Make America Healthy Again? Start With Changing How We Eat | Opinion

The ongoing coronavirus pandemic has focused the nation's attention on health. With more than two million confirmed cases of COVID-19 and 120,000 deaths, the U.S. is bearing a terrible burden from this unexpected new disease. At the same time, there is growing attention on the role that inequality plays in making life miserable for many Americans, highlighting the systemic economic and racial disparities that affect all aspects of life.

For many people, COVID-19 is little more than a nasty cold, fleeting rash or upset stomach. Maybe a quarter of those with the virus show no symptoms at all. For others, it can be a severe or even fatal disease, requiring hospitalization in the most serious cases and leaving long-term lingering side effects like fatigue, lack of smell, stomach problems and strange rashes that we are only just starting to understand.

Even for those who are less seriously ill, our research through the COVID Symptom Study, using data on nearly four million participants, suggests that around one in 10 people experiencing symptoms of COVID will suffer for a month or more. If this holds true across the U.S. population, there are potentially a million people set to experience long-term impacts on their health and well-being as a result of the virus over the coming months and years.

Good nutrition—or rather, the lack of it—is likely to be the thread that ties all these issues together, and why the U.S. and the U.K. (who eat the most ultra-processed foods in their respective regions) are among the worst-hit countries. While the elderly and frail are most at risk from coronavirus, data from more than 2.5 million American and British users of the COVID Symptom Study app showed that people who were obese were much more likely to be hospitalized with COVID-19, compared with people with a lower body mass index, and were also more likely to need respiratory support like ventilation. This was true across all the age groups we considered, including younger people. Social and economic deprivation was another major risk factor for hospitalization in both the British and American populations we studied, which also goes hand in hand with poor nutrition.

There is also a deep racial divide in how the COVID-19 pandemic is playing out in the U.K. and the U.S., with recent data showing that African-Americans are dying from the disease at almost three times the rate of white people. This is also reflected in the underlying statistics about increased metabolic conditions, such as obesity, Type 2 diabetes and heart disease, all of which make people more vulnerable to the effects of coronavirus.

In the U.S., just over 40 percent of all adults are now classified as obese, rising to nearly half for non-Hispanic Blacks. It's therefore no surprise that African-Americans are also 60 percent more likely to be diagnosed with Type 2 diabetes than are non-Hispanic white people. The underlying reasons for this are a complex mix of social and economic factors—for example, the greater likelihood of Black and other minorities living in so-called "food deserts" without access to healthy food and fresh produce—along with a side order of systemic racism.

The coronavirus pandemic has led to a change in nutritional habits and weight for many—for both better and worse. When we surveyed nearly 1.5 million American and British users of the COVID Symptom Study app, our preliminary results suggested that while most people report no change in their weight or eating habits, more than a quarter (28 percent) have gained weight, while around 16 percent have lost weight during this time. And although one in four (24 percent) have been eating healthier than usual, nearly one in five (18 percent) have had a less healthy diet.

COVID-19 has been a tragedy on a national and a global scale, and it isn't going away any time soon. Whether it's the current ebb and flow of cases or the next major wave—or a new as-yet-unknown pandemic after this one—we must take this opportunity to make America healthy again, starting from the ground up.

Obviously, the first thing to do is to try and control the spread of the virus. In the absence of a vaccine, this means effective health policy interventions on the state and federal levels, including social distancing and personal practices like good hygiene and wearing masks. After that, we must focus on improving everyone's health to cope with both the short- and long-term impacts of coronavirus.

Overweight children on scale
Overweight children on scale RAUL ARBOLEDA/AFP via Getty Images

Obesity is probably the biggest underlying health and inequality issue facing the U.S. today. But this is also a global problem. British Prime Minister Boris Johnson's own brush with COVID-19 has made him reconsider his views on tackling obesity, blaming his stay in intensive care firmly on his own weight. At the same time, it's vital not to further stigmatize people who are overweight or obese, who are already likely to suffer from poorer health care due to medical bias about their weight.

We know that people with obesity have high levels of chronic inflammation that permanently stress the immune system. The effects are likely even worse for those with poor gut and microbiome health. We have recently shown that unhealthy spikes in blood sugar and fat levels after meals are associated with increased inflammation. This further strengthens the idea that what you eat each day can influence your level of inflammation and immune system, regardless of your weight—a concept known as dietary inflammation.

The pandemic has been a great catalyst for change, although much of it has been difficult and distressing. We've seen seismic changes in attitudes towards home working, air travel and more active forms of transport. We can now see this as a tipping point moving us towards a better future and a golden opportunity to think about what good nutrition and health looks like in the era of the "new normal." This is not only to help reduce the risk of becoming seriously ill from COVID-19, but also to support, via healthier diets, the many people recovering from coronavirus in the months and years to come.

However, we should guard against reverting back to conventional "one-size-fits-all" dietary guidelines, as these are clearly not working. Recent results from our PREDICT study—the largest nutritional research program of its kind in the world—showed that even identical twins can respond to the same foods in very different ways. This tells us that the future of nutrition must be based on an understanding of how each person's body works, in order to move us all closer to our best health. We must focus on nourishment and helping people to find foods that taste good and are also good for their body—and to do so without hectoring, shaming or blaming.

In the "new normal," providing wider access to nutritious food is even more urgent. It's the kind of advice that has long been advocated by my friend Michael Pollan, whose doctrine of "eat food, not too much, mostly plants" may sound familiar. He told me, "We've long known the Western diet, by contributing to chronic disease, reliably kills us slowly. But in this pandemic, where the virus is particularly lethal to people with chronic disease and inflammation, we're seeing how that same diet can kill us quickly, too."

I'd like to imagine that the current situation brings us closer to a day when every American has the right to bear fruit, planting the seeds of a health revolution that will flourish in the years to come.

Tim Spector MD is professor of genetic epidemiology, King's College London, honorary physician at Guys and St Thomas' Hospital, PI of the COVID Symptom Study app and scientific co-founder of health science company ZOE. He is author of The Diet Myth and soon to be released Spoon-Fed. Follow him on Twitter @timspector.

The views expressed in this article are the writer's own.