"The authors of this paper have tried to use implications of data as cudgel to beat food industry"

"The authors of this paper have tried to use implications of data as cudgel to beat food industry"

If Donald Trump were a health campaigner, he may well have taken the same approach and struck a similar tone as a paper on Covid-19 and obesity published this week in the British Medical Journal, Ben Cooper writes, and if that doesn't give an academic a moment's pause, nothing will.

A paper published this week by academics from Queen Mary University of London points to the persuasive and increasing evidence of obesity as an independent risk factor for severe illness and death from Covid-19. This warrants serious and urgent attention from the public, policymakers and food manufacturers alike, but this article's confrontational vilification of the food industry is simplistic, unwarranted and out of step with the times.

What the paper has to say about the substantive issue is extremely significant. It sets out some of the growing evidence, notably a population study in the UK of nearly 430,000 people and another UK study based on the medical records of 17.4m participants, that obesity and excess weight, in themselves, are indicators for more severe symptoms or death from Covid-19. 

Summarising the likely clinical reasons behind the correlation, the article underlines how the risk of weight-related serious illness or death has escalated since the advent of Covid-19, not only for obesity sufferers but also for people who are overweight but might consider themselves relatively healthy otherwise. For instance, in the population cohort study, while the likelihood of an obesity sufferer becoming critically ill from Covid-19, after adjusting for all other variables, almost doubles, the likelihood of the same happening to someone who is just overweight still rises by as much as 44%.

Particularly if research and epidemiological data continue to bear out the experience of recent months, the Covid-19 pandemic will radically alter the evidence base concerning the health risks obesity poses. In short, the serious or possibly fatal impact of putting on excessive weight is no longer a non-communicable condition likely to develop over years, but a highly infectious, incurable disease that someone can contract today and, in some cases, be dead from within two weeks.

"The BMJ deteriorates into little more than an anti-industry rant"

As the article is entitled Obesity and Covid-19: the role of the food industry, a focus on the activities of food companies would be expected. However, following its expert summary of highly significant epidemiological data, it deteriorates into little more than an anti-industry rant.

While it has 16 citations, most relate to research into obesity or Covid-19 and only two concern food industry activity or consumption behaviour. One refers to salt reduction between 2003 and 2011 and the other to soft drinks reformulation resulting from the introduction of the UK's Soft Drinks Industry Levy, so neither has anything to do with the conduct of the food industry during the pandemic.

The paper suggests an increase in food poverty, supply disruption and panic buying "may have limited access to fresh foods, thus tilting the balance towards a greater consumption of highly processed foods and those with long shelf lives that are usually high in salt, sugar and saturated fat". While the article provides no evidence in support, these assumptions echo concerns expressed by many campaigners, while the logistical challenges and panic buying at the beginning of the lockdown are a matter of record.

It further suggests campaigns and corporate responsibility initiatives launched by food companies during the pandemic have used the outbreak as a marketing opportunity. Again, this has an element of truth to it. Companies of all kinds tend to want to associate themselves with charitable activities during times of crisis. Some people may see this as grubby, while others will be more trusting about a company's motives. However, it hardly constitutes the crime of the century and most people would probably agree it is far from being the most pressing issue of the day. The donation of half a million doughnuts to NHS staff by Krispy Kreme is in fact the only piece of evidence the article presents relating to a specific company action during the pandemic.

On the other hand, it is interesting the article fails to include any findings from a report by the Obesity Health Alliance (OHA) into how Covid-19 is affecting the UK food environment. In an online survey of 2,025 adults, conducted in April, only 14% of respondents said they were eating less fresh food, while 40% said they were eating more and 44% about the same. Only 17% said they were eating more fast food and takeaways.

The OHA findings on consumer perceptions of industry activity are even more striking. Some 39% said they had seen fewer supermarket promotions in the preceding three weeks against only 16% saying they had seen more. While 21% said they had seen more food advertising on TV, 19% said they had seen less, and 46% said it was about the same. There was a similar picture regarding online food advertising, with 19% saying they had seen more, 18% less and 46% the same. 

"It's hard not to see industry-bashing as the primary motivation"

These findings may not be conclusive but, given the absence of any other evidence whatsoever regarding food companies and consumers, it is hard not to see industry-bashing as the primary motivation here, particularly when the reader comes to what is easily the most strident assertion. "It is now clear," the paper states, "that the food industry shares the blame not only for the obesity pandemic but also for the severity of Covid-19 disease and its devastating consequences." 

This was described by Tim Rycroft, COO of UK trade body The Food and Drink Federation, which represents UK food manufacturers, as "deeply offensive". For those used to interpreting the often rather beige language of corporate communications, those words are instantly arresting. It is an emotional, visceral response that suggests the article has overstepped the mark in its tone. More than that, in its substance, it may have missed the point.

Market researchers, food companies and campaigners have all attested to the increase in snacking and consumption of comfort food during the lockdown, not just in the UK but in the US and elsewhere. 

At the same time, the impact on mental health of confinement, separation from friends and loved ones and anxiety about Covid-19 infection itself has been a major concern. In that context, the home baking boom has been hailed as positive in spite of the fact that many of the delights being prepared will have been, in the words the authors use to describe their "ultraprocessed" equivalents, "foods high in salt, sugar and saturated fat that provide only a transient sensation of fullness".

This is not to say junk food consumption does not remain a worrying issue or even that it should be afforded some sort of moral equivalence to a homemade Victoria Sponge because they both might cheer you up. In fact, there are other psychological and dietary benefits from a home-prepared cake, relating to keeping people occupied, bringing families together and increasing awareness of food ingredients and culinary skills, that a shop-bought item with the same nutritional profile would not be able to provide. Nevertheless, the baking boom has to a considerable degree been created by people's need to eat certain types of food because they find them comforting in times of stress.

Stress-related eating is a key factor in adult obesity, which in a Covid-19 context has to be the area of focus, and the distinctions just outlined between home-prepared and manufactured products underline it is a complex issue. Given the elevated stress levels people are experiencing specifically because of Covid-19, it is odd that stress-related weight gain is not mentioned in this article, which does find space to highlight the national scandal of "doughnutgate".

All the article does is repeat well-rehearsed calls for food companies to stop promoting "unhealthy" foods and for governments to force manufacturers to reformulate them. Once again, reformulation and responsible marketing remain extremely important in tackling obesity, and if the pandemic has had the effect of slowing progress, or provided cover for companies to play fast and loose either with regulations or their own stated commitments, campaigners are right to call this out. However, they have no specific relevance to the Covid-19 issue. Had the paper highlighted what food manufacturers could or should be doing specifically in relation to stress-related over-eating, for instance, the industry could have had no complaint.

Notwithstanding its rather ugly confrontational tone, arguably inappropriate for the current difficult times, the problem with this paper is not so much what it is saying, but that it is not saying anything new when clearly circumstances have changed. The same criticism could be made of the action plan campaign groups Action on Salt and Action on Sugar put before UK Prime Minister Boris Johnson two weeks ago. Indeed, the article's two senior authors, Professor Feng J He and Professor Graham MacGregor, are respectively a member and the chair of the former of those organisations.

This is also a weakness if the hope is to prompt more government action. Since his own close call with Covid-19, Johnson is said to have changed his views on government involvement in tackling obesity but campaigners will have to do much better than this to convert whatever increased receptiveness there may be into effective action. As governments battle with the twin disasters of pandemic and recession, they will be receptive to industry lobbying against the introduction of measures with adverse commercial impacts.

Obesity is a multifactorial issue and the importance of different factors varies between different groups. Most of the obesity measures implemented in recent years, and those currently under consideration by government, are targeted primarily at childhood obesity. The 9pm advertising watershed has no relevance in a Covid-19 context and those related to promotions and in-store merchandising are also far more pertinent to protecting children. Interventions targeted very specifically at adult obesity, such as increasing access to bariatric surgery, should clearly be the focus when discussing Covid-19.

Right now, governments need health professionals to contribute ideas which zero in on the causes most relevant to the increased risk of serious illness and mortality from Covid-19 among overweight and obese people, and the practices – good or bad – of the food industry may be less relevant.

The authors of this paper, among the people most qualified in the world to grasp the implications of the data on Covid-19 and obesity, have tried to use them as a cudgel to beat the food industry. 

In playing the blame game and targeting their longstanding adversary, they have adopted, dare it be said, the sort of approach Donald Trump might have taken if he were, in what would truly be the most bizarre of parallel universes, a health campaigner. And if that thought doesn't give an academic a moment's pause, nothing will.