Prevention as priority

Preventable deaths ascribed to health conditions resulting from personal behaviors have a long and sordid history in the United States.

Americans in large numbers continually adopt unhealthy habits and activities, some of which are deadly, and many of which also incur enormous medical costs because of the bodily harm they inflict.

Cigarette smoking-related deaths in the U.S. total nearly half-a-million every single year. Of those 1,300 daily fatalities — nearly one death every minute — more than 100 aren’t smokers, but victims of secondhand smoke.

Obesity and overweight conditions cause the deaths of another 300,000 Americans every year, or more than 800 people every day.

Add drug and alcohol abuse into the mix, and the annual death toll from only that handful of preventable health risks is nearly 1 million people annually.

It’s sobering to consider that America has lost some 20 million people in those categories since the millennium.

A million preventable deaths per year sounds shocking, but that statistic hasn’t commanded headlines because it isn’t really news. Preventable is often also predictable; the case for the deadly dangers of smoking, for example, was successfully made generations ago. The expectation for people who smoke two packs of cigarettes a day for 20 or 30 years is high-risk unhealthiness. Old smokers in good health are the exception.

So nobody is surprised when a lifelong smoker is diagnosed with lung cancer. And few stop to think about the true lethality of that disease, which in nine out of 10 cases is terminal.

Not surprisingly, since the bad habit is known to damage lungs, smokers have more trouble with any severe acute respiratory syndrome (SARS) virus. This has proven to be the case with covid infections as well, with studies showing that heavy smokers were more than 2.25 times likely to be hospitalized than nonsmokers.

Like smoking, obesity creates predictable health risks in general that are validated over time by outcomes. And just as most people don’t come down with lung cancer during their first year of smoking, initial weight gain seldom causes immediate health problems.

Accumulating a high body mass index (BMI) takes time, and the transition from slightly overweight to morbid obesity often spans years or decades. Our population’s scales bear this out: In 40 years, American obesity went from being relatively rare to a quietly overlooked national crisis.

Statistically, overweight and obese people comprise 70% of high blood pressure patients, 80% of coronary heart patients and 90% of Type 2 diabetes patients.

By 2030, experts believe half the nation will be obese — not merely overweight, but obese (generally considered 30-40 pounds overweight). A BMI of 30 or more is defined as obese; a typical heightweight example would be a 5’6” person weighing 186 pounds. Severe or morbid obesity begins at BMI 35, which would be a weight of 216 pounds for the same height.

In the heaviest states, the obesity percentage may be well over half. The looming cost of that foreboding forecast, in both dollars and deaths, is worrisome if not downright alarming.

As bad as obesity can be for patients in normal times, it’s become a death knell during covid. Figures indicate that nearly four out of five patients who have been hospitalized from covid, and three out of four who have died from it, were overweight or obese.

World Obesity Foundation research revealed that of worldwide covid deaths, almost 90% occurred in countries with high obesity rates (the U.S. has the highest adult obesity among developed nations). Its comprehensive analysis and report, published in March, minced few words in describing how a less obese world would have confronted covid.

“If all countries had overweight prevalence below 50%, hundreds of thousands of covid-19-related deaths and countless millions of hospital admissions might not have occurred,” the authors wrote.

A fine line to be mindful of in any candid discussion about the link between obesity and covid is the one separating fat-shaming condemnation from behavior-changing inspiration.

Obesity occurs individually, and is the complex product of many factors in each individual instance, from genetic traits like metabolism to social situations like poverty. Some illnesses and treatments can lead to obesity. Not only does it do no good to stigmatize people with obesity, it also betrays ignorance which inherently impedes real solutions.

Ironically, covid has highlighted the need for healthier living. Long before this pandemic, back when coronavirus was only a fine-print germ-word on household disinfectant products, obesity was simmering as a lethal social pathogen.

Perhaps we the people can emerge from this with a renewed awareness of and attitude toward all preventable illness.

We’ve ignored losing millions of citizens to long-term preventable health issues like smoking and obesity precisely because of the lack of any sense of urgency. The hope is that covid has opened our eyes to see that good health and strong immune systems — things that take time and individual effort to build up — are the best defense against a short-notice virus outbreak.

Whether we make those things a priority now will determine most (for better or worse) what happens when the next dangerous coronavirus appears.