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The Syndemic of COVID-19, Obesity, and Food Insecurity
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This month's newsletter is written by guest author Sydney Pryor. Sydney is currently a second year PhD student in the Department of Health Policy and Management at The George Washington University Milken Institute School of Public Health where she is also a Graduate Fellow for the Sumner M. Redstone Global Center for Prevention and Wellness. 

A syndemic is defined as having three key features: 1) a cluster of multiple diseases or epidemics that occur within a population at the same time and place; 2) biological, social, and/or psychological interactions between the diseases that significantly worsen the health of the people experiencing the clustered diseases; and 3) system-wide social forces that foster the disease clustering with a disproportionate impact on marginalized populations.
In January of 2020, we discussed the report on the “Global Syndemic of Obesity, Undernutrition, and Climate Change” published by the Lancet Commission on Obesity. The report described the underlying societal drivers and consequences of the syndemic, and comprehensive recommendations to address obesity within the context of the syndemic. Since we recognized the global syndemic, a second overlapping syndemic has arisen: the syndemic of COVID-19, obesity, and food insecurity. In this month’s newsletter, we explore the ways in which these three epidemics interact and how the syndemic perpetuates existing disparities among marginalized populations.
As discussed in last month’s newsletter, obesity is associated with increased risk of severe COVID-19 illness and death among both children and adults. The pandemic has also contributed to an increase in the prevalence of obesity in youth and adults. In both cases, the consequences of COVID-19 infection, hospitalization, and death have occurred more frequently in American Indian/Alaska Native, Black, and Hispanic adults compared to white adults. Additionally, disruptions to the food system and increased inactivity increased the prevalence of obesity in adults and youth, which in turn widened existing racial disparities in obesity prevalence.
COVID-19 has also exacerbated the existing problem of food insecurity in the United States. The prevalence of food insecurity increased among U.S. adults from 1999 to 2016, with greater increases for Black and Hispanic adults compared to their white counterparts. Although directly comparable data are not currently available, a nationally representative survey indicates that food insecurity among families was even higher in 2020 compared to adults in 2016, with especially high rates among Black or Hispanic families. Factors that have contributed to the increase in food insecurity during the pandemic include poverty, unemployment and lost wages, instability of the food supply, and lack of access to or enrollment in federal assistance programs. The pandemic has also contributed to an increase in the consumption of ultra-processed foods, especially among individuals and families who are unemployed and/or food insecure. Consumption of ultra-processed foods is associated with weight gain, obesity, and type 2 diabetes mellitus in adults and increases in BMI trajectories in children. These conditions contribute to the severity of COVID-19 illness. Surveys have also shown declines in physical activity in response to the pandemic, which contribute to weight gain and increased severity of COVID-19 illness.
The pandemic has disrupted every step of the food supply chain, resulting in negative financial and health effects on the essential workers who comprise the nation’s food and agriculture systems. The various sectors of the U.S. food system make up over 10% of U.S. employment. The food processing sector, which includes meat-packing plants, has higher proportions of Black and Hispanic individuals compared to the U.S. workforce as a whole. Numerous instances of major COVID-19 outbreaks have occurred in meat-packing plants and among farmworker employees, due to the lack of protective equipment and workers coming to work while ill because they cannot afford to jeopardize their employment. Thus, the pandemic has disproportionately impacted the historically underpaid and marginalized food supply chain workers. The inadequate protections and the resulting high rates of infection among food system workers led to processing plant closures and bottlenecks in the supply chain.

The complex nature of the syndemic requires complex solutions that address its issues from multiple angles. “Triple duty” solutions can decrease and prevent food insecurity, reduce obesity, and minimize the impact of COVID-19 infection and severe illness. Strategies include:

It is important to recognize that solutions to address the concurrent global syndemic of obesity, undernutrition, and climate change are also needed. Strategies that can simultaneously address both syndemics mainly involve strengthening local and regional food systems in a way that addresses economic inequities, creates healthier food environments, and promotes sustainable diets. City- and state-level legislation can also strengthen food systems by promoting worker equity, sustainable food production practices, local availability of healthy foods, and increasing food security. Such legislation may simultaneously reduce greenhouse gas (GHG) emissions and other environmental damage, which in turn can improve nutrition and the health of many populations and the planet.


Sydney Pryor, MPH
GW Milken Institute School of Public Health PhD Candidate, Health Policy
Sumner M. Redstone Global Center for Prevention and Wellness Graduate Fellow
Yale School of Public Health '20 
Virginia Tech '17

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Upcoming Events

Sep 10: OMA Webinar
Sep 23-26: Overcoming Obesity 2021
Oct 1: Wake Forest Webinar
Oct 14-23: Overcoming Obesity 2021 DX
Nov 1-5: ObesityWeek® 2021

COPE Award Call for Nominations
USPSTF Recommendation Statement
GLI Nutrition App with NutriStyle
World Obesity Day wins Purpose Award
Call for Nominations: COPE Award
Do you know someone who identified a nutrition/health need and worked to find a solution for that need?  The solution does not need to be large, or complex. It just needs to address a need. Nominate individuals/groups for the MacDonald Center for Obesity Prevention and Education (COPE) Feeding the Need, Developing Solutions Award.
COPE is excited to recognize this innovation, in celebration of their 10th anniversary. The streamlined application takes only minutes to complete. Access the application here
USPSTF Final Recommendation Statement: Screening for Prediabetes and Type 2 Diabetes
The U.S. Preventive Services Task Force released a final recommendation statement on screening for prediabetes and type 2 diabetes. Diabetes is the seventh leading cause of death in the U.S. and can lead to severe health problems. Overweight and obesity are some of the biggest risk factors for prediabetes and diabetes.

The Task Force recommends screening people ages 35 to 70 with overweight or obesity for prediabetes and diabetes to help prevent serious health complications

View the recommendation, the evidence on which it is based, and a summary for clinicians here. The final recommendation statement can also be found in the August 24, 2021 online issue of JAMA.

Less than a Week Remains to Get ObesityWeek® Early-Bird Rates

Less than a week remains to register and get early-bird rates for ObesityWeek® 2021. The deadline is Sept. 6, 2021.
The preeminent international conference for obesity researchers and clinicians, ObesityWeek® is home to the latest developments in evidence-based obesity science: cutting-edge basic and clinical research, state-of-the-art treatment and prevention, and the latest efforts in advocacy and public policy. ObesityWeek® is happening virtually Nov. 1-5, 2021.
Click here to register now. Visit for more information.
Global Liver Institute Partners with NutriStyle on Personalized Nutrition App
In conjunction with International NASH Day 2021, GLI and NutriStyle Inc. announced a personalized nutrition app for people living with liver disease, diabetes, and other chronic conditions or who want to maintain good liver health. The app will create personalized meal plans to meet the specific requirements set out by GLI nutritional advisors for people with NASH or a general interest in liver health. The development reflects the importance of nutrition in preventing and managing liver diseases and related conditions. 

Visit NutriStyle to learn more.

World Obesity Day Wins Best Health Cause Campaign Award

Earlier this month, the World Obesity Federation campaign for World Obesity Day, won the Purpose Award for Best Health Cause Campaign in the Charity & NGO category. The award-winning campaign, titled ‘World Obesity Day March 2021 – Every body needs everybody’, beat fierce competition from a shortlist of stellar campaigns from leading charities including Pancreatic Cancer UK and Epilepsy Research.

The global campaign has been credited for placing a spotlight on obesity and was described in glowing terms by the judges as an “Absolutely brilliant strategy, execution and the impact is unquestionable."

Read the full article here.
Register for the Overcoming Obesity 2021 Conference
OMA’s fall conference, Overcoming Obesity 2021, is just around the corner. Discover obesity treatment techniques like pharmacotherapy, nutrition, and more, for patients spanning pediatrics to geriatrics. Join us in-person in Chicago from Sept. 23-26, or through the Digital Experience (DX) happening Oct. 14-23, and earn up to 30 CME/CE.

Register here.
Upcoming OMA Webinar
This month's featured webinar, held on September 10, is titled "Assessment and Treatment of Challenging Family Dynamics in Weight Management and Bariatric Surgery." It covers new content and strategies that you can incorporate into your patients' obesity treatment plans.

The webinar will provide an overview of challenging family dynamics identified in pediatric and adult weight management and bariatric surgery contexts, methods of assessment and screening for challenging family dynamics, and approaches for treating these dynamics concurrently with weight management and bariatric surgery.

Register for the webinar here.
Wake Forest School of Medicine Webinar

On October 1, Northwest AHEC of the Wake Forest School of Medicine is holding a webinar titled "Obesity as a Disease: Innovative Approaches to Treatment." The aim of the conference is to provide healthcare professionals with the knowledge and skills needed to support and treat patients who struggle with obesity and obesity-related comorbidities. Participants will gain an evidence-based understanding of obesity as a disease and a basic skill-set that enables them to identify treatment strategies that goes beyond 'eat less and move more'.

Learn more and register here.
Dr. Sacheck Releases Two New Publications
STOP Obesity Alliance member and GW professor and chair Jennifer Sacheck, Ph.D., FACSM has authored two newly released publications on pediatric health. 

The first study, titled "Themes in Train-the-Trainer Nutrition Education Interventions Targeting Middle School Students: A Systematic Review" aims to identify and synthesize themes in nutrition education interventions that targeted middle school youth in urban, primarily low-income settings. Read the full text here.

The second study, titled "Understanding Physical Activity Patterns Across the School Day in Urban Pre-Kindergarten and Elementary Schoolchildren," examines school-day moderate-to-vigorous physical activity patterns in lower-income children to determine whether they were meeting physical activity guidelines and to identify opportunities for intervention. Read the full text here.
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