Americas COVID-19 response leaves a lot to be desired.

From the federal government.

From state and local governments.

And from certain segments of the population who refuse to wear face coverings and practice social distancing.

These are among the reasons why, despite being just 4% of the worlds population, the U.S. has suffered 25% percent of the worlds COVID-19 deaths.

But theres another factor that has likely put many Americas at greater risk for coronavirus complications: our obesity epidemic.

Last month, three Johns Hopkins University physicians published a study in Lancet that links higher body mass index to more severe cases of COVID-19 and points to obesity as a significant pre-existing condition especially in younger patients. The report confirms anecdotal observations from early in the pandemic, as well recent studies from other countries.

Comedian Bill Maher, whos been railing for years about American obesity, did so again recently during a New Rules segment on his HBO show "Real Time". He chastised both the media and government health officials for not being more direct with the public about the need to address obesity in the U.S.

Noting that he didnt think it was a coincidence that the countries with the lowest obesity rates had the lowest coronavirus death rates, he said, "Obesity was already killing us slowly. But you mix it with COVID and it kills us fast."

Obesity defined by the U.S. Centers for Disease Control as a body mass index (BMI) of 30 or more creates a cascade of comorbidities, including heart disease, hypertension, type 2 diabetes, increased risk for stroke and multiple forms of cancer and, as it relates to coronavirus, a compromised immune system response.

Cardiologist Dr. David Kass, one of the authors of the Johns Hopkins University study, told the schools magazine Hub, "Studies have now shown obesity increases the likelihood that you'll end up in a hospital or an ICU, and that your disease course can be more severe. The reason the comorbidities aren't showing up in younger patients let's say under 40 or 50 years old is that the cardiac, vascular, and metabolic risks linked to obesity may not have had enough time to develop in a concrete way."

Another concern experts have about COVID-19 and obesity is how the condition could impact the efficacy of potential vaccines.

Last week, Kaiser News reported that scientists have known since the 1980s that common vaccines for influenza, hepatitis B, tetanus and rabies, among others "can be less effective in obese adults than in the general population" and that "there is little reason to believe, obesity researchers say, that COVID-19 vaccines will be any different."

As University of North Carolina associate professor of nutrition Raz Shaikh said to Kaiser News, "Will we have a COVID vaccine next year tailored to the obese? No way. Will it still work in the obese? Our prediction is no."

According to the CDC, more than 42% of American adults are obese.

By comparison, the World Health Organization says that the European countries with the highest obesity rates Malta and the United Kingdom come in at around 29% and 28% respectively.

The last time the U.S. obesity rate was in that range? More than 20 years ago when it was around 30%.

So what happened? And what can we do about it?

Socioeconomics, industrialized food supply and more

Like so many race and economic issues the U.S. is currently wrestling with, obesity rates are, statistically speaking, largely affected by ones socioeconomic status.

The CDC notes that although "the association between obesity and income or educational level is complex and differs by sex and race/ethnicity overall, men and women with college degrees had lower obesity prevalence compared with those with less education" and that the "prevalence of obesity among adults was lower in the highest income group than [in] other groups" and the "prevalence of obesity among college graduates was lower than among those with some college and those who were high school graduates or less."

Last week, CNN detailed how, since the end of World War II, America started producing an "industrialized food supply." Originally, this was done in anticipation of potential post-war food shortages. Soon, though, manufacturers recognized the profitability of efficiently producing such products.

This, noted CNN, "led to a domestic food market rife with highly processed, carbohydrate-laden, shelf-stable and convenient foods" and a populace that began consuming less fresh fruits and vegetables and more foodstuffs filled with chemicals, additives, preservatives and high-fructose corn syrup.

The efficiency of this domestic food supply made it progressively cheaper to eat these kinds of foods, especially in comparison to clean, organic foods. In recent decades, as income inequality has grown, low-income and impoverished households became ever more dependent on these kinds of products to stretch their food dollar.

The government definition of "food insecurity" a circumstance now affecting tens of millions of out-of-work Americans is "the disruption of food intake or eating patterns because of lack of money and other resources."

But in many ways equally as harmful is "nutrition insecurity" which is "the inability to access adequate quantities of nutritious foods required for optimal growth and development."

Sicker than ever

According to experts, as a population, were sicker now than we were at the end of the Great Depression.

Whats more, diet-related illness and lack of metabolic health are starting at earlier ages.

For instance, according to CNN "a 2018 report filed by Mission: Readiness, a council of retired admirals and generals who advocate for policies that help kids stay healthy ... stated In the United States, 71 percent of young people between the ages of 17 and 24 do not qualify for military service, noting exceptionally high rates of obesity starting as early as age 2. Fewer Americans are physically ready for work and war than in 1945, yet, instead of being underweight and malnourished, they are overweight and malnourished."

What can we do now?

"Fat" "overweight" "obese" these words all carry emotional triggers and pejorative connotations. So when it comes to helping people make better nutritional choices and reverse the effects of clinical obesity, lets eliminate the terms most people associate with ones appearance.

The message could better be framed as the need to maximize ones "metabolic health" which is defined as having ideal levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, without using medications.

People with good metabolic health have better immune systems and are at less risk for disease.

"You shouldnt try to force this on people, but instead try to tactfully help them understand that there is an issue that needs to be addressed," recommended Boca Raton neuropsychologist Raphael Wald. "People have to see that theres an issue and then be properly motivated to address it."

To treat people with issues related to overeating and/or poor nutritional choices, Wald believes the "team approach" works best one that includes a medical doctor, a nutritionist, a therapist and a physical trainer.

And he believes in the power and sustainability of making small, incremental changes over time: "A lot of inertia goes into having poor nutritional habits. However, if you vow to make one healthy choice per day for, say, a week, that can break the negative cycle and start you on the path to better nutritional habits."

However, making these changes on a societal level wont be easy.

"We simply have too much access to junk food," lamented Jacqueline Botting, founder and "chief visionary" of WiseTribe, the Delray Beach-based initiative whose goal is to organize and activate communities to engage in food-related behaviors that support better health and environmental sustainability. "Unfortunately, a lack of nutrition education combined with a need for convenience, poor personal choices and aggressive advertising by fast food and junk food companies influence a lot of our behaviors and choices concerning food."

Local activists like Botting are determined to combat this.

"For the first time in history we have too many people dying from eating too much food rather than dying from starvation," she said. "The entire global food system needs to be revised with health, equity and sustainability in mind. As a country, we need to put pressure on lawmakers to enact policies that encourage the growth of production and distribution networks that favor high-quality, healthy food. Our food system should be our first line of healthcare. Its going to take an entire generation to rebuild the food system."

In 2019, WiseTribe received a grant from Children Services Council to teach local kids about "food citizenship" which Botting explained is "the practice of engaging in food-related behaviors that support, rather than threaten, the development of democratic, socially and economically just, and environmentally sustainable, food systems."

In the current absence of a federally backed national campaign on better nutrition and food citizenship, local grassroots campaigns like WiseTribes will have to suffice.

But heres to hoping that someday in the not-too-distant future, all Americans will recognize that over-reliance on the convenience of our industrialized food supply is literally killing us and must be changed.

And then we all have to be encouraged maybe even incentivized to make better nutritional choices.

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One COVID-19 risk is obvious so why wont we talk about it? - Palm Beach Post