covid-19 and health

How Health and Wellness Became a Priority in 2020

COVID-19 is a novel coronavirus that is more potent and deadly than its predecessors. COVID-19 has undoubtedly wreaked havoc all over the world. At the time of writing this article, the United States has a total of 332,000 deaths and close to 20 million infections. There are almost 100 million coronavirus cases all over the world. For local health communities treating severe cases of COVID-19 has been difficult due to the lack of resources and the mental and physical toll on healthcare workers. Although most infected individuals improve with no intervention, for people with underlying chronic conditions such as lung ailments, heart disease, or obesity, the virus can be deadly. Individuals with obesity have the added risk of hospitalization and worse outcomes due to inflammation, the risk of respiratory depression, and the increased risk of embolism (traveling blood clots). 

 

Although there is a new vaccine for COVID-19, it is currently limited to frontline workers followed by nursing home residents, therefore, the risk of infection is anticipated to continue for the majority of Americans. To combat the spread of this virus, people all over the world are social distancing in order to reduce the chances of the airborne spread of the disease. It is thought that the droplet particles for coronavirus can travel approximately 3 feet before falling to the ground, or up to 6 feet if forcefully propelled by a cough or sneeze. For this reason not only have individuals been asked to stand at least 6 feet away from each other but to also use frequent hand washing and wear a facial barrier, such as a mask. 

 

The isolation, unpredictability, mortality, and morbidity of COVID-19 has been devastating; however, in the face of adversity the lessons learned provide a small glimmer of hope. 

 

Ways that COVID-19 has made health and wellness a priority: 

 

Cleanliness 

You are not alone if you can admit that your hand washing routine prior to COVID-19 needed some work. Forty percent of Americans, pre COVID, admitted to not washing their hands after using the bathroom. In addition, many Americans fail to wash their hands before eating a meal or touching their face. Proper handwashing has become a priority because COVID-19 is spread from person to person and has demonstrated an ability to live on certain inanimate surfaces. The good news is that now Americans are washing their hands more often throughout the day and also focusing on proper hand washing. The CDC recommends wetting hands first and then adding soap until it creates a lather and rubbing hands together at least 20 seconds before rinsing and drying hands. 

 

Businesses have followed suit by employing proper cleaning techniques on a more routine basis such as cleaning surfaces and contact areas between customers, wearing gloves and masks, and using quality disinfectants such as Bleach, Lysol, and other supplies. 

 

Many Americans have finally learned to shield their coughs and sneezes. Coughing and sneezing on your neighbor without covering your nose and mouth has always been rude and unpleasant but now people are taking extra precautions to shield their germs from potentially infecting others.  Masks partially help with the spread of respiratory viruses but an elbow (recommended) or at least a hand is helpful as well. As an added incentive, some states such as Virginia have made deliberately coughing or sneezing on someone else a punishable offense that can result in jailtime and fines. 

 

Overall Americans have become much more cognoscente of cleanliness, using soap, water, hand sanitizer, and disinfectant wipes more than ever.

We appreciate "REAL" Connection

 

It's true that you don’t know what you've got till it's gone. 

 

Although the explosion of social media with TikTok, Instagram Reels, and YouTube videos has helped the world connect, it does not take the place of in-person human interaction. COVID-19 has taught us to value interpersonal relationships and being with one another.

 

Text messaging, email, facetime, social media likes, and direct messages (DMs) have taken the place of phone calls, in person meetings, and quality time.  Being forced to interact with distance or through virtual means has been an inferior substitute. We miss birthday celebrations, meet ups at the coffee shop, and happy hours at the end of a long work week. We miss hugs and physical demonstrations of affection. Events and networking are on hold or altered to avoid handshakes and close contact. 

 

The way we communicate has changed, eye contact has been replaced with a camera lens and we've been reduced to seeing people either behind a mask or from the waist up only. 

 

COVID-19 has taught us that humans cannot survive in a vacuum and no matter how introverted one may be, we are best when we connect with each other. It is essential to our existence and mental well-being. 

 

The Return of the Routine 

 

What does the school system and the in-office work environment have in common? 

 

Structure. 

 

Many parents learned quickly that their children are in a structured environment that when disrupted leads to chaos and an inability to learn and retain new information. 

 

For individuals new to working from home, the struggle with structure and routine led to poor habits such as overeating, inactivity, low productivity, and boredom. 

 

Regardless of the changes in the environment, it is necessary to establish a home routine. Structure and routine are strong success keys for weight management as well. Establishing a routine requires time management and planning for core activities like waking, sleep, meal times, and work, as well as wellness activities such as self-care, breaks and time off, and physical activity.

 

Cooking and Meal Preparation 

 

As home based hobbies continue to emerge there is no greater pastime than cooking and meal preparation. Cooking serves several purposes such as exploration of a new skill, sustenance, and healthy weight management. To add, cooking is a form of love and consideration that has allowed families in quarantine to spend quality time sharing meals together.

 

As diets such as keto and low carb continue to evolve, new essential tools to shorten cooking time also emerged such as the Instant Pot and air fryer.  New culinary tools to simplify the cooking process has allowed for more people to explore cooking and share these adventures through online videos, social media posts, recipe blogs, and businesses geared at selling meal prep and pre-packaged food mixes. 

 

Emphasis on Mental Health 

 

There are unfortunately many reasons for mental instability in 2020. Uncertainty, fear, and death are sad and hard to cope with. Many admit  to depression, boredom, and even hopelessness. Millions are unemployed and the division of the country has been disheartening. What makes 2020 unique is that quarantine has removed distractions and the ability to escape from reality. 

 

Mental health apps, virtual visits with counselors, and faith-based programs have heeded the call for compassionate self-care. COVID-19 has provided a heightened awareness that healing emotional trauma and mental toxicity is imperative to moving forward and it is refreshing to see more avenues for mental health explode in 2020. 

 

The Art of the Pivot

 

Perhaps one of the most essential lessons from COVID-19 has been how to survive less than ideal circumstances. One of those survival tactics is the art of the pivot. We have witnessed the pivot in various areas ranging from business to personal to education and health and wellness. We have leveraged technology to find alternate ways to connect and knitted fabrics for face coverings when simple masks and n95s were obsolete. We have learned to problem solve, trouble shoot, and course correct in order to reach the best solution. 

 

The lessons from COVID-19 have been life changing making 2020 a year that most will never forget.  We mourn those who were lost and have learned patience, resilience, endurance, and gratitude. 

Is obesity a disease?

Why Is Obesity a Disease?

The American Medical Association (AMA) designated obesity a disease in 2013 and as a result, the idea that obesity is caused by insufficient willpower, lack of discipline, and bad choices began to transform. The headlines, “AMA Recognizes Obesity as a Disease” were catapulted across both academic and mainstream media. Obesity was no longer a conversation topic tucked away in a dusty corner but was instead sprinkled across national news for the public to scrutinize. From “TED Talks” to The New York Timesobesity specialists were asked to “weigh in” on this groundbreaking and somewhat controversial topic and to answer the question, “is obesity a disease?”

Now, four years later, the debate continues. Is obesity a disease? For some, obesity as a disease invalidates the importance of discipline, proper nutrition, and exercise and enables individuals with obesity to escape responsibility. For others, obesity as a disease is a bridge to additional research, coordination of effective treatment, and increased resources for weight loss.

According to Merriam Webster, a disease is “a condition . . . that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” In defining obesity specifically, one of the most comprehensive definitions is provided by the Obesity Medicine Association in the Obesity Algorithm. Obesity is defined as a “chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

Individuals with obesity have an increased accumulation of fat not always attributable to eating too many calories or lacking physical activity. Individuals with obesity experience impaired metabolic pathways along with disordered signaling for hunger, satiety (the feeling of fullness), and fullness (the state of fullness). For many, efforts to lose weight are met with unyielding resistance or disappointing weight regain. This is demonstrated by the follow-up body composition results of contestants on “The Biggest Loser.” As contestants lose even as much as 230 pounds, their body’s response is a slower and less efficient basal metabolic rate. This occurs in an effort to return the body to its previous condition of obesity; it’s a counter-effort by the body that makes weight gain easier and weight loss harder.

The pathology of obesity is vast and varies based on the cause of weight gain. There is not just one type or cause for obesity. Obesity sub-types include congenital, stress-induced, menopause-related, and MC4R-deficient, to name a few. Obesity is related to genetic, psychological, physical, metabolic, neurological, and hormonal impairments. It is intimately linked to heart disease, sleep apnea, and certain cancers. Obesity is one of the few diseases that can negatively influence social and interpersonal relationships.

Why obesity is a disease is becoming more evident as we increase our knowledge of fat mechanics. To successfully confront the obesity pandemic will require attacking the disease and its manifestations, not just its symptoms.

Do you consider obesity a disease? At the end of this Medscape article, you can take a short survey and view the results to find out where you stand compared to other physician specialties.

This blog article was originally written by Dr Melody Covington MD for the Obesity Medicine Association and can be found in their weight management blog section.

what are the causes of obesity?

Obesity is Not Just Calories In and Calories Out. Here's Proof

Understanding Causes of Obesity

I attended a networking event this past weekend and I had the pleasure of meeting a young physical trainer aspiring to expand his personal fitness brand. I questioned him on his experience with training clients over 300 lbs and he was honest to state that he had never trained anyone this size. He then went on to say, "at that weight it's all about diet, so I would cut down their calories and tell them to walk for 40 minutes a day". I smiled and shook his hand to continue through the crowd of attendees but his statement stuck with me for hours and not in a positive way. I certainly understand his approach, perhaps he was thinking that in order to maintain a 300 lb frame the caloric intake would need to be approximately 4200 calories so reduce calories and increase energy expenditure and voila, we get weight loss. The approach is simplistic and works in some individuals but does not account for basal metabolism, hormone balance, or fat regulation. I would caution applying the calorie and exercise equation to a client without more depth, specificity, or validity. We have all witnessed the individual who is working out excessively and eating a restricted diet to only gain or merely maintain weight. Oftentimes these individuals are blamed for cheating on their diet but the truth is, their weight loss plan may just not work for their sub-type of obesity.

Excess calories and a sedentary lifestyle can certainly lead to excess weight but they are not the only causes for weight gain.

There are over 50 varieties of obesity!

My discussion with this gentleman lead me to write this post and share the various types and causes of obesity. The list below is derived from lectures, presentations, and published articles quoting my adopted mentor Dr. Lee Kaplan, MD, PhD and Medical Director of the Massachusetts General Hospital Weight Center Program. I remember the first time that I heard Dr. Kaplan speak, I was in the last weeks of my internal medicine residency in Charlotte, NC and he was explaining the intricate pathways involved in obesity and the disease of obesity. I was fascinated. In all of my medical training I had never heard anyone explain the complexity of weight in this way. It revolutionized the way that I practice weight management and taught me that obesity is so much more than just diet and exercise alone.

Types of Obesity

Genetic/Congenital and Syndromic Receptor or Hormone Deficiency Neurologic Metabolic Lifestyle Related or Induced Other
-Prader-Willi Sydrome

-Neonatal

-Bardet Biedl Syndrome

-Fragile X

-Cohen Syndrome

-Carpenter Syndrome

-Albright Osteodystrophy

-Alstrom Syndrome

-BFL Syndrome

-Ayazzi Syndrome

-MOMO Syndrome

-Rubenstein-Taybi Syndrome

-Leptin Hormone Deficiency

-Leptin Receptor Deficiency

-POMC Deficiency

-MC4R Deficiency

-Alpha-MSH Deficiency

-Sim-1 Deficiency

-PC-1 Deficiency

-KSR2 Deficiency

-MRAP2 Deficiency

-SH2B1 Deficiency

-BDNF Deficiency

-trkB Deficiency

-Central -Hypothalamic

Hyperphagic

-Circadian-disrupted

-Healthy Metabolic

-Thermogenesis Deficient

-Inflammatory

-Insulin Induced

-Steroid-Induced

-Progesterone Induced

-Psychotropic Induced

-Antibiotic Induced

-Endocrine Disorder Cushings, Diabetes

-Endocrine Disruptor

-Stress-induced

-Gestational

-Menopausal

-Early Childhood

-Peripubertal

-Diet Dependent

-Exercise Sensitive

-Sleep Sensitive

-Phentermine responsive

-Lorcaserin responsive

-Topiramate responsive

-Metformin-responsive

-Bupropion responsive

-GLP-1 responsive

-Bypass surgery responsive

-Bypass surgery resistant

-Gastric band responsive

-Viral Adenovirus

-Peripheral related

-Diffuse

Adapted from Presentations by Lee Kaplan, MD, PHD and publication Your Weight Matters, Fall 2016

Chart and Classification is Original ContentCopyright 2017 © Melody Covington MD, Abundant Health & Vitality Inc

Diet and exercise will always be the foundation for weight loss. We are learning so much about obesity and how to treat it. It is time to reject the notion that diet and exercise alone are the cure for excess weight. It is also time to stop overestimating the impact of exercise, it is much more essential for weight maintenance than weight loss. As listed in the chart above diet and exercise are not the only causes of obesity, so it can also no longer be our only treatment.