The current battle with coronavirus (COVID-19) has been an all-encompassing challenge – for both our physical and mental health. As we live through this era and adapt to this ‘new normal’, it’s easy to get overwhelmed by the constant flow of new information and news updates. It’s hard to avoid the facts, the figures and the headlines which sometimes bring us contradicting information and advice which can change regularly. This can be attributed to the fact that we are working with new data, the best we’ve got at that time.
The Government are working with scientists and making decisions based on the most up to date and recent available evidence. For now, it is important to follow the latest guidelines which are developed by the country’s leading scientific experts. One headline that caught our attention lately was that those at a higher body mass index (BMI) are at higher risk of corona virus complications than those at lower BMIs.
What is BMI?
BMI is a measure of weight in comparison to your height, quite literally, your weight divided by your height in metres squared. It is often used as indicator to identify if somebody is at an appropriate weight for their height. The World Health Organisation (WHO) have set the following definitions for BMI (1).
| Underweight | <18.5kg/m2 |
| ‘Ideal’ Weight | 18.5-24.99kg/m2 |
| Over Weight | 24.99-29.99kg/m2 |
| Living with Obesity | >30kg/m2 |
A persons weight or BMI is often used to assess health status, which is backed by evidence however both are sometimes challenged and considered a crude markers of health. BMI, like most measures, is not perfect and has strengths and limitations. The above categories are not explicit and it is possible to be ‘healthy’ with a BMI under 18.5kg/m² or over 30kg/m². BMI does not take into account body diversity – as individuals we come in all different shapes and sizes. Some bodies are of a slender build and some are curvy and take up more space. BMI also does not take muscle mass into consideration. Muscle weighs more than fat, so somebody could be of a large build with a low body fat and high muscle mass and by WHO definition may be considered to be overweight or living with obesity (2). The strongest evidence of a relationship between weight and health is seen at the extremes of BMI (an extremely high or low weights). All in all, it is a nuanced tool, to be used with care and perspective. At present it is the most common tool used to assess an individual’s body weight and is frequently used within the NHS.
BMI & Risks
There is a body of evidence to suggest that those at higher BMIs above 30kg/m² are at a higher risk of hypertension (high blood pressure), type 2 diabetes and heart disease. Weight increase occurs when we consume more energy (kcal in food) than we expend (movement and body functions e.g. breathing). In order to maintain weight the two must be equal. To lose weight, an energy deficit must occur (take in fewer kcal than we expend). Current clinical recommendations for weight loss do not advocate that those at higher BMIs try to reduce their weight and aim to be in the ‘healthy’ BMI range. Rather, they recommend aiming for a 3-5% reduction in body weight, as evidence suggests the healthy BMI range is unrealistic and unachievable for most individuals (3). Those at higher BMIs with raised cholesterol, high blood pressure and type 2 diabetes can benefit from as little as 5% weight-loss (4).
There is emerging evidence to suggest that those at higher BMIs (>30kg/m²) are at an increased risk of corona virus complications including the need for intensive care admission and need for artificial ventilation support. Evidence currently states that higher BMIs may effect the severity corona virus infection. It is important to note that this is not definitive, and it is based on the small body of available evidence so far. What the evidence is not suggesting at present is that those with higher BMIs are an increased risk of catching the infection itself.
Government Reaction
This evidence has triggered the Government to act in a bid to improve the health and fitness of the Nation. You may have seen the Government’s better health campaign already, but if not, here is a quick breakdown:
- A ban on adverts for foods high in fat, sugar and salt before 9pm
- A stop to ‘buy one get one free’ deals on foods high in fat, sugar and salt
- Calories to be displayed on menus of food establishments who have over 250 employees
- Calories to be displayed on alcoholic drinks
- Expanded NHS weight management services
- Acceleration of the NHS Diabetes Prevention Program
- More research around the efficacy of front-of-pack nutritional labelling (traffic light system) (5)
2020 Feelings
It’s been a challenging time where lots of people have been isolated, emotional, less active and likely suffering from loneliness and boredom. A survey by the British Heart foundation in June reported that approximately 50% of adults have spent more time on social media and watching T.V. A quarter reported that they are less physically active and 30% reported feeling less healthy since lockdown began(6).
Weight gain and feeling less physically fit can lead people to start intense diets and exercise regimens which are not sustainable and often lead to burn-out and binge restrict cycles. Restricting pleasurable foods, food groups and rapid weight loss can lead to hormonal changes resulting in strong food cravings and increased hunger cues. These biological processes are difficult to over-ride and often end up in subjective ‘binging’ on energy rich foods which can lead to feelings of failure on ‘diets’(7).
What Can We Do?
Evidence suggests that a ‘lifestyle’ or ‘small changes’ approach to health can lead to positive and sustainable health effects (8,9,10). These approaches do not always focus on weight loss as a goal, however a consequence of adopting healthier diet and exercise behaviours can often be reduced body weight, improved body composition and increased self-esteem.
Slow down
Eating slowly is shown to increase self-reported food enjoyment and satiety as well as shown to lead to smaller meal/portion size likely due to allowing your body the time to recognise when you start to feel full(11). Eating slowly often helps us to chew our food more too. Food breakdown starts in the mouth so chewing your food well and slowly can support and aid healthy digestion. Eating without distractions like TV, phones can be helpful with this.
Be a Mindful Eater
Begin to notice what, why and how you eat. Allow yourself to be present and aware throughout eat process of food preparation and enjoyment. Mindful Eating invites us to tune into and trust our bodies inner hunger and fullness ques. Check out these resources if you think mindful eating could help you manage your eating habits: Todays Dietitian-Mindful Eating, Principles of Mindful Eating.
Hydration
Our bodies are made up of 55-75% of water. It helps our body to carry out many biological processes and mild dehydration has been seen to reduce alertness, concentration, exercise endurance and motivation (12). Fluid helps the body to maintain its temperature. Not having enough fluid can cause heat stress during hot weather or exercise, which can affect our mood and cause feelings of distress(13). Soft drinks and fruit juices are high in sugar and are sometimes considered to be ‘empty calories’ as they provide energy only (as opposed to their whole food equivalents which contain vitamins, minerals, and fibre).
Try staying hydrated with still/sparkling water (you can get some tasty zero sugar flavours too), sugar free squash or add your own fruit to your water bottle (we love cucumber or strawberries).
Why not have a family hydration contest. You could have a rewards chart for kids. Gold star for winner!
Download an app to help. Adults-Hydro Coach and Water Drink Reminder. Children- Tummyfish or Plant Nanny.
Spice up your 5-a-day
Try introducing a new type of fruit and vegetable to your diet every week. Try to get the kids involved by learning about the food they are eating and preparing it together to enjoy food. This will add variety to both your taste buds and your gut bacteria. Most vegetables contain prebiotics, which are non-digestible food components that have a beneficial effect on the body. Prebiotics encourage the growth of different ‘good’ bacteria species living in your gut. Unfortunately, some of these prebiotics are FODMAPS so make sure you research the food before you introduce it if you have IBS and are following a low FODMAP diet.
Enjoy some joyful movement
Exercise doesn’t have to be dripping in sweat in a spin class, it doesn’t have to be a painful chore that you dread. You can make it fun.
A morning Pilates routine, a game of football or how about organising a family sports day? Get out in nature and try a hike or forest walk/cycle. Find a fun online dance work out dance work out class (We love www.RetroSweat.com.au). Learn about Intuitive Exercise with Tally Ryes new book ‘Train Happy’ which takes the focus away from exercising to lose weight and hones in on health, strength and those feel good endorphins released after moving our bodies.
Running has become a very popular hobby since lockdown and there are lots of helpful apps available such as Couch25K. If running is not your thing or you find it hard to find time to exercise try Active10 which can help you to slot some 10 minute brisk walks into your day. Small changes can make a big difference.
The NHS Weight Loss Plan App is a more structured outlet of support. It includes a 12 week plan and involves diet and physical activity advice including workouts and weekly challenges, it is specifically aimed at weight loss. Only you know what approach is best for you, so be kind to yourself and choose an approach which brings you some joy and positive feelings- as that’s the approach you are most likely to stick with and incorporate into your life.
Eating Out
Eating a delicious meal out an experience and when this happens occasionally, is something to be enjoyed rather than be restricted. The Governments Eat Out to Help Out scheme has been helping to support businesses get back on their feet after being closed for almost 3 months- and now lots of restaurants are extending the scheme past August.
The reduced prices and novelty of being free from cooking and clean ups is encouraging more people to go out to eat. If you find yourself eating out more frequently, perhaps try to make mindful choices. What are the foods that are going to leave you feeling good- both during eating (tasty) and after (wholesome energy and fuel).
Try ordering whole foods with vegetables and/or salads (also count towards your 5-a-day).
People tend to drink alcohol while out for dinner. Sometimes alcoholic calories can go unnoticed and contribute to an energy surplus possibly leading to weight gain. So, why not opt for a diet drink or water if you are eating out more than usual.
Stay simple- sometimes less is more. Traditional dishes e.g. Salmon with fresh vegetables and potatoes when prepared by a chef are next level delicious and likely rich in nutrients including vitamins and minerals.
When it comes to sauces tomato based dishes are usually lighter and less energy dense that rich creamy sauces and can leave you feeling a little lighter afterwards.
If there is an option why not choose the whole-grain rice/bread/burger buns that are higher in fibre? These can help us to feel fuller for longer and aid digestion.
All in all..
By making small changes and adopting a balanced and moderate approach to food and exercise we can make a big difference to our health. There is no magic fix or one size fits all and sometimes it is best to get back to basics to get fitter and healthier and feel energetic and comfortable in our bodies.
If you would like further advice that is tailored to your individual needs why not ask to see a dietitian either in the NHS or privately, we at Sunlight Nutrition Limited would be happy to help.
References
- World Health Organisation (2000) ‘Obesity: Preventing and managing this global epidemic’ Geneva: Report of a WHO Consultation. Available at: https://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/ (Accessed August 2020)
- Nuttall F. Q. (2015) ‘Body Mass Index: Obesity, BMI, and Health: A Critical Review’ Nutrition today, 50(3), 117–128. https://doi.org/10.1097/NT.0000000000000092. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890841 (Accessed August 2020)
- National Institute for Health and Care Excellence (2014) ‘Weight management: lifestyle services for overweight or obese adults’. Public Health Guidline. Available at: https://www.nice.org.uk/guidance/ph53 (Accessed August 2020).
- Wing, R. R., Lang, W., Wadden, T. A., Safford, M., Knowler, W. C., Bertoni, A. G., Hill, J. O., Brancati, F. L., Peters, A., Wagenknecht, L., & Look AHEAD Research Group (2011) ‘Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes’ Diabetes care, 34(7), 1481–1486. https://doi.org/10.2337/dc10-2415. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120182/ (Accessed August 2020)
- Department of Health and Social Care (2020) ‘New obesity strategy unveiled as country urged to lose weight to beat coronavirus (COVID-19) and protect the NHS’. Available at: https://www.gov.uk/government/news/new-obesity-strategy-unveiled-as-country-urged-to-lose-weight-to-beat-coronavirus-covid-19-and-protect-the-nhs. (Accessed August 2020)
- British Heart Foundation (2020) ‘Screen time rises as lockdown makes exercise difficult for many’. Available at: https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2020/june/brits-ramp-up-screen-time-and-ditch-exercise (Accessed august 2020)
- Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C. and Calogero, R. M. (2014) The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss, Journal of Obesity. Hindawi. doi: https://doi.org/10.1155/2014/983495
- Chapman, G. E., Sellaeg, K., Levy-Milne, R., Ottem, A., Barr, S. I., Fierini, D., Marchessault, G., Nolan, D., Paquette, M.-C., Saunders, N., Thiele, K. and ‘Do It With Focus’ Research Group (2005) ‘Canadian dietitians’ approaches to counseling adult clients seeking weight-management advice’, Journal of the American Dietetic Association, 105(8), pp. 1275–1279. doi: 10.1016/j.jada.2005.05.004.
- Schaefer, J. T. and Zullo, M. D. (2017) ‘US Registered Dietitian Nutritionists’ Knowledge and Attitudes of Intuitive Eating and Use of Various Weight Management Practices’, Journal of the Academy of Nutrition and Dietetics, 117(9), pp. 1419–1428. doi: 10.1016/j.jand.2017.04.017.
- Barr, S. I., Yarker, K. V., Levy-Milne, R. and Chapman, G. E. (2004) ‘Canadian dietitians’ views and practices regarding obesity and weight management’, Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association, 17(6), pp. 503–512. doi: 10.1111/j.1365-277X.2004.00562.x.
- Ferriday, D., Bosworth, M. L., Lai, S., Godinot, N., Martin, N., Martin, A. A., Rogers, P. J., & Brunstrom, J. M. (2015) ‘Effects of eating rate on satiety: A role for episodic memory?’ Physiology & behavior, 152(Pt B), 389–396. https://doi.org/10.1016/j.physbeh.2015.06.038 (Accessed August 2020)
- Gopinathan, Pichan & Sharma (1988) ‘’Role of dehydration in heat stress-induced variations in mental performance’’ Available at: https://www.ncbi.nlm.nih.gov/pubmed/3355239. (Accessed August 2020)
- Tawatsupa et al. (2012) “Heat stress, health and well-being: findings from a large national cohort of Thai adults’’ Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3532977 (Accessed August 2020)