COVID-19, food and nutrition, and the presidential debates

Watching the first presidential debate, many things stood out. Among them, one crucial — but still largely overlooked — issue was the absence of any meaningful questions or discussion on one of the most important challenges and opportunities facing our nation.

As cardiologists from Michigan and Massachusetts who study how policy can be leveraged to save lives, we have a message for the candidates and the debate moderators: it’s time to fix food.

At current rates, COVID-19 will claim a quarter of a million American lives by Election Day. The current national plan to address the virus is heavily focused on creating a vaccine: $12.6 billion committed to-date. We need a vaccine. Yet, at the same time, comparable focus should be given to treatment — to reduce the severity of COVID-19 infections. Unfortunately, treatment has received relatively little national emphasis or investment. For our country to successfully conquer COVID-19, the current nominees, and the next president, must make this a top priority. Figuring out how to leverage healthier eating tops the list.

The powerful linkages between diet-related poor metabolic health and how sick a person becomes when infected by COVID-19 are now well documented — but widely underappreciated. A 35-year old infected with COVID-19 who also has obesity, high blood pressure, diabetes, or a handful of other less common conditions, has the same risk of hospitalization as a 75-year old infected with COVID-19 who has none of those comorbidities. These diet-driven metabolic conditions are a top risk for critical illness with COVID-19; each independently increases risk of severe illness about two-fold. And these risks are cumulative: a person with diabetes, high blood pressure and obesity would be expected to have about an eight-fold higher risk of hospitalization.

What if we start reversing these conditions in the U.S.? Can you imagine if we identified a drug that might reduce the risk of being hospitalized from COVID-19 by many fold, within a few months? Our national government would be investing billions of dollars to test such a drug. Such a treatment, by greatly reducing the severity of COVID-19 infections, would also help schools and universities to reopen, businesses to restart and help our lives and economy to return toward normal. Notably, even when an effective vaccine is developed, it could take many more months and would likely take even longer to be widely delivered. Despite development of a vaccine, an effective, safe treatment to reduce the severity of COVID-19 among those who still get infected will remain incredibly important. 

Better nutrition holds this promise. COVID-19 is like a heat-seeking missile for poor metabolic health. This “fast” pandemic is far worse because it’s hitting us on top of a “slow” pandemic of diet-related diseases, like diabetes, obesity and other conditions. More Americans die prematurely from a poor diet than any other risk factor. This year, about 500,000 Americans will die from diet-induced diseases. These deaths, like COVID-19, also disproportionately affect Black and Brown Americans, through long-standing systems of structural racism that are in large part mediated through lifestyle and diet-related metabolic risk factors. It’s time to address these inequities. 

Crucially, healthy eating doesn’t require years to work. Changes in our food choices can alter metabolic health within six to eight weeks, even with no weight loss. And, of course, improving diet can also significantly improve our weight over just a few months. We’re not talking about years, but just months to see and test potential benefits.

The potential for food-related actions to bend the curve of COVID-19 must be prioritized by federal, state and local governments. For our nation’s presidential candidates, we call for the following actions:

• Rapid testing of how food and lifestyle interventions that improve metabolic health can reduce severity of COVID-19 infection and other “long hauler” effects

• Expedited funding of clinical trials to assess how natural food compounds may improve immunity and directly target COVID-19

• Pilot programs in the Supplemental Nutrition Assistance Program that leverage financial incentives and disincentives (SNAP-Plus) to nudge participants toward healthier food choices

• Greatly expanded funding for the CDC’s work in nutrition, physical activity and obesity, currently receiving only about $0.1 billion per year, compared with $160 billion spent by the government on medical care for diabetes 

• Test and scale Produce Prescription programs and medically tailored meals in Medicare, Medicaid and private insurance

• Accelerate and expand nutrition science discovery and innovation, including with a new National Institute of Nutrition

• Coordinate our more than $150 billion per year investments in federal food and nutrition programming through a new Office of the National Director of Food & Nutrition

Sensible food and nutrition policy can help reduce the severity of COVID-19, restore our shattered economy, improve national resilience toward future threats and be a major step toward health equity. Such policies can also save hundreds of thousands of Americans from premature disability, suffering and death each year. Governments in the U.K. and Mexico are recognizing this need and they are taking action. It’s time we demand the same from our presidential candidates and the next administration.

Eric J. Brandt, MD, MHS., is a clinical lecturer for the Division of Cardiovascular Medicine and the University of Michigan Medical School. 

Dariush Mozaffarian, MD, DrPH, is dean and professor at Tufts Friedman School of Nutrition Science and Policy and professor of medicine at Tufts School of Medicine.