To better fight Covid-19, Asia can no longer afford to ignore obesity

With the world's attention turned toward the coronavirus pandemic, the issue of obesity as a rising burden took a back seat in the first half of the year. Recent research has shown, however, that we can no longer afford to ignore obesity and its associated conditions as they are worsening the impact of Covid-19 on patients. In light of this, the global health care community has come to recognise combating obesity as a way to stave off some of the worst effects of the virus.

Obesity rates across Asia have increased rapidly in recent decades due to rising incomes and urbanisation, and the pressure on health care systems worldwide to address obesity-related conditions has grown in tandem.

In Malaysia, a staggering 64 per cent of males and 65 per cent of females are either obese or overweight and a similarly worrying trend has been observed in other Southeast Asian countries. Between 2010 and 2014, the incidence of obesity in Indonesia and Vietnam increased three times as fast as that observed in the US and Britain.

Obesity rates have also been on the rise in China. Between 2004-2014, the incidence of obesity tripled, affecting around 14 per cent of adults by 2014. The data from India is equally alarming. The country's obesity rates are increasing at a faster pace than the world average, growing from 6.4 per cent to 14.9 per cent in women between 1975-2014. This has been accompanied by an escalating burden of chronic diseases, which has the national health care system struggling to keep up.

While the prevalence of obesity is also growing elsewhere in the world, there are important reasons for paying special attention to Asian countries. Certain Asian populations have a higher percentage of body fat compared to Caucasians of the same age, gender and body mass index (BMI), which places them at greater risk of developing obesity-related morbidities such as Type 2 diabetes and cardiovascular conditions.

Obese people face high Covid-19 mortality risk

Although obesity and its associated ailments have always been known to be detrimental to health, the rapid spread of Covid-19 around the world has further highlighted the vulnerability of those suffering from these conditions as they are at an elevated risk for complications.

According to the World Health Organisation, those suffering from non-communicable diseases are more likely to become severely ill with the virus. New studies have also suggested that obesity can lead to severe complications in Covid-19 patients. At a French medical centre, over 85 per cent of patients with severe obesity ended up being placed on a mechanical ventilator.

Government action is crucial

Public health policies are considered among the most important tools for tackling obesity, but governments have often focused too heavily on prevention. Addressing this epidemic must extend beyond prevention to ensure access to treatment options, which include metabolic surgeries as well as related aftercare and support.

Australia leads the way in this. All recognised metabolic surgeries such as gastric bypasses, gastric bands, and gastric sleeve procedures, are covered by public health service and private insurance companies. Australia's Medicare also provides coverage for follow-up sessions with general practitioners and post-surgery adjustments, and even aftercare support like consultations with dietitians and psychologists. This ensures that optimal care is provided even after the procedure.

This is in stark contrast to Asian countries. In Malaysia, bariatric surgery costs at least US$7,050 and is not covered by public health insurance. Such a hefty price tag means that the treatment is available only to a small pool of patients. This is also the case in the Philippines, Indonesia, Thailand, and Hong Kong, among others.

Certain Asian populations have a higher percentage of body fat compared to Caucasians of the same age, gender and BMI. Photo: Getty Images alt=Certain Asian populations have a higher percentage of body fat compared to Caucasians of the same age, gender and BMI. Photo: Getty Images

Tackling long-held biases

Another hurdle for the obesity crisis lies with patients. Even though health care professionals are aware of the importance and effectiveness of surgical treatments, patients tend to be unwilling to opt for metabolic procedures as they view such options as "taking the easy way out".

To undo such misconceptions and biases, health care professionals should help patients recognise that obesity is a chronic medical condition, and that metabolic surgery can help them to achieve a significantly higher quality of life.

Furthermore, as experts in their fields, they are also well-placed to drive conversations with legislators on the role of metabolic surgery in reducing long-term health care costs. If successful, this would go a long way in fostering understanding and reshaping attitudes towards treatment.

Here, Australia again serves as an example. The country was one of the earliest in the world to establish an interest group for the condition in 1980. The Australian and New Zealand Metabolic Obesity Surgical Society has consistently engaged with the government to advocate for patient coverage, provide education on the effectiveness of metabolic surgery, and to ensure they are kept up to date on new techniques.

As a result of these efforts, surgical options are regarded as effective treatments for patients struggling with obesity in Australia. Almost 23,000 patients opted for weight loss surgery in the management of their condition between 2014-2015 and the number continues to grow, with over 38,000 undergoing such procedures between 2017-2018.

The pandemic has cast light on old challenges, and the obesity problem is now a front and centre issue for all nations trying to manage the public health crisis. As we continue this fight, governments and health care professionals need to work together on all fronts - from prevention and reduction through public policy, to treatment with surgical interventions and aftercare support.

This article originally appeared on the South China Morning Post (SCMP).

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