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

 Laura Elder: 409-683-5248; laura.elder@galvnews.com

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(6) comments

Bailey Jones

I don't doubt the importance of obesity as a comorbidity with COVID, but I did question the COVID death rate in Japan - if they aren't testing, how do they know whether people are dying from COVID? A good place to look would be the "excess" death rate in 2020 vs earlier years. This measure makes it evident that the attribution of 300K+ deaths to COVID in the US is correct. It would also tell us whether Japan's claims are correct.

A useful resource for examining excess mortality is https://ourworldindata.org/excess-mortality-covid however Japan is not included in this dataset. A few studies seem to indicate that Japan has not suffered excess deaths during the pandemic - here:

https://www.medrxiv.org/content/10.1101/2020.07.09.20143164v9

and here:

https://www.jstage.jst.go.jp/article/jea/advpub/0/advpub_JE20200492/_pdf/-char/en

So, I'm convinced. Whether the difference in mortality is fat, or the tendency of the Japanese to follow scientific guidance is still a question. (The second study here indicates that deaths from other respiratory illnesses and accidents were both down during the pandemic in Japan, presumably due to mask-wearing, social distancing, and staying home.) But the evidence for the health implications of obesity is clear. It's also clear that Americans aren't really interested in doing better.

Virginia Stone

I agree that eating a healthier diet is very important in preventing obesity. I also think that if we all learned that portion control helps us eat less and that exercise 'which is the big key in my body' can save lives. However, I am genetically obese so it's not so cut and dry to simply make some dietary changes and you are magically on your way to good health. Since heart disease and type two diabetes are also factors that make the outcome of COVID less positive and are also diseases that could be related to bad eating habits I have a few ideas that I believe would benefit all Americans

Restaurants should cut way back on the portions, charging the same per entree, or a family of four could go out and eat one entree making sure to tip the server for the three extra plates.

I really wouldn't mind if we didn't have fast-food restaurants at all since this convenience feeding contributes to bad eating habits and people becoming less willing to prepare meals at home if they are fortunate enough to be able to have one.

Americans have too many conveniences we even have services that deliver your convenience feeding this needs to end for people with roofs.

Advertisers must stop the overselling of too much food and too much drink including, coffee, soda, and highly caffeinated drinks since all of these beverages contribute to diseases that can make COVID worse.

Let's Move as Michelle Obama says because even a little daily movement will help.

The common thread in all of the mentioned diseases is poverty shouldn't that be the goal, ending poverty will make Americans healthy.

Maybe the author should be grateful and try to remember there are many reasons some people aren't as fit as others and trying to put such a complex issue as obesity into such a small little idea (put the fork down) is wrong with the simple little solution of eating better is a weak argument that really has little to do with COVID.

Dwight Burns

Amen!!!!

David Schuler

There is nothing in Laura's fine article that attempts to pass judgement on why a person is obese or not, only that apparently people who are obese - for whatever reason - are more likely to have a severe case of Covid. The "Fat is Fun" lobby has worked so hard to shame those who might pass such judgement that of course, no one in their right mind makes such a comment. But it doesn't take a rocket scientist to see that being overweight puts extra strain on ankles and knees, circulatory and respiratory systems and other body functions, and it only makes sense that folks who are already pushing the limits of human anatomy would be more at risk.

John Nilsson

There has been a direct causal connection between obesity and Covid-19 (not always, but enough to be a factor) that has been largely unmentioned in the media during the pandemic. When returning from travel in other countries, one cannot help but notice the increased amount of obesity in the US. Thanks, Laura, for writing about this.

Stuart Crouch

Ok, we all (or most should) know that we have too many fat people in this country. Welcome to our world of excess. Duh. It's also no secret that the Japanese live healthier lives than most on the planet and live to very ripe old prune-like ages. Selecting them for comparison and use for your position was no accident, I'm sure. Certainly, there must have been more recent supporting data on how Japan has been dealing with this pandemic than citing something from May 25th. Then, the various conspiratorial/non-believer/nay-sayer/pro-business capitalist demon begins to rear its ugly head in this article. Is there some worry that the Biz Buzz column will lose its support and informational sources if they are not afforded some sympathy and support against pandemic restrictions? Or, could the businesses, who provide the revenue stream to this paper through their advertising dollars, need an voice and an ally to their cause?

This article is an opinion piece, and I get that; it simply presents itself as being a thinly-veiled attempt to further a belief that there is a myriad of reasons for all of these deaths (that must somehow be the fault of those affected) and that there cannot be any justifiable reason for placing some temporary restrictions on people, places and things that are deemed to be for the greater good of all of us. If you want to present the argument that business revenue is of a greater societal interest and value than the health and well-being of a community and the human beings that occupy it, there is no need to 'mask it' (see what I did there?) by the assertion that comorbidities in some way lessen the significance and seriousness of this virus. If I were a 'chubba-bubba' and had been for a number of years, and I contract Covid-19 tomorrow and perish six weeks later, the smart money is on the fact that I died from 'complications related to the Covid-19 virus', not because I was a 'friend of the fork'. 'Putting people ahead of profits' didn't exactly leap off the page here; quite the opposite.

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