When the COVID-19 pandemic hit our shores, vulnerable people were instructed to lock themselves up and not venture out. The vulnerable were declared to be all the over-65s and those with pre-existing conditions weakening their breathing or their immune system.
The suggestion from overseas experience that the overweight and obese, even if young, were also vulnerable to serious complications if they caught the virus, was ignored. As a result, over-65s had to show their identity card at some establishments and were turned away because of their numerical age. The younger overweight and obese could go about unhindered.
Now, the European Centre for Disease Prevention and Control says that three-quarters of critically-ill patients with COVID-19 in Italy, Spain, Sweden, Switzerland and Holland are obese. The UK claims obesity doubles the chances of death from the virus.
British Prime Minister Boris Johnson admitted that at one stage in hospital he was in a serious condition. He weighed 17-and-a-half stone (111kg) and now says he’s already lost a stone to improve his health. About two-thirds of UK adults are reckoned to be overweight and almost a third obese.
According to the World Health Organisation, Malta currently holds top of the European league positions for overweight teenagers.
Being overweight has become such a common feature it may have come to be considered ‘normal’. Even pointing it out politely might be taken as verbal abuse.
Overweight and obese are just different degrees of the same medical problem – the ‘mother’ of the most common serious chronic diseases that clog up clinics and hospitals and shorten lives. The ‘offspring’ of the ‘mother’ are these disabling and/or serious conditions such as diabetes, high blood pressure, heart attacks, heart failure, stroke, some cancers, arthritis and destruction of weight-bearing joints, fatty liver and risk of cirrhosis, and an increased risk of dementia. And now we’ve learned the overweight also risk more serious complications with COVID infection.
What is the mechanism of excess body fat and poor health? The most unhealthy body fat is thought to be abdominal, so a bulging tummy is medically bad news. Why? Increasing abdominal fat appears to induce chronic inflammation in various organs, increasing risk of cardiovascular disease characterised by damage and narrowing of arteries, high blood pressure, diabetes, cholesterol abnormalities, fatty liver, immune system deterioration and also dementia.
Unfortunately, the pathology laboratory at Mater Dei Hospital seems to have not noticed the CDC advice about diagnosing early diabetes
A bulging tummy needs an immediate blood pressure check and a test for diabetes. The pandemic of obesity and diabetes has not been taken seriously enough. The more recent views about the chronically high blood sugar levels of diabetes are that they are probably more dangerous than ‘high cholesterol’.
Although blood sugar is the fuel that keeps all body organs alive, chronic high blood sugar levels are now recognised to act as an inflammatory agent in many body tissues and which damage the inner lining of blood vessels, increasing risk of coronary artery heart disease, stroke, kidney failure, deteriorating eyesight and poor circulation in the legs.
The best test for diabetes is the laboratory Haemoglobin A1c (HbA1c) blood test. You don’t need to fast for this test and it’s an elegant surrogate marker of your average blood sugar level over the last three months.
The most important recent point about this test is that the authoritative US Centres for Disease Control and Prevention (CDC) has advised that the earliest stage of diabetes is diagnosed by an HbA1c level of between 5.7 and 6.4 per cent. The CDC calls this stage ‘prediabetes’, but this label might be misinterpreted and instil a false sense of normality.
There is now published medical scientific evidence that the potentially serious complications of diabetes actually start in this ‘early diabetes’ stage diagnosable by an HbA1c level of between 5.7 and 6.4 per cent. This early stage of diabetes can be reversed by weight loss and the old, plant-derived, safe and cheap drug metformin. Metformin extends the life span of laboratory animals, and scientists claim this is the first human longevity drug.
Unfortunately, the pathology laboratory at Mater Dei Hospital seems to have not noticed the CDC advice about diagnosing early diabetes and continue to claim that diabetes is diagnosed when the HbA1c is above 6.4 per cent. I recently saw the laboratory results from an Italian institution and it stated diabetes is diagnosed from HbA1c 5.7 per cent upwards, as per the CDC advice.
This is a crucial public health matter. There must be a substantial proportion of overweight Maltese with early diabetes, according to the CDC, and who are not only unaware of their medical condition but have been wrongly advised they are ‘normal’. Then they might suffer a heart attack and wonder how this came about.
It is obviously right and proper that we now worry and concentrate on dealing with COVID but we also need to once again tackle overweightedness, food addiction, bad diet and diabetes because they are the main cause of morbidity and mortality.
We now also know the overweight are among the vulnerable members of the population and can experience serious COVID complications.
Albert Cilia-Vincenti is a pathologist and a former delegate to the European Medicines Agency.