a golden opportunity to think about what good nutrition and health looks like in the era of the ‘new normal’. This is not only to help reduce the risk of becoming seriously ill from COVID-19 but also to support through healthier diets the many people recovering from coronavirus in the months and years to come.

However, we should guard against reverting back to conventional ‘one-size-fits-all’ dietary guidelines, as these are clearly not working. Recent results from our PREDICT study - the largest nutritional research program of its kind in the world - showed that even identical twins, who share 100 percent of their genes, can respond to the same foods in very different ways. This tells us that the future of nutrition must be based on an understanding of how each person’s body works, in order to move us all closer to our best health. We must focus on nourishment, helping people to find foods that taste good and are also good for their body without hectoring, shaming, or blaming. 

In the ‘new normal’, providing wider access to nutritious food is even more urgent, by making fresh produce and healthy options cheaper and convenient  It’s the kind of advice that has long been advocated by my friend Michael Pollan, whose doctrine of ‘Eat food, not too much, mostly plants’ may sound familiar. He told me, "We've long known the Western diet, by contributing to chronic disease, reliably kills us slowly. But in this pandemic, where the virus is particularly lethal to people with chronic disease and inflammation, we're seeing how that same diet can kill us quickly too."

I’d like to imagine that the current situation brings us closer to a day when every American has the right to bear fruit, planting the seeds of a health revolution that will flourish in the years to come.