The warning signs were there with the second wave of the coronavirus. It was winter, people were working from home and barely setting foot outside the door. “More and more of our overweight patients complained that they were finding it difficult to maintain a healthy daily rhythm, to keep fit and stick to the diet that had taken so much planning,” says Philipp Gerber. Gerber is privatdozent at UZH, doctor in the Department of Endocrinology, Diabetology and Clinical Nutrition and clinical lead of the Obesity Center at the UniversityHospital Zurich.
The specialist center for people with weight problems was established three years ago. And there’s certainly a need for it: Over 40 percent of adults in Switzerland are overweight in medical terms (BMI >25) and 10 to 12 percent are even obese (BMI >30). The weight per se is not the problem, rather it is the associated consequences such as circulation and metabolic disorders that are concerning. The USZ Obesity Center therefore employs a mixed interdisciplinary team, including a nutritionist, a visceral surgeon and a psychiatrist, among others. With the pandemic, the center’s workload increased substantially. “Every day we were seeing patients who despite receiving treatment were no longer unable to really get their weight problems under control,” says Philipp Gerber. “Something was going wrong, and we wanted to investigate the reasons in depth. Especially seeing as nobody knows how long the pandemic will continue.”
Gerber and his colleagues at USZ are not the only ones to have observed this problem. Studies have been conducted in several countries into the connections between coronavirus and obesity. The studies, based mainly on representative questionnaires and tests, have yielded some contradictory findings. Some came to the conclusion that lockdown and working from home had led to unhealthier and less disciplined eating, which clearly has negative consequences. Others noted a trend toward more home-cooked meals and less fast food as positive consequences of the pandemic. So which is true?
“The results are not necessarily a contradiction,” says Gerber, who has studied the topic intensively. Experience shows that people’s reactions to exceptional situations in terms of eating habits is very individual. “Those who already consciously made an effort to eat healthily beforehand are now paying even more attention to what they eat. But those who had problems with food before are now having an even harder time.” For people with a tendency to overeat, working at home can be their downfall: The fridge is humming away in the corner, and the snack cupboard is within easy reach. No wonder that Swiss wholesalers reported increased turnover on cookies and pastries in the first wave.
A tendency to obesity begins with the genes and ends with eating habits. People with this tendency, says Gerber, often reward themselves with snacks, for example. In stressful situations, the need for reward increases and people treat themselves more often. One effect of the pandemic has indeed been increased anxiety and tension: “Some of my patients admit that working from home combined with difficult family situations, uncertainty about what will happen next in the pandemic, existential fears and lack of social contacts cause them a great deal of stress,” says Gerber. The stress is compounded by the lack of movement. An office worker who would normally visit clients, walk up and down stairs to talk with colleagues in other offices, or walk to a restaurant at lunchtime might instead spend hours on end sitting at a desk when working from home.
Gyms were closed, and the hard winter with lots of snow made it harder to go jogging or cycling. For patients with obesity, such circumstances can often be the start of a vicious cycle, says Gerber: “They put on weight rapidly, feel embarrassed to go out in public and then have even less exercise in their daily lives.” Exercise and a controlled diet, alongside medication, are the best way to prevent people with a predisposition for obesity from gaining too much weight. “For many overweight people the pandemic has been the straw that broke the camel’s back, the thing that made their finely balanced system finally tip over,” says the endocrinologist.
A study that Philipp Gerber began working on long before Covid has shown how fragile our system really is. Together with other researchers at UZH and the UniversityHospital Zurich, he investigated the effects of sugar on our metabolism. Over the course of seven weeks, around 100 young test subjects drank lemonade sweetened with various types of sugar – fructose, glucose or sucrose. The researchers investigated the effect of the substances and compared the data with data from a control group which did not consume sugary drinks.
They concluded that it is not just the extra calories that makes the sugar bad for us: The fatal thing is what the extra sugar does to the liver. Three glasses of a common soft drink stimulates fat production so much that the liver keeps reacting and working hard long after we have finished the drink. Four glasses of lemonade contain 80 grams of sugar. According to statistics, Swiss people consume 100 grams of added sugar on a daily basis – not including sugar and carbohydrates occurring naturally in basic foodstuffs such as pasta, bread and fruit, which on their own would actually be enough to meet our body’s sugar requirements.
Increased fat production in the liver doesn’t just make us fat, it also leads to diseases such as fatty liver or diabetes. The World Health Organization (WHO) therefore recommends a maximum daily sugar ration of 50 grams, or better still only half that. A bottle of coke or half a pack of cookies thus already tips you over the daily allowance. Convenience foods are also a no-no, as they almost all contain added sugar.
“Originally,” says Gerber, “there were positive reasons to consume sugar: Our cave-dwelling ancestors ate lots of ripe fruit in the fall and the fruit sugar caused their bodies to store fat for the harsh winter ahead.” But nowadays we consume sugar all year round, and not just fruit sugar. This leads to the daily production of fat that we do not really need.
As if all that was not enough, along comes a pandemic that causes anxiety and stress, lack of movement and overeating. “For me, obesity and coronavirus are actually two interlinked pandemics that are making each other worse,” says Philip Gerber. That really worries him – just as the measures taken to combat the spread of Covid-19 led to people gaining weight, being overweight makes people more at risk from the virus. The higher the body-mass-index, the greater the risk of having a severe case of Covid-19, showed one of the many studies into the risks of the virus. At the same time, after the pandemic started, there was a clear increase in patient numbers at the USZ Obesity Center. Among them were more cases of second and third-degree obesity (BMI > 35 and BMI > 40). “These people are all high-risk patients for coronavirus,” warns Gerber.
What can be done? The important thing, says Gerber, is to be aware that the pandemic poses an additional difficulty for all those who have to battle with weight problems in normal times. Obesity is often the neglected stepchild in primary healthcare because it is a psychologically sensitive issue. “We have it easier in this regard at the Obesity Center, because people only come to us when they have acknowledged the problem and want to tackle it,” says Philipp Gerber. His advice to anyone who has a serious weight problem: “Don’t wait for the pandemic to be over, get help as soon as possible.”