But it also brought the return of a pyramid-like graphic—this time flipped on its head, emphasizing foods like steak, full-fat milk, and butter. The visual prominence of such options might have you thinking saturated fat limits were tossed out with the MyPlate graphic, but the actual Guidelines retain the longstanding upper limit of 10% of total daily calories. 

“I think the new Guidelines move in the right direction by reinforcing the importance of reducing added sugars and cutting back on refined grains and other highly processed foods,” said Frank Hu, professor of nutrition and epidemiology and chair of the Department of Nutrition at the Harvard T.H. Chan School of Public Health. “However, there appear to be several contradictions within the DGAs and between the DGAs and the new pyramid. The mixed messages surrounding saturated-fat-rich foods such as red meat, butter, and beef tallow may lead to confusion and potentially higher intake of saturated fat and increased LDL cholesterol and cardiovascular risk.” 

While the other largest section of the pyramid is sensibly composed of vegetables and fruits, Dr. Hu did flag the relatively smaller depiction of whole grains in the pyramid despite the Guidelines’ recommendation of 2-4 servings per day.  

These details matter, as images and taglines may be more memorable than the nuanced details and underlying text. It’s one of the reasons why we created our Healthy Eating Plate (and the Healthy Eating Pyramid before that).  

Below we unpack some key changes in this newest edition of the DGAs, considering both its written guidance and the “New Food Pyramid.”  

Calling out “highly processed” foods 

While previous DGAs have emphasized whole foods while minimizing added sugar and sodium, this edition is the first to call out a broader category of “highly processed foods.” Although this terminology is somewhat vague on the surface (food processing is a spectrum after all), the text recommends avoiding sugar-sweetened beverages as well as salty or sweet packaged snacks and ready-to-eat foods (even the illustrated yogurt container in the pyramid specifies “unsweetened”). The guidance on grains prioritizes whole, fiber-rich options while calling for a significant reduction in highly processed, refined carbohydrates, such as white bread. 

Further reductions on added sugar 

The new DGAs take an overall strict position on sweets, noting that “no amount of added sugars or non-nutritive sweeteners is recommended or considered part of a healthy or nutritious diet.” In practice, it recommends no one meal should contain more than 10 grams of added sugars (although meals aren’t generally how people track added sugar in their diet). This is reduction from the previous DGAs’ limit of 10% of daily calories (e.g., 50 grams of added sugar each day in a 2,000-calorie diet). It also now calls for children to avoid added sugars until age 10—a jump from age 2. The DGAs are clear on avoiding added sugar, but far less clear on how these recommendations can be implemented in everyday life. 

Contradictory guidance on healthy fats

When it comes to dietary fat and long-term health outcomes, what’s most important is the type of fat you eat—reducing saturated fat and replacing it with sources of unsaturated fat. As mentioned, the DGAs maintained existing consensus that saturated fat consumption should not exceed 10% of total daily calories.  

What’s confusing is that the “healthy fat” guidance groups animal-based foods higher in saturated fat—such as meats and full-fat dairy—with plant-based foods lower in saturated fat. There is no mention as to which of these foods should be chosen more or less often to help stay within the upper limit. And on the pyramid, steak, cheese, whole milk, and butter seem to play a prominent role.  

While olive oil is visualized in the pyramid and suggested as a healthy fat, it is referenced as an option with “essential fatty acids.” While olive oil is a healthy choice lower in saturated fat (2 grams per tablespoon), Dr. Hu explains how there are better sources when consuming essential fatty acids is the goal:  

“Olive oil contains mostly oleic acid, but relatively small amounts of essential fatty acids such as alpha-linolenic acid and linoleic acid compared with other oils that are rich sources of these fatty acids, such as soybean oil and canola oil. Importantly, all these plant oils have been shown to lower LDL cholesterol and cardiovascular risk compared with animal fats such as butter or tropical fats such as coconut oil and palm oil.” 

Hype around protein quantity 

The new DGAs suggest that adults consume 1.2 to 1.6 grams of protein per kilogram of body weight per day, 50-100% more than what was previously recommended for minimum intake. Certainly, protein needs are highly variable—and wider ranges have been set by groups like the National Academy of Medicines—but these needs are best determined by a healthcare provider or a registered dietitian, as consuming excess protein can still be converted to fat in the body and lead to weight gain. What’s also missing from the Guidelines is clarity on the quality of different protein foods, especially when many in the U.S. are consuming more than enough protein. 

“Substantially raising overall protein intake without distinguishing between different protein sources may have unintended long-term health implications,” says Dr. Hu. “Evidence continues to suggest that plant-based proteins and fish are associated with more favorable health outcomes than diets high in red meat.” 

When we eat foods for protein, we also eat everything that comes alongside it: the different fats, fiber, sodium, and more. It’s this protein “package” that’s likely to make a difference for health. While the Guidelines recommend a “variety of protein foods” from both animal and plant sources, there’s no clear messaging about which options should be chosen more regularly. Given the DGAs’ stated saturated fat limits, this is an important consideration depending on what other foods are consumed throughout the day. For example: 

• A 4-ounce broiled sirloin steak is a significant source of protein—about 33 grams worth. But it also delivers about 5 grams of saturated fat. 
• A cup of cooked lentils provides about 18 grams of protein and 15 grams of fiber, and it has virtually no saturated fat.  

“Less” Alcohol

On alcohol, the DGAs offer a vague message to “consume less alcohol for better health,” Without concrete limits, it’s hard for people to know what “less” actually means.

Still no consideration of environmental impacts 

Another concern is that the DGAs do not consider the environmental and socioeconomic impact of dietary recommendations. This omission is problematic because food choices significantly affect the environment, and in turn are strongly shaped by socioeconomic and cultural factors. 

Bottom line 

Despite stronger positions on added sugars and highly processed foods, and technical alignment with the scientific consensus on saturated fat limits, certain aspects of the 2025 Guidelines send mixed signals. The New Food Pyramid graphic itself is particularly puzzling, given the visual emphasis on animal products high in saturated fat. Although DGAs are typically launched as policy documents, this edition appears more consumer-friendly, given its shorter length, associated graphics, and interactive website. Historically, research finds that Americans do not follow the dietary guidelines, so it remains to be seen if this edition will be any different. However, if you find yourself confused by some of the conflicting messaging, we recommend checking out the Healthy Eating Plate, or consulting a registered dietitian for more personalized guidance.  

“The apple in your hand is the body of the cosmos.” – Thich Nhat Hanh

Happy New Year, and welcome to the fourth edition of the Healthy Living Guide! 2023 was an exciting year in the Department of Nutrition, as we celebrated the launch of the Thich Nhat Hanh Center for Mindfulness in Public Health. Aligned with its name and location, the Center is committed to researching ways to apply mindfulness to improve well-being at the population level—not just for individuals, but across large groups globally. Mindful eating and its impact on both personal and planetary health is a core focus of the Center—a theme you’ll find integrated throughout this year’s Guide.

You’ll also see research highlights and tips related to our annual categories of nutrition, physical activity, and sleep, including the latest findings on ultra-processed foods and mental health, turning up the tunes and moving with Zumba, and evidence on different sleep “chronotypes” and health.

Wishing you a healthy, fulfilling, and mindful 2024.

Download a copy of the Healthy Living Guide (PDF) featuring printable tip sheets and summaries, or access many of the full online articles through the links below. 

Key features this issue:

• Mindful eating
• Plate and the planet
  • Strategies to reduce red meat and elevate your plate
• A blueprint for building healthy meals
• Intuitive eating
• Healthy beverage guide
• Spotlight on low-calorie sweeteners
• Staying active
  • Zumba
• Updates on sleep
• Healthy longevity

Plus: Test your healthy living knowledge

Hint: the answers can be found throughout last year’s Healthy Living Guide. Access the full edition here if you haven’t checked it out!

The World Health Organization (WHO) has released updated guidelines for defining healthy diets, with particular attention to carbohydrates, total fat, and specific types of fat such as saturated and trans fats. The guidelines are an addition to their previous recommendations on added sugars, sodium, and non-sugar sweeteners. With the exception of total fat intake, the recommendations below are geared toward everyone ages 2 and older:

• A healthy dietary pattern—a combination of foods that is influenced by availability, affordability, preferences, culture, traditions, and other factors—is encouraged with the core tenets of adequacy, diversity, balance, and moderation.
• A variety of food groups and a variety of foods within each food group are encouraged to reduce the risk of vitamin and mineral deficiencies, and to provide health-promoting components found in a diverse diet.
• Carbohydrate intake should comprise 40-70% of total calorie intake and come mainly from minimally processed whole grains, vegetables, fruits, and legumes, with research finding that these foods are associated with a reduced risk of deaths from any cause and diet-related non-communicable diseases (e.g., diabetes, cardiovascular disease, cancer). They advised 400 grams of fruits and vegetables daily (equivalent to about 2 servings each), and 25 grams fiber daily.
• Saturated fatty acid intake should be reduced to 10% or less of total calorie intake, and trans fat intake to 1% of total calorie intake, which is associated with reduced risk of deaths from any cause, reduced cardiovascular disease, and lower LDL levels. They advise replacing saturated fatty acids with polyunsaturated fatty acids.
• Total fat intake for adults ages 20 and older should comprise 30% or less of total calorie intake for the prevention of unhealthy weight gain, and the type of fat consumed should be mostly unsaturated fatty acids. This amount was associated with reduced body weight, body mass index, waist circumference, and body fat percentage. They cited evidence that suggested a dose response, in that the more fat intake was reduced, the greater the reduction in body weight. A reduced-fat intake was associated with a lower calorie intake, leading to decreased weight. The guidelines also cited that individuals who can maintain their weight may be able to consume higher levels of fat greater than 30%; for example, one may consume 40% of calories from fat but intakes of carbohydrate and protein would decrease in order to maintain energy balance by consuming the same calorie level. [1]

Experts in the Department of Nutrition at the Harvard T.H. Chan School of Public Health disagreed with the WHO guidelines to limit total fat intake to 30% or less of total calorie intake, citing evidence from dozens of long-term cohort studies and randomized trials that showed a lack of benefit of low-fat diets for lowering risk of chronic conditions including cancer, diabetes, cardiovascular disease, and weight loss. For example, the PREDIMED trials—which randomly assigned people to a Mediterranean diet with a higher fat intake of 39-42% of total calories (mostly from unsaturated fats) or a low-fat diet—found a lower risk of cardiovascular disease and type 2 diabetes on the higher fat diet. [2,3] The Harvard researchers also expressed concern that lowering total fat intake could mean increasing carbohydrate intake, especially refined carbohydrates and sugars, which has been shown to increase blood pressure and triglycerides.

“The new WHO recommendation that intake of total fat be limited to 30% of calories is narrowly based on one deeply flawed meta-analysis of weight gain,” said Dr. Walter Willett, Professor of Epidemiology and Nutrition. “This ignores the last several decades of research on dietary fat and excludes the traditional Mediterranean diet, which has been widely recognized as a healthy model for eating, based on a massive body of evidence. Although other aspects of the WHO dietary recommendations are well-supported, the limit on total fat is best ignored.”

In the meta-analyses supporting the WHO guidelines, Willett and colleagues noted that the WHO report did not include a comprehensive assembly of randomized controlled trials but rather selective studies in which weight change was not the primary outcome, and many participants had chronic conditions like cancer, diabetes, and cardiovascular disease, and therefore were not considered healthy.

They also noted that the meta-analyses excluded studies that were carefully designed to look at dietary fat and weight changes, and that many of the included studies provided an unequal intervention. For example, in many studies, the low-fat diet group received intensive guidance and monitoring of fat reduction, whereas the control group received no advice or monitoring. This is meaningful as close dietary guidance and monitoring itself results in small reductions in weight.

“Even if the result of the meta-analysis were to be believed, the difference between the low- and high-total fat groups was only about two pounds (0.9 kg after accounting for sample size), hardly sufficient to be setting global dietary recommendations,” Willett added. “On the other hand, the type of dietary fat has major implications for long term health and wellbeing, and the recommendation to emphasize unsaturated sources of fat from plants over those high in saturated and trans fat is well-founded.”

Last updated July 18.

When looking at observational cohort studies, long-term use of NSS-containing beverages was associated with an increased risk of cardiovascular disease and early death in adults. A higher intake of NSS, either in beverages or added to foods, was also associated with increased risk of developing type 2 diabetes. The WHO noted that “reverse causation” may have contributed to the positive association: participants with the highest intakes of NSS tended to have a higher body mass index and obesity or metabolic risk factors, and therefore may have already been predisposed to chronic disease (for which they were choosing NSS as a health measure). No association was found with intakes of NSS-containing beverages and cancer or cancer deaths.

Based on these findings, WHO advised that people work to lower the overall sweetness in the diet starting early in life, as NSS do not provide nutritional value. Examples of NSS include acesulfame K, aspartame, saccharin, sucralose, and stevia. Their analysis did not study sugar alcohols (polyols) such as maltitol, xylitol, and sorbitol that are added to many foods and beverages.

Harvard Chan School experts agreed with the WHO recommendation to tame our sweet tooths, but had some criticisms that the meta-analysis excluded certain large studies. [1-3] The omitted cohort studies—which included more than 100,000 people—found that increasing consumption of artificially sweetened beverages at the expense of sugar-sweetened beverages was associated with less weight gain over time, consistent with findings from small, short-term randomized controlled trials. Based on statistical modeling, it was estimated that replacing one serving of sugar-sweetened beverage with an artificially sweetened beverage was associated with a 4% lower risk of total mortality, 5% lower risk of cardiovascular disease-related mortality, and 4% lower risk of cancer-related mortality.

Of course, when it comes to optimal beverages for long-term health, we should look to other options. Frank Hu, Chair of the Department of Nutrition at the Harvard T.H. Chan School of Public Health, explains that “for habitual consumers of sugar-sweetened beverages, artificially sweetened beverages can be used as a temporary replacement, although the best choices would be water and unsweetened coffee or tea.”

Related

Throughout 2022, food and nutrition were often in the spotlight, perhaps most notably with the White House Conference on Hunger, Nutrition, and Health. The national strategy that emerged from the event (the first of its kind since the original conference in 1969) aims at ending hunger and increasing healthy eating and physical activity by 2030. While the plan includes many promising approaches, such as expanding nutrition assistance programs and covering medically tailored meals under Medicare, our Department of Nutrition experts also noted some major omissions, including protecting children from unhealthy food marketing, as well as transforming the food system in response to climate change. “To have a significant impact, the administration must bring together the public and private sectors, along with philanthropists, academia, and individuals to develop truly sustainable food systems that support both public and planetary health,” Drs. Frank Hu, Walter Willett, and Lilian Cheung wrote in reflection of the event.

Indeed, there is much work to be done in creating policies that ensure there is not only enough food to sustain current and future generations, but also make optimal choices accessible and affordable to all. In the meantime, we encourage you to incorporate healthy behaviors wherever you can—no change is too small! We hope you find this Guide useful, and we wish you a fulfilling 2023.

Download a copy of the Healthy Living Guide (PDF) featuring printable tip sheets and summaries, or access many of the full online articles through the links below. 

Key features this issue:

• Spotlight on our food supply:
  • Strategies for eating well on a budget
  • Accessing supplemental food resources
  • Navigating infant formula shortages
• A blueprint for building healthy meals
• Vitamin D
• Healthy longevity
  • MIND diet review
• Clean eating
• Processed foods and health
• The science of snacking
• Food feature: Chia seeds
• The importance of oral health
• Staying active
  • Considerations for special populations
  • Bicycling
• Updates on sleep

Plus: Test your healthy living knowledge

Hint: the answers can be found throughout last year’s Healthy Living Guide. Access the full edition here if you haven’t checked it out!

What you can do now:

• Consult first with your child’s pediatrician, especially if your child has allergies or special formula needs. They can inform you of safe alternative brands.
• Be flexible in trying different brands, including generic. Many brands advertise special health benefits that have more to do with marketing than an actual difference in their nutrition content.
• The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offers guidelines for alternatives to brand name infant formulas and for special sensitivities in the event of a shortage.
• If your child is older than 6 months, encourage a mixture of both infant food and formula. If they are closer to one year of age, they may be able to use toddler formula if approved by your pediatrician. After one year of age, babies no longer need formula and can be weaned off.

What not to do:

• Avoid hoarding commercial infant formulas, which only prolongs a shortage. The American Academy of Pediatrics advises buying no more than a 10-day to 2-week supply of formula. [1] In addition to regular supermarkets, check drugstores, smaller store chains, and reputable online sites.
• Do not make homemade infant formulas. The U.S. Food and Drug Administration (FDA) warns that they carry a risk of bacterial contamination and may not provide appropriate amounts of nutrients and fluids required for an infant’s growth. [2] Infants have been hospitalized or even died due to use of homemade infant formula recipes lacking nutrients.
• Do not add extra water to formula to extend its use. This will dilute the nutritional content of the formula and increase the risk for deficiencies.
• Avoid infant formulas from other countries unless they are approved by the FDA. FDA approvals are expected soon for formulas manufactured in Europe, for instance, so contact your health care provider (pediatrician, registered dietitian) with specific questions.

Future Directions

Policy changes are needed to prevent a recurrence of severe formula shortages in the future. An article from the American Journal of Clinical Nutrition outlines the following action steps: [3]

1. Completion and release of all investigative documents about formula recalls and public hearings to communicate the findings.
2. The FDA and U.S. Department of Agriculture should create specific rules for formulas that are identified as critical for specialized use to be produced at multiple sites and preferably by multiple companies (as opposed to the current situation of specialized formulas that are produced by a small handful of companies).
3. Establishment of a national plan related to assessment of formula needs and response to shortages, including those caused by natural disasters or recalls, especially in rural communities and for specialized and medical formulas. This should include considering the use of formulas made by reliable international manufacturers.
4. Creation of a database of “similar” formulas (e.g., amino acid-based or partial hydrolysate formulas) easily accessible to both consumers and health care providers, so that families can easily identify similar products if their usual formula is out of stock.
5. Changing of WIC rules to increase flexibility for families to purchase formula alternatives when a shortage occurs, with re-evaluation of the WIC state contracting processes.
6. Strong advocacy for workplace and postpartum rules to enhance breastfeeding and increase time for breastfeeding at work and before return to work.
7. A national policy allowing reimbursement for donor breast milk for families, especially when it is medically indicated or when formulas are in short supply.

Over the course of 2021, many of us continued to adapt to a “new normal,” characterized by a return to some pre-pandemic activities mixed with hobbies or habits that have emerged since 2020’s lockdowns. On the topic of food and eating, according to one U.S. consumer survey the year marked a decrease in certain behaviors that had changed abruptly during 2020. For example, fewer Americans reported that they were “snacking more” (18% in 2021 vs. 32% in 2020) or “eating more in general” (11% in 2021 vs. 20% in 2020). However, consumers also signaled a decrease in cooking at home (47% in 2021 vs. 60% in 2020); while other survey findings underscored significant disparities in food security. Beyond food, the COVID-19 pandemic continues to generate a wide range of unique and individual impacts, and the emergence of new disease variants is a sobering reminder of the urgency for increased vaccination globally, especially in low- and lower-middle-income countries.

As we all continue to navigate the twists and turns of this pandemic, we once again invite you to do what you can to incorporate healthy behaviors into your daily life. This year’s edition revisits the core themes of eating well, being active, and getting enough sleep with selected research highlights, as well as a closer look at some popular nutrition and lifestyle topics. We hope that you find it useful, and we wish you a very healthy and fulfilling 2022.

Download a copy of the Healthy Living Guide (PDF) featuring printable tip sheets and summaries, or access many of the full online articles through the links below. 

Key features this issue:

• A blueprint for building healthy meals
• Exploring aquatic foods
• Are anti-nutrients harmful? 
• Navigating information on food packages
• The science of cravings
• Anti-inflammatory diet review
• Clearing up confusion on soy and health
• Spotlight on collagen
• Staying active:
  • Yoga for exercise
  • High-intensity interval training
• Workout supplement review
• Updates on sleep

Plus: Test your healthy living knowledge

Hint: the answers can be found throughout last year’s Healthy Living Guide. Access the full edition here if you haven’t checked it out!

As we transition from 2020 into 2021, the COVID-19 pandemic continues to affect nearly every aspect of our lives. For many, this health crisis has created a range of unique and individual impacts—including food access issues, income disruptions, and emotional distress.

Although we do not have concrete evidence regarding specific dietary factors that can reduce risk of COVID-19, we do know that maintaining a healthy lifestyle is critical to keeping our immune system strong. Beyond immunity, research has shown that individuals following five key habits—eating a healthy diet, exercising regularly, keeping a healthy body weight, not drinking too much alcohol, and not smoking—live more than a decade longer than those who don’t. Plus, maintaining these practices may not only help us live longer, but also better. Adults following these five key habits at middle-age were found to live more years free of chronic diseases including type 2 diabetes, cardiovascular disease, and cancer.

While sticking to healthy habits is often easier said than done, we created this guide with the goal of providing some tips and strategies that may help. During these particularly uncertain times, we invite you to do what you can to maintain a healthy lifestyle, and hopefully (if you’re able to try out a new recipe or exercise, or pick up a fulfilling hobby) find some enjoyment along the way.

Download a copy of the Healthy Living Guide (PDF) featuring printable tip sheets and summaries, or access the full online articles through the links below. 

In this issue:

• Nutrition and immunity:
  • Understanding the body’s immune system
  • Does an immune-boosting diet exist?
  • The role of the microbiome
  • A closer look at vitamin and herbal supplements
  • 8 tips to support a healthy immune system
• A blueprint for building healthy meals
• Food feature: lentils 
• Strategies for eating well on a budget
• Practicing mindful eating
• What is precision nutrition?
• Diet reviews:
  • Ketogenic diet
  • Intermittent fasting
  • Gluten-free
• Staying Active:
  • 10 tips to keep moving
  • Exercise safety
  • Spotlight on walking for exercise
• Stress and health:
  • How does chronic stress affect eating patterns?
  • Ways to help control stress
• Sleep:
  • How much sleep do we need?
  • Why do we dream?
  • Sleep deficiency and health
  • Tips for getting a good night’s rest

How many tips from the Guide can you put into practice? Play the healthy living bingo challenge!

Download your printable bingo card

Highlights from the Guidelines

Where the Guidelines fall short

While the Guidelines include dietary patterns that remain examples of healthy diets (“Healthy Mediterranean-Style Pattern,” and “Healthy Vegetarian Pattern”), the dietary targets for the “Healthy U.S.-Style Pattern” emphasize a diet relatively high in meat, eggs, and dairy foods. Dr. Walter Willett, Professor of Epidemiology and Nutrition in the Department of Nutrition at Harvard T.H. Chan School of Public Health said this about the new Guidelines:

In general, there was minimal change from the last edition of the Guidelines, which did include many positive suggestions. However, guidance that considers scientific evidence on specific protein sources and health, and also the environmental consequences of dietary patterns, is needed to provide Americans with advice and policies for healthy and sustainable diets. The current Dietary Guidelines fail to do this.

Like the previous edition, the Guidelines are silent on the environmental impacts of their dietary targets, which other analyses show would have serious impacts on climate change and other environmental footprints because of the relatively large amounts of meat and dairy foods recommended. [2] Along with varying impacts on human health, different foods also have differing impacts on the environment. The production of animal-based foods tends to have higher greenhouse gas emissions than plant-based foods—and red meat (especially beef) and dairy stand out for their disproportionate impact.

Willett points out that the Guidelines’ continued dairy recommendation of 3 servings per day has never been justified by evidence for health outcomes, and the guidance for low-fat and fat-free dairy products doesn’t detail a plan for disposal of the fat naturally present in milk:

Because the disposal of dairy fat would be hugely wasteful, it would almost certainly remain in the food supply, which makes this recommendation somewhat of a fantasy. The report does appropriately mention that soy milk is an alternative to cow milk, but to avoid the large greenhouse gas emissions associated with dairy food consumption at three servings per day, the majority of milk and dairy foods would need to be plant-based.

Similarly, the Guidelines also recommend lean meats, but don’t discuss the fate of cuts of meat that are not lean. Willett says that realistically, they would almost certainly be consumed, “probably as cheap cuts and processed meats, especially by low-income groups who already experience excess rates of obesity and diabetes.”

It’s notable that the overall protein recommendation leads with “lean meats,” which could be interpreted by consumers as including “lean” or “low-fat” cuts of bacon or other processed meats. Although further guidance clarifies that “most intake of meats and poultry should be from fresh, frozen, or canned, and in lean forms (e.g., chicken breast or ground turkey) versus processed meats (e.g., hot dogs, sausages, ham, luncheon meats),” [1] this statement is buried within the chapters of the guidelines, rather than emphasized within the summarized protein recommendation. This is a particularly important distinction, since consuming healthy protein sources like beans, nuts, fish, or poultry in place of red meat and processed meat can lower the risk of several diseases and premature death.

The novel Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has created a global pandemic with its syndrome, COVID-19. The number of people affected by COVID-19 continues to increase worldwide, and information about risk factors for severe COVID-19 and mortality is emerging almost daily.

Older adults and those who are immunocompromised due to underlying medical conditions are at higher risk for developing serious complications from COVID-19 illness. For both young and old adults, emerging data suggests that obesity may be linked to risk of severe illness and hospitalization. [1,2] A recent systematic review of 75 studies found that compared to people of healthy weight, individuals with obesity were 113% more likely to be hospitalized, 74% more likely to be admitted to the intensive care unit, and 48% more likely to die. [3] The review incorporated earlier research looking at obesity and COVID-19, including:

• A study in France which showed that the risk for needing ventilators in patients with COVID-19 was more than 7-fold higher for individuals with a body mass index (BMI) above 35, compared to those with a BMI less than 25. [4]
• A study in New York City which found people younger than 60 years of age with a BMI above 30 were significantly more likely to be admitted to care than individuals with a BMI less than 30. [2]
• Additional research from New York City demonstrating that patients with obesity had significantly higher rates of admission to intensive care units or rates of death. [5]
• A study In Mexico where COVID-19 patients with obesity had higher rates of admissions to intensive care units, were more likely to be intubated, and had a five-fold increased risk for mortality. [6]

Its also important to note that COVID-19 has disproportionately affected racial/ethnic minority groups in the United States; in particular, Black, Hispanic, and Native American communities. These racial/ethnic minority populations experience higher hospitalization rates, severe illness, morbidity, and mortality from COVID-19. Long-standing systemic health and social inequities have contributed to such disparities, which increase the risk of COVID-19 severity. [8,9]

The pandemic has highlighted several structural shortcomings of our healthcare system, and the need for coordinated federal obesity prevention funding and efforts. COVID-19 has laid bare the devastating impact of the intersection between infectious and chronic disease. Focusing efforts on policies and strategies that target the root causes of obesity and metabolic health, particularly among vulnerable and racial/ethnic minority populations, continue to be as critical as ever.

Related

• Food safety, nutrition, and wellness during COVID-19 [The Nutrition Source]
• Ask the Expert: The role of diet and nutritional supplements during COVID-19 [The Nutrition Source]
• COVID-19 Response: Public Health In Action [Harvard T.H. Chan School of Public Health]