The New Pandemic of Disease and Death: Global Obesity 2021, in Company of Covid-19

HEALTH, 19 Apr 2021

Prof. Hoosen Vawda – TRANSCEND Media Service

Obesity and Covid Concurrently: Guaranteed Death

14 Apr 2021 – Obesity is not just a condition but is now officially classified as a disease, like Heart Disease, or Lung Disease and is therefore medically managed as any other disease. Obesity may be basically classified into two broad categories of types.  These are Lifestyle Obesity and Pathological Obesity.  The former is the result of over-indulgence in foods containing high carbohydrates and fatty diet, including fast foods, hence it can be present in the disadvantaged sectors of the community and genetic predisposed individuals.   The latter type is caused secondary to some primary medical condition such as Cushing’s Disease usually resulting from an overactive section of the adrenal glands or caused iatrogenically, due to a body mass increasing side effects of some medication, such as steroids and others used to treat a primary medical condition, such as asthma or auto immune arthritis.

Obesity is probably present from the time of evolution of humanoids, from the primaeval broth, based of Darwinism or according to the Abrahamic scriptures since the Lord created them.  Whilst enjoying Heaven, Adam and Eve, not only to satisfy the inherent rebellious nature of humans, but also, probably, their satiety centres were not properly operative, nor controlled, in the opulence of Heaven, allowing them to partake of the “forbidden fruit”. This resulted in their eviction from the comforts of heaven, to continue with their misdemeanours on Earth and in addition their progeny ended up becoming obese.  While early humanoids, were hunter-gatherers and therefore NOT prone to obesity, as they did NOT store food, as soon and the so called more civilised norms of social hierarchy were established and the marauding activities of our ancestors ceased, obesity became a challenge in prehistoric communities over the years. The individuals become obese due to their affluent lifestyle, while the “have nots” became leaner, often bordering on starvation and malnutrition, based on their “karmas[1]” according to the Hindu, Vedic philosophy’

The prevalence of obesity is known to vary according to sociocultural factors. [2][3]Additionally, patterns can be specific to race, ethnicity age, gender, the economic status of a society, literacy, traditions, the geographic region in the world, advertising, type of food available, patterns of human migration, exposure to commercialism and advertising using high profile brand names, as observed in developed countries. Overweight and obesity has become a global health problem, in which the numbers of obese and overweight people all over the world just keep on rising. There exist many contributors to the epidemic of overweight and obesity. One of the possible influences on the overweight and obesity rates in a specific country, are cultural factors. The individualistic versus a collectivistic society, may contribute to the increase of overconsumption of food, leading to different rates of overweight and obesity, in different countries.

Let us begin our discourse on obesity with reference to the scriptures. The Holy Bible states in many specific versus; “And put a knife to your throat, If you are a man of great appetite.”[4]  Do not be with heavy drinkers of wine, Or with gluttonous eaters of meat;[5] Have you found honey? Eat only what you need, That you not have it in excess and vomit it.[6]   Whose end is destruction, whose god is their appetite, and whose glory is in their shame, who set their minds on earthly things.[7] He who keeps the law is a discerning son, But he who is a companion of gluttons humiliates his father.[8]  He presented the tribute to Eglon king of Moab. Now Eglon was a very fat man.[9]  Or do you not know that your body is a temple of the Holy Spirit who is in you, whom you have from God, and that you are not your own?[10].  It is clear from these extract that the Holy Bible frowns upon “largeness” in the literal sense of the word.

In Islam, Umar bin Al Khattab[11], a Caliph, would encourage exercise and did not like obesity, in fact he was against obesity. He said, “O People! Beware of overeating because it makes you lazy in your prayer, it makes your body weak and makes you unhealthy and Allah dislikes the obese man.[12] and you should be modest in your food because that is closer to righteousness and further from excess and makes you stronger in worshipping God and you will perish when your desires become more dearer to you than God or your religion.”[13]

Furthermore, in Islam it is forbidden to laugh at someone who becomes obese from overeating, for a greater reason it is forbidden to laugh at someone who is genetically obese or has some medical condition. “Whoever sees a wrongdoing from his brother and then laughs in front of him has betrayed him.”

In the pre-Islamic era, in the Arabian Peninsula, a person, in the male dominated society was considered important if he had a moustache, a bold head and a big belly.  They also had an idea about obesity in the old books, in Al Mustadrak[14] which states that when they enquired from a Bedouin, ‘When do you know you have eaten enough?’ He replied, “When I cannot tell the difference between the heavens and earth, between what is optional and compulsory and between length and height, that is when I have had enough food.”

A man came to Umar bin Al Khattab and he had a big belly, Umar asked him, ‘What is this?’ The man replied, “It is a blessing from God!” Umar retorted, ‘No, it is a punishment from the Lord!.’ Referring to how much to eat, on seeing a fat man, it was stated “If you did not have a paunch (belly fat), it would be better for you”. Further narrations reported that “Overeating does not go with good health.”[15]

In summary, according to Islamic physicians and clergy, amongst the causes of weak faith is overeating, which leads to sleeping a lot and has a detrimental effect in your worship to the Lord, laziness in your prayer, makes your body weak and unhealthy. “The one who is physically healthy, safe in his community and is sufficiently nurtured will possess the whole world.”[16]

In Judaism, as the Jewish philosopher Philo of Alexandria put it, “The body is the soul’s house. Therefore, shouldn’t we take care of our house so that it doesn’t fall into ruin?”[17] Moses Maimonides[18], a towering Jewish thinker and physician to Egyptian royalty, knew the importance of physical health and wellness and its relationship to spirituality better than most. He devoted an entire chapter to bodily health and well-being in his comprehensive compendium of Jewish law, his magnum opus, Mishneh Torah[19]. He began the chapter by writing: “When keeping the body in health and vigor, one walks in the way of God … it is a person’s duty to avoid whatever is injurious to the body and cultivate habits conducive to health and vigor.”

Examining the problem of obesity in India, one tends to conclude that this would NOT be a problem in that country.  The spectre of obesity is concomitant with the rise in the economic growth of the country as in South Africa, where are 1994, obesity and associate ischaemic heart disease in Black people has increased rampantly.

As many as 135 million Indians are currently battling obesity and tackling related health issues. On World Obesity Day[20] annually observed on 26^th October, Kamala Thiagarajan[21] elaborates.

In a country where excess is usually frowned upon and an estimated 30 per cent of the population live below the poverty line, you might find it difficult to digest the fact that millions of Indians are now battling the bulge and opening the lid on a Pandora’s box of health issues. This is the greatest Indian paradox. “Those who do the most activity on a daily basis eat the least and those who eat the most food, perform the least activity! This is perfectly normal when you think about how economics plays a role in obesity; the coolie[22] who doesn’t have access to quality food because of poverty must compromise on nutrition, whereas the sedentary white-collar worker who sits around most of the day has access to a variety of fare.”[23]

Obesity is NOT genetic curse: One of the biggest myths related to obesity today is that it is a genetic issue and no matter what the individual does, it remains a life-long problem. Another myth is that you’re born with genes that somehow make you obese and that you’re helpless when it comes to reversing it. “While it’s true that some people may tend to gain weight easily, they don’t have to go through life being overweight,” says Dr Anjana. “Obesity can certainly be prevented and even reversed. Clearly, we are over-estimating our nutritional needs and consuming far more calories than required.” Even 50 extra calories a day (which is a very conservative estimate, considering how people tend to consume far more) can add up to around 18,000 calories a year, resulting in an annual weight gain of around 2 kilos. “Over a ten year period, that can make you over twenty kilos overweight,” says Dr Anjana. “If you examine family photos from ten years ago, you’ll find that you can hardly recognize your own family members!” Since this weight gain happens gradually over a period of a decade, seldom do people notice it. “For this reason, obesity can be a very stealthy disease,” says Dr Anjana. “Rather than being born with the affliction, it quietly creeps up on you.”  This overeating, together with increased consumption of alcohol, bordering on comfort consumption of food and drinks is a major problem during Covid related lockdowns, resulting in obesity and ever-increasing abdominal girth of individuals.  A sensible diet and exercise remain the cornerstones of obesity treatment.

The immediate practical anti-obesity strategies which can be engaged in are; the need for extra-vigilance during childhood: Does obesity run in your family? Then you’ll need to be very vigilant with your children. Matching your intake with activity levels: patients who are obese is to cut their portion sizes by half. Learning to train your appetite: While it’s natural to feel a little hungry when cutting your intake by half, your appetite too can be ‘trained’ until eating the correct quantity of food that you require becomes a second nature. Experts say that it is possible for the stomach to ‘shrink’ as it adopts to its changing quantities of food. Counting calories for Indian foods is prudent. Daily dose of exercise is certainly therapeutic. However, for significant weight loss, you’ll need at least 250-300 minutes (an hour, 5 times a week). Taking small steps will help you progress faster in your fight against obesity and onwards in your journey towards healthy living.[24]

Obesity is an enormous challenge during Pandemic[25]  From the very beginning of the pandemic, a strict lockdown was imposed. People were forced to stay at home for their better good as they saw the pandemic unfold. As a result of this, the daily routine of people got disrupted. As the Covid cases spiked the graph of obesity saw a similar increase. People started gaining weight because their movement was completely restricted. People were locked up in their houses and this did not allow them to exercise which is required for weight maintenance.

As the dine-in facilities were restricted, people started ordering food at their homes. Fatty food is one of the main reasons for the rising obesity in the American Adult Population. This increases bad cholesterol in the body which starts accumulating as fats in the body. This increases body fats and in turn, results in obesity of the individual. People have gained more than 0.68 kg in the total span of the pandemic.

All the fitness regimes have been bypassed therefore maintaining a healthy lifestyle should be the utmost priority during the pandemic.

In the past 35 years, the prevalence of obesity jumped from 15% of the population to 35%.  Furthermore, our Health-Care System is feeding the obesity.[26] obesity in America is a staggering public health crisis, ravaging the population, hampering the quality of life for millions and wreaking fiscal havoc along the way.

Each year in America, the wide variety of obesity-related diseases (ranging from muscle and joint problems to diabetes to heart disease to cancer) result in an estimated 400,000 deaths and $190 billion in health care costs—nearly 21% of all medical spending.

An epidemic with such a high impact, in terms of lives and dollars, would seem to demand a clarion call from the White House to Congress to the halls of Health and Human Services and every health-care system, major medical society, employer and insurer. Instead, we’ve seen an approach that is heavy on concern but light on coordinated action. We have no clear plan for battling the obesity epidemic that impacts tens of millions of lives in the U.S. alone.

The health-care system is blamed for obesity for three reasons; failed incentives, lack of medical education, both in the public sector as well as in the traing of health care professional and limited role of physicians.

As long as physicians only address the individual patient on the examination table, the medical profession cannot effectively prevent and treat obesity. How useful is telling patients to improve their diet and increase their physical activity if the stores in their neighborhoods do not sell fresh fruits and vegetables and they do not have the time to exercise or the budget for a gym membership?

Let us look at some ancient civilisations in Ancient Egypt[27]  In a time with no machinery, no sedentary life and no famous fast-food restaurants. There was plenty of fruits and vegetables, and bread high in fiber. Archaeologically there is little evidence of the presence of obesity in ancient Egypt even the mummy of Hatshepsut that claimed to have obesity and diabetes was not the Queen’s but  it was of KV20, a foster mother who was hired for breast feeding of babies.

According to Aly R Abdel-Moemin[28] senior officials were sometimes portrayed with extra rolls of fat, showing that they were successful, had access to plenty of food, and did not have to engage in physical labor.  See the statue of Hemiunu, for example, from the time of Khufu; the sculptor was very accurate in showing his double chin, heavy shoulders, and the fat around his middle, a back view of the statue is particularly impressive, as pointed out by Edna Russmann!  Similarly, in the Old Kingdom tomb of Qar and Idu, one of these men is shown in his slender, youthful phase and also–a different aspect of the same person–as an overweight middle-aged man.  In fact, some officials may have been portrayed with a bit of extra weight simply as a marker of their eminence, not necessarily reflecting their real appearance.

Also, a number of mummies of upper-class New Kingdom individuals, both male and female, indicate that these people were well-nourished and probably not very physically active.  One of the early 18th Dynasty princesses was described as having been quite heavy (although that description was from Eliot Smith’s catalogue and relied on visual examination only–it’s not always straightforward to draw conclusions about a person’s weight from the appearance of his or her mummy).  Some mummies show evidence of physical conditions, such as arterial disease, often related to overweight and a rich diet.  If they were members of high-ranking priestly families, they would have been able to feast on large amounts of meat, pastries, and so forth.  (The temple of Karnak had a pastry chef on the staff.)

On the other hand, the Spanish team working at Aswan has found that even members of elite families sometimes show evidence that they had survived periods of inadequate nutrition.

In the Middle Ages, too, was there a difference of opinion on body fat from religious, medical, and aesthetic perspectives. The disagreement is reflected in modern literature on medieval bodies. The French historian Georges Vigarello[29], in his Les métamorphoses du gras, looks at the Middle Ages as a repository for positive attitudes about fat (quite unlike modern France), which acquired negative connotations as time went on. Christopher Forth, in his Fat: A Cultural History of the Stuff of Life, shows how fat bodies have always been read in a variety of ways. The one author shows a progression from medieval alterity to modern attitudes; for the other, fat is a polyvalent and ambiguous symbol.

To be sure, fatness could often seen as ugly, effeminate, stupid, slothful, and sinful, while thinness was associated with holiness and muscular, lean body was considered manly and martial. However, only listening to the medieval fat-shamers is oversimplifying matters: body fat could also be a sign of prosperity, social status, success, and even rulership. Furthermore, it was often men who were often going to great lengths to acquire a svelte body, while what we might consider extra weight today could be beautiful on a woman.  Furthermore, a medical case study of fatness in the Middle Ages is that of the tenth-century King Sancho I of Leon[30], who was deposed from his throne because his morbid obesity kept him from riding a horse, wielding his sword, bedding his wife, or even walking. Reportedly, he weighed up to 530 pounds and was reported to eat seven meals a day, chiefly composed of rich meat dishes

Plumpness was by no means considered a bad thing in medieval women. Vigarello, in his Metamorphoses of Fat, sees largeness as the sine qua non of female beauty in early medieval romances. The late fourteenth-century Goodman of Paris says that a horse ought to have four qualities also found in comely maidens: a handsome mane, beautiful chest, fine loins, and large buttocks.

One would think that Christian asceticism would militate against fatness, and indeed, thinness could be holy. Religious fasting was mandatory for all Christians, and penance could include a restricted diet. For instance, the sixth-century Irish Penitential of Finnian has anyone considering murder or fornication abstain from alcohol and meat for a year. A cleric who strikes another is put on bread and water for a year, and actually fornicating earned bread and water for two years.

In religious art, saints and other heavenly figures are similarly portrayed as tall and thin—a visual rhetoric carried through to day by using tall and thin models to display fashionable clothes, elevating consumption to the level of worship. (Slightly curvier women, who read as more “voluptuous” and “earthy,” are employed as swimwear or lingerie models… though they still tend to be much taller and thinner than the average American woman.) One of the few exceptions to the uniform tallness and thinness of medieval art is fat wine steward in Giotto’s early fourteenth-century “Wedding at Cana,” whose fatness echoes his stubborn doubts about the miracle. Likewise, Jews were often depicted as fat as symbols of their spiritual sloth.

By the turn of the sixteenth century, Albrecht Dürer was showing how to portray people of different classes by physiognomy—peasants were stouter—and Martin Luther was joking that his middle-aged girth would provide a feast for the grave-worms. By the seventeenth century, painters such as Peter Paul Rubens or Charles Mellin’s, in his famous portrait of the hefty Italian general Alessandro dal Borro, were unapologetically portraying body fat. On the other hand, Rubens’ male nudes are rather fit and athletic, underscoring a dichotomy between female as passive and weak and male as active and strong.

As some of us may strive against it, and others may shame it, normal human variations of body weight have a long history. Our bodies naturally want to put on weight, and they want to keep that excess weight on. However, bodies are mediated through the social. Fatness was read in various ways by medieval people—perhaps as unmartial and unmanly for those who had no problem in obtaining food, but for the lower classes, it was something enviable and aspirational. For women, a certain amount of fatness could indicate fertility, just as a lack of it could indicate sanctity and a withdrawal from the world. But, no matter how it was read, polyvalent medieval attitudes about fatness and thinness were not our own.

Obesity in the United Kingdom[31] is a significant contemporary health concern, with authorities stating that it is one of the leading preventable causes of death. In February 2016, former Health Secretary Jeremy Hunt described rising rates of childhood obesity as a “national emergency”.

Causes cited for the growing rates of obesity in the United Kingdom are multiple and the degree of influence of any one factor is often a source of debate. At an individual level, a combination of excessive food energy intake and a lack of physical activity is thought to explain most cases of obesity. Reduced levels of physical activity due to increased use of private cars and desk bound employment.

The Victorian England[32] was the time of the world’s first Industrial Revolution, political reform and social change, Charles Dickens and Charles Darwin, a railway boom and the first telephone and telegraph. But the Victorian Era—the 63-year period from 1837-1901 that marked the reign of England’s Queen Victoria—also saw a demise of rural life as cities rapidly grew and expanded, long and regimented factory hours, the start of the Crimean War and Jack the Ripper.

On a humorous note, for years, airlines have penalised luggage for weighing too much. Now at least one carrier is applying that same logic to its flight attendants. Air India[33] is grounding about 130 of its flight attendants, mostly women, because they are overweight. The state-owned airline said the decision was based on safety concerns and recent government regulations, but critics said it was “ridiculous” and “shockingly sexist.”

More recently, Chinese company Qingdao Airlines was accused of grounding or firing employees due to their weight. A Qingdao spokesman told the South China Morning Post that the airline did, indeed, have stringent weight requirements, but denied any employees had been grounded or sacked.

An obese American tourist[34] who made headlines when he forced an air hostess to wipe his butt as he moaned in pleasure midair has died in Thailand. The unnamed man left several Taiwanese stewardesses traumatised when he demanded they help him in the lavatory by removing his pants and wiping his butt on an LA-to-Taipei EVA Air flight.

The present SARS Cov-2 pandemic has compounded the global obesity trends and has resulted in a pandemic in tandem.  While the Covid pandemic results in acute illness and demise, in most patients afflicted by the virus, the “Obesity Pandemic” causes long term morbidity and shortens lifespan, just by being overweight.  It is also prudent to note that obesity itself is an independent risk factor for acquiring Covid infection.  Furthermore, technically it is much more difficult to maintain a patient on a ventilation than an individual who is not.

The management of obesity is a holistic approach involving a multidisciplinary team of professionals.  This team must include not only the healthcare professionals , including a clinical psychologists, social worker, and a dietician but also the family support structure and even the surgeons, as bariatric surgery is now an option in severe cases of grossly morbid patients where a conservative approach has failed

The realisation that obesity is not just about adiposity, but it is centrally housed in the hypothalamus of the brain[35], where the satiety centre[36], located deep in the hypothalamus and the hunger centre[37] may be dysfunctional.  This knowledge gained by high tech experimental studies has resulted in Novo Nordisk[38], pharmaceutical company, formulating an injectable medication, Liraglutide[39], which is a new generation, anti-diabetic drug, guaranteed to reduce body mass by up to 10% in some patients.  This is the beginning of “future medicine”, based on extremely high-powered, nano technology, research.

The fate of management of obesity looks promising, while that of SARS Cov-2 pandemic is becoming abysmally darker, as we progress to Third and even the Fourth Wave of the pandemic, resulting in millions of deaths, worldwide.  The vaccines are either ineffective against the virus due to multivariant mutations, like the annual influenza virus or they are generating serious adverse events in some patients resulting in the suspension of their use in certain countries, including South Africa, which has henceforth suspended the administration of Astra Zeneca vaccine[40].

Finally, the Covid pandemic is here to stay because, certain countries simply do not have the finance to purchase the vaccines while other countries cannot acquire them due to shortage of the supply chain impacting, on the manufacture of these vaccines.

The bottom line is you either die from a Covid infection, quickly or if you survive the pandemic during lockdowns, death is slow due to the concurrent Obesity Pandemic.  Which ever way one analyses the situation “Death is Guaranteed” by the self-caused destructive mechanism generated by humanoids.

References:

[1] https://en.wikipedia.org/wiki/Karma

[2] http://arno.uvt.nl/show.cgi?fid=116174

[3] https://www.sciencedirect.com/science/article/pii/B9780128188392000119

[4] https://bible.knowing-jesus.com/Proverbs/23/2

[5] https://bible.knowing-jesus.com/Proverbs/23/20

[6] https://bible.knowing-jesus.com/Proverbs/25/16

[7] https://bible.knowing-jesus.com/Philippians/3/19

[8] https://bible.knowing-jesus.com/Proverbs/28/7

[9] https://bible.knowing-jesus.com/Judges/3/17

[10] https://bible.knowing-jesus.com/1-Corinthians/6/19

[11] https://www.islamicfinder.org/knowledge/biography/story-of-umar-ibn-alkhattab-ra/

[12]https://www.bing.com/search?q=what+does+the+quraan+says+about+obesity&cvid=2533751193134272885aa1089c417acb&aqs=edge..69i57.19644j0j1&pglt=299&FORM=ANNTA1&PC=U531

[13] https://www.eaalim.com/download/index.php/blog/entry/what-is-the-islamic-stance-on-obesity.html

[14] https://en.wikipedia.org/wiki/Al-Mustadrak_alaa_al-Sahihain

[15] https://en.wikipedia.org/wiki/Ibn_al-Haytham

[16] https://en.wikipedia.org/wiki/Al-Tirmidhi

[17] https://reformjudaism.org/what-jewish-tradition-says-about-health-and-wellness

[18] https://en.wikipedia.org/wiki/Maimonides

[19] https://en.wikipedia.org/wiki/Mishneh_Torah

[20] https://www.who.int/news-room/events/detail/2020/03/04/default-calendar/world-obesity-day

[21] https://www.kamala-thiagarajan.com/

[22] https://en.wikipedia.org/wiki/Coolie

[23] https://www.thehindu.com/features/education/issues/the-obesity-epidemic/article5268607.ece

[24] https://www.thehindu.com/features/education/issues/the-obesity-epidemic/article5268607.ece

[25] https://washingtonsources.org/obesity-a-big-problem-during-times-of-pandemic/

[26] https://time.com/4485435/health-care-obesity-epidemic/

[27] https://www.researchgate.net/post/Was-Obesity-Prevalent-in-Ancient-Egypt

[28] https://www.researchgate.net/profile/Aly_Abdel-Moemin3/13

[29]

[30] https://www.britannica.com/biography/Sancho-I-king-of-Leon

[31] https://en.wikipedia.org/wiki/Obesity_in_the_United_Kingdom

[32] https://www.history.com/topics/19th-century/victorian-era-timeline

[33] https://www.independent.co.uk/travel/news-and-advice/air-india-grounds-130-flight-attendants-being-overweight-10502119.html

[34] https://nypost.com/2019/04/19/creepy-tourist-who-made-flight-attendant-wipe-his-butt-dies-on-vacation/

[35] https://www.medicalnewstoday.com/articles/312628#:~:text=The%20hypothalamus%20is%20a%20small%20but%20important%20area,the%20brain%2C%20between%20the%20pituitary%20gland%20and%20thalamus.

[36] https://www.lexico.com/definition/satiety_centre

[37]https://www.thefreedictionary.com/hunger+center

[38] https://www.novonordisk.com/about/insulin-100-years.html

[39] https://en.wikipedia.org/wiki/Liraglutide

[40] https://www.who.int/news-room/feature-stories/detail/the-oxford-astrazeneca-covid-19-vaccine-what-you-need-to-know

_____________________________________________

Professor G. Hoosen M. Vawda (Bsc; MBChB; PhD.Wits)

• Director: Glastonbury Medical Research Centre; Community Health and Indigent Programme Services; Body Donor Foundation SA.
• Principal Investigator: Multinational Clinical Trials
• Consultant: Medical and General Research Ethics; Internal Medicine and Clinical Psychiatry:UKZN, Nelson R. Mandela School of Medicine
• Executive Member: Inter Religious Council KZN SA
• Public Liaison: Medical Misadventures
• Activism: Justice for All
• Email: vawda@ukzn.ac.za

This article originally appeared on Transcend Media Service (TMS) on 19 Apr 2021.

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