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Letter to The Times

We read with interest, and optimism Mr. Swinson's article "Boris Johnson to launch war on fat after coronavirus scare" in the Times yesterday (15th May 2020). We are a group of obesity specialists - bariatric surgeons from England, the USA, Finland, and Brazil. The previous day we met virtually to host and debate an international discussion, with a global audience on what should be done for obesity services around the world as most obesity centres and programmes have understandably been put on hold during the pandemic.
Mr. Johnson’s voice resonates strongly with that of ours. We seek to advocate for patients suffering from obesity and to fight the stigma of obesity head-on for tens of millions of patients worldwide, who are often cast aside as second-class citizens. Obesity is still seen as a self-inflicted problem by too many who choose to ignore the available evidence. But obesity is a disease, not a choice. There is now enormous data in the scientific literature to implicate genetic, metabolic, mental health, education, social deprivation, access to healthcare, and other factors beyond an individual’s control, in the complex aetiopathogenesis of this disease.
A large number of patients with obesity also suffer from Type 2 Diabetes. This further increases their risk of suffering an adverse outcome with COVID-19 infection. The twin pandemics of COVID-19 and Obesity (The COVesity Pandemic) will continue to cause considerable disruption to society in general for the foreseeable future, especially if there is a second spike. We have to, therefore, attempt to reduce the burden of the virus and the burden of the disease of obesity simultaneously. While the search for interventions to fight the pandemic continues, we mustn’t forget that effective tools to fight obesity exist already.
Bariatric Surgery is known to deliver up to a 40 % reduction in all-cause mortality in patients suffering from severe, complex obesity. It reduces heart attacks, strokes, cancer risk, diabetes risk, and can even reverse the end-organ damage from chronic diseases such as diabetes. Understandably, most bariatric surgery services globally have been closed down during the pandemic. However, rather worryingly, the plans to restart them are all up in the air. Here in England, bariatric services have become very much like our patients – second-class citizens in a climate of constrained resources. Furthermore, in many countries across the globe access to surgery is very limited since it is often considered as cosmetic surgery and not included in public or private insurance plans. In this environment, Mr. Johnson’s support sounded very much like a call to arms in this battle to restart bariatric surgical services and provide improved access to bariatric surgery, so that patients vulnerable to all the co-morbid conditions of obesity, including COVID-19, can avoid such suffering and death.
We will undoubtedly need to develop newer ways to manage and mitigate risks associated with the pandemic. Several such strategies such as pre-operative isolation, testing, personal protective equipment for staff, and shorter hospital stays are already being piloted by colleagues around the world. There will be new lessons to learn as we try and adapt to the changed reality but the answer surely cannot be to never start in the first place. Centers across the world that are starting services again are using digital consultation, web-based multidisciplinary team meeting platforms, newer surgical approaches, and closer virtual follow up protocols to deal with the new reality.
There is much work to be done by all stakeholders to tackle COVesity. But we need to start somewhere and start now or else the risk is that we end up perpetuating the obesity stigma for generations to come.

- Sanjay Purkayastha: Consultant bariatric surgeon, clinical senior lecturer in Bariatric Surgery, Imperial College, London.
- Philip Schauer: Professor of Metabolic Surgery Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana, USA.
- Paulina Salminen: Professor of Surgery, Turku University Hospital, Turku, Finland.
- Almino Ramos: Medical Director Gastro-Obeso-Center Institute, Sao Paulo Brazil.
- Kamal Mahawar: Consultant Surgeon, Sunderland Royal Hospital & Visiting Professor, University of Sunderland, UK

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