Obesity, Severe Obesity & COVID-19

The Centers for Disease Control and Prevention (CDC) recently updated its list of underlying medical conditions that put individuals at increased risk for severe illness from COVID-19. One of the changes is obesity.

The CDC says that strong and consistent evidence now shows that obesity with a BMI of 30+ increases risk for severe COVID-19 illness. Previously, only severe obesity (BMI of 40+) was linked to complications. (See the evidence used to determine risks here.)

This means that more Americans are in danger of becoming very sick if they get COVID-19. According to the CDC, about 42 percent of U.S. adults have obesity, while about 9 percent have severe obesity.

With COVID-19 cases continuing to rise across the country, what can nutrition and health educators do?

1. Remind people who have obesity to be even more careful to protect themselves. The CDC advises:

  • Limit your interactions with other people as much as possible.
  • Take precautions to prevent getting COVID-19 when you do interact with others.
  • If you start feeling sick and think you may have COVID-19, get in touch with your healthcare provider within 24 hours.

2. Empower people who have obesity to make changes to lose weight (or at least maintain their weight during these stressful times). Our 12 Lessons of Wellness & Weight Loss Program program is perfect for this:

  • With 12 PowerPoint shows, you can customize the program. Spread the 12 lessons over a month, several months, or a year. Or let your clients choose which lesson(s) they want to tackle first.
  • Use the included Leader Guide to create contests and incentives for each lesson. Since your audience will likely be viewing the lessons from home, it’s nice to add the personal touch of sending them a handwritten note or prizes like our wristbands, stickers, and bookmarks.
  • Supplement the PowerPoint shows with printed material. We provide PDF handout sets for each lesson so you can send them to participants.

The CDC emphasizes that we’re learning more about COVID-19 every day. Make sure to keep your clients, employees, and students up to date. And remind them to wear a mask!

COVID-19, Obesity, & Weight Loss

The link between obesity and COVID-19 is scary. For people who’ve struggled with their weight for years, it might be a much-needed wake-up call. They may be ready to face the issue head-on, once and for all.

So how can we help them succeed? If you’re working with a chronic dieter, chances are the scale is not a friend. Daily or even weekly weigh-ins might do more harm than good.

Yes, research shows that people who weigh themselves frequently are more successful at losing weight and keeping it off. But for some people, the number on the scale holds too much power. Whether it’s up or down, it can sabotage even the best of intentions.

Take the focus (and power) away from that daily number on the scale by looking at Body Mass Index (BMI) and waist circumference. Our BMI 101 PowerPoint lesson teaches people how to calculate their BMI, measure waist circumference, and take steps to lower both.

Here are some tips for using BMI and waist circumference to help people get to a healthy weight:

Talk to your clients about how they relate to the scale. Does seeing the number go up cause a downward spiral of self-hate and emotional eating, followed by a vow to start fresh tomorrow? Does the thrill of seeing the number go down make you think, ‘I’ve been good, so I can afford to have a little treat today’?

Calculate your BMI: use an online BMI calculator or the Body Mass Index Table.

  • BMI of 25.0 to 29.9 = overweight.
  • BMI of 30.0+ = obese.
  • CDC warns that a BMI of 40+ puts people at higher risk for complications from COVID-19.

Measure waist circumference accurately by following instructions found here. It’s probably worth it to measure three times and take an average.

  • A waist circumference of more than 40 inches for men and 35 inches for non-pregnant women increases the risk of obesity-related chronic diseases.

Set a realistic goal:

  • Lowering BMI by 2-3 points is enough to improve weight-related health risks. This is equivalent to a 10% weight loss in overweight or obese individuals.
  • Reducing waist circumference indicates the loss of abdominal fat, even if BMI doesn’t go down. This helps reduce your risk of heart disease.

Remind your clients to practice self-care, especially during the pandemic. Stress and poor sleep habits make it hard to lose weight, so focus on these things as you make other lifestyle changes.

Use the code MYPLATE to get 10% off plus free shipping for all items now.

Health News: Chronic Disease Risk Factors

A recent study published in the Journal of Clinical Endocrinology and Metabolism suggests that “metabolically healthy obese” people, a subset of obese individuals who were initially thought to not be at high risk of heart and other chronic diseases, still might have elevated health risks.

Study author Kristine Faerch from the Steno Diabetes Center in Copenhagen states that while it was once thought that it was not unhealthy to be overweight or obese if you lived a healthful lifestyle, newer research suggests that this is not the case.1 Overweight and obese individuals face an increased risk of type 2 diabetes and heart disease. To lower risk, maintaining a healthy weight throughout the lifecycle is vital.

Faerch and her team of researchers evaluated data from over 6,200 men and women that joined a Danish study wherein they were tracked for over 10 years. The subjects’ initial BMIs and risk factors for heart disease (including HDL a.k.a. “healthy” cholesterol levels, high blood pressure, triglycerides, and blood glucose) were all monitored. “Metabolically healthy” subjects had none of these risks, while “metabolically unhealthy” subjects were defined as having at least one risk factor. In the follow up period, 323 subjects developed heart disease. Men who were metabolically healthy but obese had 3 times the risk of heart disease when compared to metabolically healthy men at a normal weight. Women that were metabolically healthy but obese had double the risk of heart disease. Overweight men that were metabolically healthy had equivalent risk as their normal weight counterparts. Overweight women had a slightly higher risk than normal weight subjects. The authors note that only 3% of male and female subjects were obese, but considered metabolically healthy. Over a 5-year period, 40% of those considered metabolically healthy became metabolically unhealthy.

Joshua Bell from the UK’s University of Bristol was not surprised by these results. He and his colleagues published a paper this past February which noted that obesity increases age-related disability and decline, even in metabolically healthy individuals.2 His research found that after 2 decades, physical ability declined two times more while pain increased six times more in obese individuals when compared to normal weight individuals. Bell further stresses that heart disease is not the only risk factor to consider when discussing healthy aging.

Matthias Schulze at the German Institute of Human Nutrition in Potsdam-Rehbruecke believes that other measurements such as waist to hip ratios, waist circumference, and body fat could be explored to determine whether someone is “metabolically healthy” and obese.3 Healthy and obese can change to unhealthy and obese very quickly.

More research is needed to find how to decrease disease risk in both groups.

By Lisa Andrews, MED, RD, LD


  1. Louise Hansen, MSc, Marie K Netterstrøm, MSc, Nanna B Johansen, MD, PhD, Pernille F Rønn, MSc, Dorte Vistisen, MSc, PhD, Lise LN Husemoen, MSc, PhD, Marit E Jørgensen, MD, PhD, Naja H Rod, MSc, PhD, DMSc, Kristine Færch, MSc, PhD. Metabolically healthy obesity and ischemic heart disease: a 10-year follow-up of the Inter99 study. J Clin Endocrinol Metab jc.2016-3346. Published March 7, 2017.
  2. J A Bell, S Sabia, A Singh-Manoux, M Hamer, and M Kivimäki. Healthy obesity and risk of accelerated functional decline and disability. International Journal of Obesity advance online publication 14 March 2017; doi: 10.1038/ijo.2017.51.
  3. Kristin Mühlenbruch, Tonia Ludwig, Charlotte Jeppesen, Hans-Georg Joost, Wolfgang Rathmann
    Christine Meisinger, Annette Peters, Heiner Boeing, Barbara Thorand, Matthias B. Schulze. Update of the German Diabetes Risk Score and external validation in the German MONICA/KORA study. Diabetes Research and Clinical Practice. June 2014 Volume 104, Issue 3, Pages 459–466.

And here are a few fantastic posters to promote healthy weight management…

Motivation Tip: Use a Reward Chart

Reward Chart Poster

One of the most popular tools in my nutrition educator’s bag of tricks is a good reward chart. It helps with motivation, makes it easier to celebrate important milestones, and adds a sense of fun to a new endeavor.

That’s why I created the Reward Chart poster. I wanted a resource that would help people focus on important health goals, and it has been flying off the shelves since its introduction to the store.

Today, because I love ya, I’m giving away the handout that comes with this poster, for free.

Yes, you read that right!

In order to further boost motivation, the Reward Chart poster comes with a simple handout about selecting rewards and the evaluating the impact of healthful choices. I’ve copied that information below and slipped in a free downloadable PDF of the handout too…

Choosing Rewards:

When it comes to choosing rewards for your achievements, it’s important to choose options that will encourage your efforts. Skip food or drink rewards. Instead, try one of these options…

  • High FiveHand weights
  • Resistance bands
  • Yoga mat
  • Swim goggles
  • Running shoes
  • Movie passes
  • New cooking equipment
  • Sharp knife
  • Colorful cutting board
  • Nonstick skillets
  • Fresh herbs
  • New spices
  • New workout clothes
  • iPod or other digital music device
  • A deposit in a savings account for a vacation
  • A trip to a museum or art exhibit

The Benefits of Your Decision:

There are tons of benefits to good health.

A balanced diet and exercise plan will reduce your risk of…

  • Family JogDiabetes
  • Heart disease
  • Stroke
  • Certain cancers
  • Metabolic syndrome
  • Obesity

At the same time, making healthful diet and exercise choices will provide the following benefits…

  • Increased stamina
  • Better sleep
  • Improved mood
  • Increased flexibility
  • Stronger bones
  • Higher energy levels

Congratulations on starting down the road to good health.

You can do it!

And, as promised, here is the PDF handout that’s (usually) only available to people who already bought the Reward Chart poster. I hope you like it!

Reward Chart Handout

Last but not least, we have some other great resources in the Nutrition Education Store — they’re sure to give your clients a motivation boost!

Save Calories with 7 Simple Steps Poster

Reward Chart Sheet

Poster: How Much to Work it Off?

Thoughts on the Dietary Guidelines for Americans

Let’s get serious about dietary guidelines.

HealthThe Dietary Guidelines for Americans are published jointly every 5 years by the U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA), as mandated by Congress. The goal of the Dietary Guidelines is to provide science-based nutrition and food safety recommendations for people two years and older to help promote habits that maximize good health and reduce the risk for chronic disease.

Unfortunately, despite widespread efforts, eating habits overall remain largely unchanged. The majority of the population consumes too many refined grains, solid fats and added sugars, yet at the same time consumes too little fruit, vegetables, whole grains, and low-fat dairy products. I find it disturbing that vegetable intake has actually declined since 2001-2004. Many young children consume the recommended amount of fruit and dairy, but these levels drop once they reach school age.

The 2015 Dietary Guidelines Advisory Committee’s (DGAC) most recent recommendations outline what we can expect to see in the updated guidelines later this year. Overall, the dietary pattern recommended by the 2015 DGAC reaffirms the dietary pattern characteristics recommended by the 2010 DGAC. Let’s take a look at the highlights…

Over- and Underconsumption of Nutrients: Health Effects

HalfPlateVeggiesThere is a continued emphasis on consuming a diet high in fruit, vegetables, whole grains, and low-fat dairy products, all of which are good sources of the nutrients that continue to be underconsumed by the majority of Americans: vitamin D, calcium, potassium, and fiber. These foods are also low in the saturated fat and sodium that are typically overconsumed by Americans. Of interest, cholesterol is no longer considered a nutrient of concern.

There is strong evidence that a high sodium intake increases risk of hypertension, leading the DGAC to continue to recommend decreasing sodium intake to 2,300mg per day. There is limited evidence of the value of reducing sodium intake further, or in terms of the role of potassium in hypertension. So make of that what you will.

The DGAC strongly states that people should discourage the consumption of low-fat or non-fat foods when the fat is replaced by refined carbohydrates or added sugars. The committee continues to recommend that less than 10% of a person’s overall daily calories should come from saturated fat, noting that replacing saturated fat with polyunsaturated fatty acids (PUFAs) reduces LDL-cholesterol levels and cardiovascular disease (CVD) risk. There is strong evidence that replacing saturated fat with carbohydrates does not lower CVD risk, and there is limited evidence that replacing saturated fat with monounsaturated fatty acid (MUFA) leads to reduced CVD risk. Encouraging the use of non-hydrogenated vegetable oils including soybean, corn, olive and canola oils instead of animal fats or tropical fat is recommended instead of reducing saturated fat in the diet and increasing carbohydrate intake.

Instead of replacing fat with refined carbohydrates and added sugar, the recommendation is to increase nutrient-dense foods including whole grains, legumes, vegetables and fruit. It also includes increasing healthful sources of protein including legumes, nuts, low-fat dairy, and lean meats.

The DGAC recommends limiting added sugars to a maximum of 10 percent of total daily caloric intake. To meet this goal, sugar-sweetened beverages, which currently provide 39% of added sugars, should be replaced with unsweetened beverages.

Consumption Patterns and Plant-Based Foods

What's in your cart?What offers the most nutrient-dense diet? The guidelines explain that a diet that is based on vegetables, fruit, whole grains, legumes, nuts, and low-fat dairy, which includes more seafood and less red and processed meat, which is moderate in alcohol, and which contains low amounts of refined grains and sweetened foods and beverages provides the most nutrient-dense diet.

The DGAC notes that there are several different diet patterns that follow these guidelines, including the Healthy U.S.-Style Pattern, the Healthy Vegetarian Pattern, and the Healthy Mediterranean-style Pattern. Each of these patterns provides more plant-based foods and lower amounts of meat than are currently consumed by the US population.

The committee notes that overconsumption of nutrients from foods and beverages, including fortified foods is rare. However, folate, calcium, iron, and vitamin D may be overconsumed when using high-dose supplements.

Energy Intake

The information on the breakdown of energy intake is not surprising given the increase in overweight and obesity. Here’s a closer look at the breakdown of energy intake by Americans…

  • 28% from mixed dishes, primarily pizza and burgers/sandwiches (also major contributor of sodium and saturated fat)
  • 16% from snacks and sweets (also major contributor of saturated fat and added sugars)
  • 12% from beverages not including milk or 100% fruit juice; provides 47% of added sugar intake
  • 11% from protein foods
  • 11% from grains
  • 8% from vegetables
  • 7% from dairy
  • 5% from fruit and 100% fruit juice

The committee found that the majority of the population consumes three meals plus at least one snack, with adolescent females, young adult males, non-Hispanic Blacks, Hispanics, and individuals with lower incomes being the least likely to consume three meals a day. While breakfast tends to have a higher overall dietary quality compared to other meals and snacks, adolescents and young adults are the least likely to eat breakfast. Snacks contribute about 25% of daily energy intake, and unfortunately tend to be lower in important nutrients and higher in sodium, added sugars, and saturated fat.

It’s surprising that the USDA food patterns do not meet recommendations for potassium and vitamin D, and additional fortification strategies may be necessary to reach the RDA for vitamin D.

It’s well-known that rates of chronic disease are linked to overweight and obesity, playing a role in hypertension, CVD, type 2 diabetes, and some types of cancer, and that these weight-related illnesses now are present in children and adolescents who are overweight or obese. It’s not surprising that 90% of children with type 2 diabetes are overweight or obese.

Promoting Behavior Change

Balance diet and exerciseI believe that more research and emphasis on promoting lasting behavior change is crucial, especially since the overall dietary choices haven’t changed significantly in the past 10 years. The DGAC suggests focusing on strategies that address:

  • Reducing screen time, especially for children and adolescents to promote a healthy body weight as they transition into adulthood.
  • Reducing the frequency of eating fast food for all age groups
  • Increasing the frequency of family or shared meals
  • Self-monitoring diet and physical activity behavior to promote lasting behavior change
  • Effective food labeling to target healthier food choices

Food Environment

What's the food environment like near you?The food environment is an area that requires more research to establish the most effective strategies to improve nutrition and health in schools and workplaces and to presents opportunities for RDs to collaborate with other groups to effect change.

The DGAC found strong to moderate evidence that multicomponent school and worksite policies are associated with improved dietary intake, including increased vegetable and fruit consumption and reduced body weight. Polices that include increased opportunities for physical activity, nutrition education, food service changes, and in schools (and parental involvement) are the most effective.

Food Safety and Sustainability

Fish: where do you get it?The conversations around food safety and sustainability are often heated, with drastically opposing views. The DGAC recommends a moderate approach:

  • Both farmed and wild-caught seafood are nutrient-dense foods that are rich sources of healthy fatty acids. The risk of contamination is similar between farmed and wild caught seafood and does not outweigh the health benefits of consuming seafood.
  • Wild-caught seafood cannot meet the growing demand, creating a need for sustainable seafood farming practices.

Caffeine Consumption

The research shows that in general, caffeine intake does not exceed recommend levels.

Moderate coffee consumption is considered to be 3-5 cups per day, or up to 400mg of caffeine per day. Moderate coffee consumption does not lead to increased health risk, and in fact is associated with decreased risk of type 2 diabetes, cardiovascular disease, liver and endometrial cancer, and Parkinson’s disease. The DGAC agrees with the American Academy of Pediatrics and the American Medical Association that until safety has been demonstrated, vulnerable populations including children, adolescents and young adults should avoid high-caffeine energy drinks or other products with high amounts of caffeine. Alcohol and energy drinks should never be mixed or consumed together.

Women who are pregnant or planning to become pregnant should be cautious and adhere to current recommendations of the American Congress of Obstetricians and Gynecologists and consume less than 200 mg caffeine per day (approximately two cups of coffee) to reduce risk of stillbirth, miscarriage, low birth weight, and small for gestational age.


What do YOU think about aspartame?Aspartame is the football of sugar substitutes, going back and forth from being banned to considered a safe option. The DGAC concurs with the European Food Safety Authority (EFSA) Panel on Food Additives that aspartame in amounts commonly consumed is safe and poses minimal health risk for healthy individuals without phenylketonuria (PKU). The risk to pregnant woman is unknown. However, long-term human studies are needed to assess a possible relationship between aspartame and risk of non-Hodgkin lymphoma and multiple myeloma. The recommendation is to stay below the aspartame Acceptable Daily Intake (ADI) of <50mg/kg/day. A 12-ounce diet beverage contains approximately 180mg aspartame. A 150-pound (68 kg) woman could drink up to 18 12-ounce diet beverages sweetened with aspartame and meet this guideline.

Anyway, that’s a collection of my immediate thoughts about the highlights from the latest DGAC update. What stood out to you? What most affects your practice?

By Lynn Grieger RDN, CDE, CPT, CWC

ALL-NEW Health/Nutrition Education Materials

ALL-NEW Health/Nutrition Education Materials!

The Nutrition Education Store is overflowing with BRAND-NEW nutrition education materials. We have over 70 brand-new items that will make your life easier. Here are some of the latest and greatest…

Healthy Cooking Workbook

MyHealth Bulletin Board Kit

Quality Nutrition Poster Value Set

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