A key message is missing in government and health guidelines to combat COVID-19 in the United States. Wear a mask, wash your hands, keep your distance, close your business, stay home — such is the advice and orders governments have doled out since the early days of the pandemic. But few elected officials have had the gumption to tell us to put down our forks and think about our diets, which could prove far more effective in easing the burden on hospitals.
When nations around the world in June were experiencing surges in COVID cases, scientists and health officials were wondering why Japan was faring so well and the United States wasn’t.
By Oct. 21, the United States had reported 216,872 COVID deaths compared with Japan’s 1,646, according to Peterson-KFF Health System Tracker. To date, the United States is reporting 330,901 COVID deaths, according to the U.S. Centers for Disease Control and Prevention, while Japan reports 3,152.
Those aggregate numbers don’t tell the whole story, of course. The United States has a population of more than 331 million; Japan about 127 million. The difference is more telling in the details. The case mortality rate, the number of confirmed cases that result in death is 1.7 percent in this country; it’s 1.4 percent in Japan. Close, but consider this. The number of deaths for every 100,000 people in the United States is 101; in Japan it’s 2.4. Not even close.
What’s most eye-opening was that Japan didn’t go by the COVID playbook, according to news agency Bloomberg in a May 25 report.
“No restrictions were placed on residents’ movements, and businesses from restaurants to hairdressers stayed open,” according to Bloomberg. “No high-tech apps that tracked people’s movements were deployed. The country doesn’t have a center for disease control. And even as nations were exhorted to “test, test, test,” Japan has tested just 0.2 percent of its population — one of the lowest rates among developed countries.”
What accounts for the fact relatively fewer Japanese are dying in a country that didn’t completely lock itself down? One thing might be the general health of the population.
Obesity is a top risk factor for developing a severe case of COVID-19 in people under the age of 55, Dr. Kyle Stephens, weight loss surgeon at Houston Methodist Hospital, warned earlier this year.
Multiple studies suggest obese and even merely overweight COVID patients are more likely to require invasive mechanical ventilation or intensive care unit admission and are more likely to die. Population-level studies also suggest higher COVID-19 mortality rates in countries with greater prevalence of obesity, according to the Boston University School of Medicine.
The vast disparities in COVID deaths between the United States and Japan could partly be chalked up to the odd way the United States counts COVID deaths. Since the pandemic began, U.S.health officials — locally and at the highest levels — have counted people who died of causes such as heart disease, kidney failure, influenza and pneumonia, to name a few, but also were infected by the coronavirus as COVID-19 deaths.
Perhaps the Japanese are using stricter guidelines to count COVID deaths.
Some speculated the Japanese are more accustomed to wearing masks, that the government used contact tracing more effectively to contain outbreaks, and that handshakes aren’t a widespread cultural practice, public radio program The World reported June 12.
But Dariush Mozaffarian, a cardiologist and the dean of Tufts Friedman School of Nutrition Science and Policy, asserted that one of the major reasons Japan is dealing with the coronavirus more successfully than the United States was because of obesity.
“America has one of the highest rates of obesity in the developed world, and Japan has one of the lowest,” Mozaffarian said. “And it’s obesity that’s making America’s response to COVID-19 much more difficult.”
While scientists and researchers know this, it’s not a big part of the mainstream conversation.
Perhaps elected officials believe the topic is too sensitive, irreversible or hopeless.
But it isn’t hopeless and sharing an optimistic, encouraging message could be an effective tool in the fight against COVID.
“People think that if you’re obese, it takes years and years to deal with that and get healthy,” Mozaffarian said. “But many well-controlled trials have shown that if you’re overweight or obese and have poor metabolic health, and you just change what you eat ... within four to six weeks, [there are] dramatic improvements in many metabolic parameters.”
Increased physical activity can help, too, he said.
Mozaffarian acknowledges some Americans don’t have access to affordable, healthy food, which makes following his advice difficult. But governments should tell people to eat healthier — much as they’ve encouraged hand-washing and mask-wearing, he said.
Although governments haven’t sent clear messages about the links to obesity and poor COVID outcomes, more people are making that connection.
MyBioSource.com, a biotechnological products distribution company, polled 3,120 Americans ages 18 and older and in October revealed 33 percent of Texans believe the government, either state or federal, should immediately act on campaigns to reduce obesity in this country. Doing so could lower the number of acute virus cases in the future and help ease the burden on health care services, they said.
It’s also reassuring that 18 percent of Texans admit the coronavirus pandemic has prompted them to try to lose weight, while 59 percent of Texans said they would encourage an overweight partner, family member or friend to lose weight to reduce their risk of complications should they become infected with the virus, according to the MyBioSource.com study.
As New Year’s Day approaches, let us all collectively resolve to get the message out and improve COVID outcomes.
• Laura Elder