The New Normal

by Jennifer Ashton, M. D.

  Desha is right. This is not a norm any of us ever thought we’d see. It’s a new normal. But we now know a lot more than we did in March 2020. And we know that there are specific, impactful steps we can take to avoid ending up in the same spot Desha has found herself in: severely impacted by COVID-19. We can take precautions like wearing masks and physically distancing to help prevent others from getting seriously ill or dying from the disease. We can also take precautions that go way beyond wearing a cloth face covering to keep ourselves from getting very ill.

  From a doctor’s perspective, I know that Jason had several risk factors that made him more vulnerable to serious illness with COVID-19. He was a black man, and we now know that people of color and men, in general, are more likely to develop severe complications from the virus. He also worked an essential job that put him at risk during the height of the early outbreak.

  While Jason couldn’t change his gender or his color, he had other risk factors that we have since learned likely made him more vulnerable to the virus. Desha told me that her husband was overweight and diabetic and had high blood pressure—three of the biggest predictors of serious COVID-19 complications that people can potentially change. By the time researchers discovered this about the virus, it was too late for Jason. But it’s not too late for everyone else.

  “This virus is taking no prisoners,” she told me. “And if you have these underlying issues, you could be affected. People who are obese—we can manage that. We can take control of that.”

  Desha told me she is also overweight and now doing everything she can to make sure her story doesn’t end like her husband’s did. “Get out there and go for a walk. Drink your water. Eat healthier,” she told me. “And I’m talking to me, Desha, because I don’t want to be another Jason story. I can’t just give a message—I have to be the message.”

  Desha’s story is powerful. It’s also all too common. The majority of coronavirus patients featured on Good Morning America have been overweight or obese. Many have suffered from diabetes, high blood pressure, or other chronic conditions. Similarly, the majority of those whom I’ve known personally who’ve been hospitalized or died from the disease were black, overweight or obese, and/or had underlying conditions.

  It’s a difficult truth to face, but as more time has passed, and living with the virus has become our new way of life, we have a clearer understanding of the preexisting health issues that are most available to exploitation by the virus. Now that we know what will make us more susceptible to the virus, it’s up to us to do something about it and try everything in our power to get these conditions under control. Health risks like diabetes and obesity don’t mean the same things that they used to—now they are much more concerning. Jason didn’t have a choice—the science didn’t exist when he became infected. But you do, and now’s the time to be proactive about your health and your ability to survive and thrive in the world’s new normal.

  One of the most critical lessons I’ve learned after almost a year of reporting daily on national TV about COVID-19 is this: Doing everything you can to be as healthy as you can possibly be right now is one of the best ways to pandemic-proof your body and adapt physically to the additional health risks that COVID-19 carries. As a practicing doctor for the past twenty years, I know that every single person on the planet, you included, has ways and means of mitigating disease risk, whether we’re talking about cancer, coronavirus, or some other microorganism that makes up the world’s next pandemic. I don’t need to know everything about a specific pathogen or your individual medical history per se to know ways in which to help you minimize the negative effects of disease.

  That said, after incessant reading of the top studies conducted on the coronavirus to date, talking with the world’s top infectious disease specialists, and distilling what I find to millions of ABC News viewers almost daily, I know that there are specific conditions that make us much more vulnerable to COVID-19—and specific steps we can take to significantly reduce our risk.

  If you’ve been lucky enough to avoid the virus so far, that’s fantastic. But if we’ve learned anything since New Year’s Eve of 2019, when the first case of COVID-19 was identified in Wuhan, China, it’s that the coronavirus works in mysterious ways, striking in widely disparate degrees of severity at any time, no matter who you are, where you live, or how much money you make.

  I often use analogies on air when I talk about healthcare because medicine is complicated. So here are some others ways to look at it. Let’s say that, in one or two months’ time, you’re asked to do something that will take all your energy, like run an Olympic race, give a high-stakes presentation at work, or take a final exam. If you know that you’ll be put to the test in this way, would you start doing everything now to prepare? Or would you wait until you were toeing the starting line, standing in front of your entire office, or sitting down for the test to start getting ready?

  Preparation is the name of the game in pandemic times, as we have no idea if and when we could get infected and how severely we might react. While doctors like me have been warning people for years that we should focus on our overall health and weight, the need has never been more urgent. I know you’ve heard before—likely many times over the years—how important it is to prioritize your health and take better care of yourself, but that advice means something different today than it did in 2019. We have to do everything possible now—train for that race, prepare for the presentation, study for the final—in order to improve our chances of not only performing our best but also crushing it, if and when our day ever comes.

  Consider this your wake-up call. It’s time to train and to help pandemic-proof your body as much as possible, and I’m here to show you how.

  Weight Loss

  Where to start? The single most effective thing you can do to help pandemic-proof your body is to lose weight. That’s because being overweight or obese is the biggest chronic risk factor to developing severe COVID-19 complications. Obesity is a bigger risk factor than cancer, heart disease, and other serious illnesses. It’s even a bigger risk factor than respiratory conditions like asthma, emphysema, and lung disease.

  Here are the facts: In August 2020, a meta-analysis that included nearly 400,000 patients found that those who were obese and contracted COVID-19 were 113 percent more likely than people of healthy weight to be hospitalized, 78 percent more likely to be admitted to the ICU, and 48 percent more likely to die.1 Similarly, an April 2020 study conducted on 4,100 people with COVID-19 in New York City found that obesity was the primary predictor after age of whether someone would get seriously sick from the virus.2 Young people who were obese were also much more likely to be hospitalized with COVID-19, even if they had no other risk factors.3 Subsequent studies have reached the same conclusion, over and over again.

  But what is it about obesity that’s so incendiary for the virus? The truth is, carrying too much weight is a chronic disease state in and of itself, as qualified by the American Board of Obesity Medicine. What this means is that being overweight or obese acts like most other diseases in the body, increasing inflammation, weakening the immune system, and thwarting the body’s ability to fight infection. That’s all bad news for you if you happen to contract coronavirus, which menaces the body by also driving up inflammation. When you add more inflammation onto chronic inflammation, the body can’t take it—it simply starts to shut down.

  Compounding this issue is that, if the scales aren’t tipping in your favor, you’re more likely to have or to develop type 2 diabetes, high blood pressure, and heart disease, all of which also put you at a much greater risk for severe illness or death from COVID-19.

  This is not good news for most people, I understand. Two-thirds of all Americans are overweight or obese. The condition is so widespread, in fact, that if you are overweight, you may think you’re perfectly healthy because everyone around you looks the same. Some of my patients fall into this mindset, and it’s a real problem. Because if you don’t realize that you�
��re walking around with a potentially deadly disease, you’re likely not taking all the precautions you need to now.

  I want to make something crystal clear about obesity, however: If you are overweight or obese, you are not to blame. Obesity is not a disease brought on by laziness or lack of discipline. There are genetic, metabolic, nutritional, hormonal, and behavioral components to the condition, along with many other complex factors. Sometimes prescription medication alone can cause excess weight gain. I’ve seen so many of my own patients struggle with this, and I know how difficult the issue can be. And I’m here to help. I know it may seem like a futile effort or an uphill battle. I know the “I’ve tried it all, and nothing works” history of many with the conditions of obesity or overweight. This is not a character flaw—it’s a medical condition, and now is the time to address it as such, without judgment, blame, or shame.

  Being overweight or obese isn’t your fault. But no matter what your experience has been like in the past, I want to help you try to continue to make strides to change your situation—now more than ever before, because your life may depend on it. And if you haven’t paid attention to your weight, nutrition, or fitness levels before, now is also the time to start doing something about it—STAT.

  Weight loss isn’t easy—if it were, there wouldn’t be a multibillion-dollar diet industry built around helping people drop anywhere from three to three hundred pounds. But losing weight to lower your risks from COVID-19 is unlike any kind of weight loss you’ve tried. That’s because dropping pounds for a pandemic isn’t the same as getting ready for summer swimsuit season. You don’t need to be a size 2 or look like a model to survive and thrive in our new normal. The goal shouldn’t be huge, dramatic, and unattainable weight loss. Instead, it should be to get your BMI in a healthy range. If you’re motivated to lose more—especially once you get started and realize how good losing weight can feel—that’s a bonus that will only strengthen your physical and mental arsenal.

  Here are ten steps to take to help pandemic-proof your body:

  1. Assess whether your weight is a problem. If you think you may be overweight or obese, you probably are. In our heart of hearts, most of us know whether our weight is a health problem. To be sure though, go online and calculate your body mass index (BMI)—the measurement and accompanying scale will indicate if you’re overweight or obese. Your BMI isn’t a perfect assessment by any means—muscle weighs more than fat, which is why some athletes have immoderately high BMIs. But the measurement has been clinically correlated to specific health outcomes hundreds of times, and it’s one of the best free, readily available measurements we have.

  If you’d feel better with a medical diagnosis that you’re overweight or obese, make an appointment with an obesity-medicine physician, your primary-care doctor, or a healthcare provider. You may want to see a doctor at this time anyway, especially if you haven’t been to one in more than a year (learn more about a pandemic physical here).

  2. Drop the blame game. If you are overweight or obese, remind yourself that it’s not your fault and that you didn’t do anything wrong. Allowing yourself to wallow in guilt can make it more difficult to adopt the mindset you need to lose weight.

  3. Be willing to try and tell yourself you CAN. It’s just like the story of The Little Engine That Could: If you think you can’t lose weight, you probably won’t. Lots of people stay stuck at an unhealthy weight because they’ve already accepted that they can’t lose it. Don’t be one of those people. Every one of us is capable of amazing things. Choose to be the little engine that could and believe in yourself.

  4. Put a carrot at the end of the stick. Not a real carrot, of course, but rewarding yourself with a non-food item when you lose a certain amount of weight can help motivate you to stay the course. Promise to treat yourself to a new pair of shoes, for example, or a day out with friends, or another material item or special experience if you drop ten pounds. Set similar incentives for twenty, thirty, forty pounds, etc., depending on how much you have to lose.

  5. Pick a weight-loss plan from this doctor-approved device. One of the simplest strategies for weight loss and weight management comes from a lecture I attended while becoming board certified in obesity medicine: a three-tiered obesity-treatment pyramid that boils weight loss down to three distinct action plans.4 If you’re overweight, with a BMI equal to or greater than 25—or even if you’re at an ideal weight—choose the bottom tier of the pyramid, which prescribes healthy nutrition and exercise (see steps 6–8), or what I like to refer to as the Two F’s: Food and Fitness. The middle tier advocates FDA-approved weight-loss medications, which an obesity-medicine specialist or other licensed provider can prescribe to those who are clinically obese, with a BMI equal to or greater than 30. The top tier of the pyramid recommends bariatric surgery, like sleeve gastrectomy, for those with a BMI equal to or greater than 40, which qualifies as extremely obese and is life-threatening.

  6. Stop agonizing over what you eat. Most people don’t lose weight because they follow restrictive diets or crazy food fads. The truth is, you don’t have to cut out multiple food groups, eat only green vegetables, or count calories or carbs for months or years on end—oftentimes, these types of diets can be effective in the short term, but they’re almost never sustainable. Instead, focus on eating until you’re satisfied, not stuffed, and on consuming less food throughout the day.

  7. Prioritize low-sugar and low-carb consumption. We’ll go into detail about the best nutrition for our new normal in chapter 4, but prioritizing foods high in protein and healthy fat and low in sugar and carbohydrates is the most effective way to lose weight. You don’t have to start counting carbs—instead, reduce the amount you eat so that carbs make up only a quarter of every meal. In addition, don’t snack on processed foods like crackers, bread, chips, or baked goods, even if they’re gluten-free or plant-based.

  8. Move more, but don’t assume exercise will save you. Ninety percent of your ability to lose weight depends on the foods you eat (or don’t eat). Only 10 percent of your weight depends on how much you exercise. Moving more will certainly build muscle, improve your health, and help you lose weight faster and keep it off longer. But don’t make the mistake of relying too heavily on exercise to compensate for a junk-food diet if you want to lose weight.

  9. Beware of quick fixes. If it sounds too good to be true, it probably is. The weight-loss industry is full of quick fixes, scams, and “cures,” all of which prey on people’s desperation and frustration. Despite what you may see on social media, however, very few of these fixes are actually effective, and they can be unsafe.

  10. Be patient. Losing weight takes time. Being overweight or obese didn’t happen to you overnight and it’s not going to be fixed overnight.

  Do You Still Need to Pandemic-Proof Your Body If You Get a Vaccine?

  Yes. And here’s why: It’s just good health. As the pandemic has made clear, the risks of obesity and other chronic health conditions like diabetes and heart disease aren’t just theoretical—they are very real and potentially very deadly. Doctors have been warning people about these conditions for years, and they’ll always pose a threat with or without a pandemic. Even with a vaccine that reduces the risk of COVID-19 infection, we all still need to prioritize our health. COVID-19 has helped to show us that chronic health problems like obesity and heart disease aren’t abstract, and there’s no way of knowing when and what the next pandemic might bring. Get vaccinated and take every step possible to be as healthy as you can in our new normal.

  Beyond the Scale: Other Risk Factors

  While losing weight is the most important thing you can do to lower your risk of COVID-19, there are other critical research-backed ways to bolster your health in our new normal based on what we know about the disease.

  At the beginning of the pandemic, I must have said the word comorbidities on national television dozens of times, which is much more often than I ever did in medical school or residency. I wasn’t alone, of course: The
term, used to describe the presence of one or more physical complications alongside a primary health condition, was falling out of the mouth of every medical expert. In a matter of weeks, most Americans understood the pedantic term, which had previously been uttered only by doctors, medical professors, and a few characters on Grey’s Anatomy.

  For our purposes, you can think of comorbidities as the same as preexisting conditions: Both are need-to-know info in pandemic times. If a person has certain comorbidities or preexisting conditions, he or she is much more likely to be hospitalized or die from COVID-19. But not all preexisting conditions are the same. Some are riskier than others, and it’s not always intuitive which ones are worse for COVID-19.

  What You Can’t Change

  Let’s start with the facts. You already know that the biggest risk factor for coronavirus is age. Older people are simply more likely to get seriously ill or die from the disease than younger people, which is why the virus has wreaked havoc on nursing homes across the country. The second biggest risk factor, as we now know, is being overweight or obese.

  But after age and weight, things start to get a little murky. According to research to date, men are twice as likely to die from COVID-19 as women, despite a similar infection rate between the sexes. We have theories about why: Some comorbidities like high blood pressure (more on hypertension here) and heart disease are more common among men, and women tend to have a more robust immune system than men (remember, autoimmune diseases are more common in women than in men), but no one knows for sure if this is the reason.

  People of color are also much more likely to get seriously ill or die from COVID-19 than white people. This racial inequity is largely due to socioeconomic reasons. People of color are more likely to be classified low income, which means they’re also more likely to have reduced access to quality healthcare, higher rates of obesity and other serious illnesses, multiple live-in family members or roommates, and jobs with greater exposure or without a work-from-home option.