BY NOW, most people understand that the elderly are especially vulnerable to Covid-19. But studies of Covid-19 patients in France, Italy, China and the United States have also identified chronic conditions that place even younger patients at risk, near the top of the list is obesity.
As we work to protect ourselves during this pandemic – and prepare ourselves for the next one – health officials need to be clear about the connection between obesity and Covid-19. Obesity increases the risk of respiratory failure, alters the immune system and may cause chronic inflammation that can rapidly escalate out of control with coronavirus infection.
In the wake of Covid-19, we need to treat obesity not just as a disease, but also as a public health emergency. As an internist, I know how hard it can be for some patients to adopt healthier lifestyles. But the road to a healthier lifestyle requires a change in the doctor-patient relationship itself – and perhaps a radical one.
The truth is, most of my patients know what they need before they set foot in my office. By then, they’ve been told countless times to lose weight. The question is how. They often wonder: what should I eat? What kind of exercises should I do and how often? Should I try supplements? Unfortunately, and more often than not, patients leave many of our primary care appointments without answers because we simply don’t have enough time to give them. It doesn’t matter if you’re the best doctor in the world: a 20-minute interaction once or twice a year probably isn’t enough to change a patient’s life, let alone save it.
As a result, doctors and patients take a Hail Mary approach to chronic disease management. After years of general discussions about needed lifestyle changes, the patient is diagnosed with a chronic disease, and then there is an intensive effort to prevent its irreversible consequences. But even then, doctors tend to offer generic advice which is too little, and too late, to make much difference.
But in light of the connection between obesity and deadly contagions like Covid-19, we all need to do better. Doctors need enough quality time with patients for them to develop together lifetime health strategies with detailed interventions on how to implement them.
If that sounds too good to be true, consider the current doctor-patient strategy for relatively complex chronic diseases, like type-two diabetes. A patient whose blood glucose level is far above target may see his or her provider as often as every three months. And since these patients are frequently considered complex, managing their chronic conditions require a higher reimbursement and longer appointments.
With obesity, the key is early intervention. If patients can change their lives before suffering chronic disease consequences, they have a far greater chance of living longer, healthier lives with or without Covid-19. But this change requires the type of intensive doctor-patient relationship that goes beyond conventional engagement on diet and exercise.
Our patients deserve medical advice that is personalized to their metabolism, body composition and other relevant individual factors. They deserve a tailored exercise regimen as well as access to useful tools like nutrition-tracking and optimizing apps. They also deserve the time and space to provide their doctors in-depth information about their environments and habits. This way, doctors can give their patients medical advice within the proper context. Sure, this isn’t necessarily the most profitable way to practice medicine, but our patients most at risk of becoming obese don’t just deserve this type of intensive care. They need it.
They also need government to promote preventive health at a national level. Federal and state governments should offer tax incentives to companies that provide their workers at least five hours a week to exercise during working hours. Likewise, they should give individuals tax credits for taking courses in healthy lifestyle modification while they are still healthy. The government offers tax incentives for businesses to operate in specific areas or for individuals to adopt clean energy; those are good models for how this could work.
“Getting back to normal” is not enough. One of the best things we can do to prepare for the next pandemic is to prevent chronic disease before it starts. As healthcare providers, we have an oath to help our patients and to advocate for them. The time to get our country’s obesity epidemic under control is now.