Open Letter to the World Health Organization

­­4 June  2020

Dear Dr Tedros,

We would like to commend the WHO for its leadership and commitment to address NCDs within its ambition to “build back better”, including the role of NCDs as major risk factors for complications and mortality in COVID-19 and the recognition that disruption to care of people with NCDs will have major adverse effects on global health.  We hope that this leadership and recognition can be extended to WHO guidance on obesity’s role in the complications of COVID-19.

As a group of experts, stakeholders and people with obesity, we are writing today regarding the emerging data showing that obesity is a key risk factor for COVID-19 complications and mortality. While a number of NCDs have been widely recognised as specific risk factors for becoming seriously ill with COVID-19, there appears to be much less acknowledgement by the World  Health Organization of the fact that obesity is also a leading independent risk factor for complications of COVID-19. Research from China, UK, USA and Italy demonstrate an approximate doubling of risk of complications and mortality from COVID-19 in obesity; this is similar to other chronic diseases such as diabetes and cardiovascular disease.  Subsequent national guidance documents recognise that people with obesity represent a population who are more vulnerable to the complications of COVID-19.  This leadership and recognition should be extended to explicitly reference obesity in WHO guidance as well. 

We also note that treatment and services for people with obesity have been significantly curtailed during this time, leaving them at risk at a time when support is needed more than ever.   This is an issue that cannot be ignored. With close to 1 billion people affected by obesity globally, no country is on track to meet the 2025 WHO Global Targets and the greatest increase in obesity prevalence is being seen in low-and middle-income countries.  Indeed, we know that obesity is one of the leading concerns for which governments have been requesting guidance and technical assistance from WHO. This highlights the urgent need to include obesity in COVID-19 responses, and that more resources, attention and surveillance are urgently needed on the links between covid-19 and   obesity.

Finally, obesity cannot be adequately addressed by only focusing on nutrition and physical activity.  The links between COVID-19 complications and obesity also highlight the importance of recognizing obesity as a disease, similar to how diabetes is acknowledged as both risk factor and disease in its own right. Strong policies on the prevention and treatment of obesity, including support for close to 1 billion adults and children living with obesity, is vital. Unless we address obesity, countries will remain vulnerable to pandemics such as COVID-19.

This is a time when restrictions are impacting many of the roots of obesity - diet, physical activity and mental health. We therefore encourage the WHO and NCD working group to explicitly reference overweight and obesity in NCD and COVID workplans and strategies in the short- and long- term, and to provide appropriate guidance and advice to governments, as a key pillar in efforts to build healthy and resilient populations. We formally request that WHO incorporates language about the risks of COVID complications for people with obesity in its guidance to countries. 

END