Before 2020 there was Good consensus that the new epidemic was obesity. Increasing prevalence, increasing incidence, limited available first line effective treatments, clear social gradient, …. all the facts are there to make it a concerning disease. Then came SarsCov19, and all the lights turned to this ‘other’ pandemic, that came at a much faster pace, is taking a high toll in human lives and in economic figures.
However both pandemics share a number of characteristics. Obesity, as demonstrated by Christakis and others, is a communicable disease. It is lethal, and carries over a number of comorbidities, leading to substantial personal health loss as well as economic losses. As in Covid19, the economic impact to the society is immense, not only because some consume large number of resources but also because the prevalence is colossal.
As per today, the treatment of obesity is based on 3 pillars: nutritional counselling (education), exercise (positive prevention of more harm) and psychological support. Should we try to apply this paradigm we could suggest the three pillars por pandemics should be:
- education on hygiene and how to cope with communicable diseases, not to diminish the transmission of the infective agent but as a general attitude, including antibiotic use, hand-wash or sanitation.
- Positive prevention, instead of reactive healthcare stressful measures. This would include the permanent deployment of capacitated sentinels that would look at deviations from the mean, raising flags whenever abnormal signals appear. And clearly avoiding misuse of real-world data as we have seen in the messy hydroxychloroquine case.
- Reinforcement of measures, sometimes by psychological support but mainly through common school based educational programmes and enforcement of periodic reminders, as Japan does with Earthquakes.
Covid19 is just a reminder that some things, from the public health perspective have to be done, even if avoiding obesity means damaging the food industry.