Pandemic Perspective #19    July 25, 2020

COVID-19, obesity and Type 2 diabetes. Is this the wake-up call?

For more than a half century the First World has been experiencing epidemics of obesity and type 2 diabetes. They are so closely related that some use the term diabesity to emphasize their twinship. Together they are responsible for or contribute to the chronic non-infectious diseases that comprise nearly all of the leading causes of death. From the earliest weeks of the COVID-19 pandemic it was clear that obesity and diabetes, along with their complications of heart disease, hypertension, kidney disease and immune system dysfunction were serious comorbidities, especially among the elderly.

At the beginning of the 20th century only about five percent of Americans were obese and type 2 diabetes, which occurred mostly in persons of late middle age, was so uncommon that it wasn’t clearly differentiated from type 1 diabetes until the 1950s. Today’s numbers are appalling: more than forty percent of us are obese and nearly as many more are overweight. More than ten percent have type 2 diabetes, and 34.5 percent of Americans have prediabetes according to the CDC (Centers for Disease Control and Prevention in their 2020 report). These trends are getting worse, killing increasing numbers of Americans and threatening the economic stability of the healthcare system.

The SARS-CoV-2 virus is a particular threat to older persons not only because they have diabesity but because these conditions weaken an immune system that is already faltering because of the aging process. Diabetes causes damage in another way: the long-term elevation of blood sugar causes blood vessels to become distorted, leaky and unable to properly deliver oxygen and nutrients and to dispose of waste products. The final blow is coronavirus infection, which attacks already-damaged blood vessels. This seems to explain the high incidence of heart attacks, strokes, blood clots and peculiar changes in the fingers and toes of many victims.

The new coronavirus, already the source of surprises, has come up with another: it causes abnormally high levels of blood sugar in persons with no prior history of diabetes or prediabetes, a phenomenon called stress hyperglycemia. Patients with this complication as well as diabetics whose blood sugar has not been well controlled are two to three times as likely to die as those whose blood sugar stays in the normal range.

It’s a sad fact that obesity and type 2 diabetes are the results of lifestyle, not aging. Perhaps humanity can salvage something from the tragedy of this pandemic. Our children should learn the basic principles of good health in the classroom: a mostly plant-based diet that is free of refined grains and sugar, and regular physical activity. When the next pandemic arrives – and there certainly will be others – a population that is free of diabesity will handle it as well as the COVID-19-infected youngsters of 2020, virtually all of whom have come through it with ease.