Obesity is the biggest risk factor for death from Covid-19 in under 50s, according to a new study from the US Centre for Disease Control based on 99 countries and 14 states from March.

The research​ examined the underlying conditions of patients hospitalised with the virus to find out which risk factors – among them obesity, heart disease, diabetes, chronic lung disease and high blood pressure -- led to the most severe disease.

It found that nearly 60% of patients aged 18-49 were obese. It was also the biggest risk factor in those aged 50-64, present in nearly half (49%) of patients in this age group. For those over 65, high blood pressure was the biggest risk factor, which was most prominent in over 70% of cases, with obesity an underlying condition in 41% of patients.

Rising links between poor diet and coronavirus deaths ​

In light of the mounting evidence that obesity and poor diet increases the risk of a severe response to Covid-19 infection, medical professionals now want the public health message urgently updated. And this, they warn, potentially means the food industry bracing itself for regulation, such as bans on advertising and taxes.

“Not only would a massive public campaign on diet save lives it would change the course of our nation’s health forever​,” Kailish Chand, Honorary Vice President at the British Medical Association, wrote on Twitter.

Tim Spector, Professor of genetic epidemiology at King’s College London, said: "Obesity and poor diet is emerging as one of the biggest risk factors for a severe response to Covid-19 infection that can no longer be ignored."​

Robert Lustig, Professor of paediatric endocrinology at the University of California and chairman of the Institute of Responsible Nutrition, said: "I've heard Covid-19 referred to as a beast, because it doesn't distinguish. In point of fact, it doesn't distinguish who it infects. But it does distinguish who it kills. Other than the elderly, it's those who are black, obese, and/or have pre-existing conditions. What distinguished these three demographics? Ultra-processed food. Because ultra-processed food sets you up for inflammation, which Covid-19 is happy to exploit. Just another way processed food kills. Time to rethink your menu."​

Junk food: the new tobacco? ​

Dr Aseem Malhotra, a London-based cardiologist, told the BBC that a Government and Public Health England failure to tell the public to change its diet would represent an act of “negligence and ignorance​”.

He said conditions such as obesity, type 2 diabetes and high blood pressure were all linked to poor diet, adding “the increase of mortality if you have a cluster of these conditions from covid is tenfold higher.”​

On a brighter note, he said it was possible that people could reverse these types of conditions “within a few weeks of changing diet​”. He noted that more than half of the calories taken in by the British population came from ultra-processed foods​, such as mass packaged foods full of additives and preservatives, and unhealthy fats from industrialised seed oil, sugar and starch. If the whole of the UK population was to cut down on ultra-processed foods and eat what he called nutritious foods “just for a month​” potentially up to 50% could send their type 2 diabetes into remission, could lose significant amounts of body fat and would be in a much healthier state to deal with and survive Covid-19 if they were to contract it, he claimed.

Whose responsibility is obesity anyway? ​

He denied the UK obesity crisis was a question of personal responsibility to seek out healthy nutritious foods.

“Junk food has infiltrated itself within the whole of the British diet,”​ he said. “Our food environment has made these foods unavoidable… the food industry has profited from these foods which are highly addictive, that don’t make you feel full​.” He lamented the fact that the food industry managed to get these products “available to anyone, anywhere at any time​”.

Speaking to FoodNavigator, Dr Malhotra’s message to the food industry was simple. "Stop mass marketing and selling ultra-processed food,” ​he said. “It’s clear that these foodstuffs are damaging and detrimental to health.” ​

Companies would argue that they merely respond to the demands of their customers. Why reformulate if there’s a lack of consumer uptake​? The latest company earnings reports, what’s more, point to increased demand for traditional comfort foods​ among shoppers amid the lockdown.

This was an ‘excuse’, according to Dr Malhotra. For him, the pandemic highlighted that it was in the interests of everybody, including those in the food industry, to make sure the population was as healthy as possible. Take the example of South Korea. It has one of the lowest obesity rates in the world. This could explain, in part at least, its low mortality rate from coronavirus.

Back in the UK, Dr Malhotra praised efforts to innovate and reformulate so far, such as Finnebrogue’s nitrate-free bacon​. But he added that the food industry needed to continue to look to make healthier and more nutritious foods that don’t have an “adverse health impact"​. If not, it could wait for government intervention, such as the banning of advertising of ultra-processed foods or taxes on unhealthy foods to make healthier choices more affordable.

"Poor diet is the primary biological factor that's driving increased [covid] death rates,” ​he stressed. “I think from that perspective they [the food industry] will have to change. The question is whether they are going to wait for government to regulate, or are they going to get ahead of the curve and crackdown on this to shift the balance towards minimally processed foods and try and get rid of the ultra-processed foods.”​

He continued: “We need to reduce the availability, reduce the affordability, and reduce the acceptability of ultra-processed foods. I tell my patients if it comes out of a packet and has five or more ingredients, it’s ultra-processed.”​

The ‘scandal’ of junk food in hospitals ​

The problem is currently being exemplified by food options within UK hospitals: three quarters of food purchased in hospitals is unhealthy​, he suggested. “So it doesn't surprise you that more than half of the NHS workforce are overweight or obese as well.”​

He therefore described it a ‘scandal’ that companies such as Krispy Kreme and Domino's were delivering thousands of doughnuts and pizzas to British hospital staff.

"I'm concerned at seeing companies, with the best of intentions, donating food for free to NHS staff - and it's cheap junk food like Domino's. I'm not saying there's anything wrong with the occasional treat. But these products should not be in the middle of an obesity crisis." ​