Does the American diet make us more vulnerable to Covid-19?

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When the CEO of Whole Foods attempted to connect our vulnerability to the virus with our food choices and diet-related disease, the internet fired back. We asked experts if he was onto something.

In September, Whole Foods CEO John Mackey sparked an internet backlash when he said the American diet was partly to blame for U.S. deaths from Covid-19. And he wasn’t talking about flouting mask rules.

In an interview with The New York Times, Mackey noted a “very high correlation between obesity and Covid deaths,” and added that this country “had more of a problem” with the virus because “comorbidities like diabetes, heart disease, high blood pressure, they’re just higher in the U.S.” The message: our vulnerabilities are directly related to our behavior. “People have got to become wiser about their food choices,” he said. “We’ve opened up stores in poor areas. And we see the choices. It’s less about access, and more about people making poor choices.”

On Twitter, the outrage was swift. “It’s not ‘poor choices.’ WE HAVE NO MONEY to buy your OVERPRICED bullshit,” one Tweeter seethed. “Sorry we can’t all afford your six dollar asparagus water, Mr. Whole Foods Man. We should make better choices,” another joked

Some recent research does support Mackey’s premise: Last week, the centers for Disease Control and Prevention (CDC) updated its list of underlying conditions that increase the risk of severe illness from the virus that causes Covid-19—specifically obesity (a body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2) and severe obesity (BMI ≥ 40 kg/m2). 

While public health advocates for years have highlighted the correlation between poor nutrition and disease, Mackey’s commentary assigned causation far too early in pandemic that’s just reaching its third peak. Still, as we endeavor to connect the dots between planetary and human health and the increasing risk of future pandemics, Mackey’s thesis seemed worth probing further.

So we asked six experts who study food and nutrition: How should we be thinking about the connection between what Americans eat and our excessive rates of Covid-19?

The Experts


Rita Nguyen, chronic disease physician specialist, San Francisco Department of Public Health; director, Food as Medicine Collaborative

Barry M. Popkin, professor of nutrition at the University of North Carolina at Chapel Hill

Sara Bleich, professor of public health policy at the Harvard Chan School of Public Health

Mary Story, professor of global health and family medicine and community health, Duke Global Health Institute; director of Healthy Eating Research program at Robert Wood Johnson Foundation

Kelly Brownell, director of the World Food Policy Center at Duke University, author of Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis, & What We Can Do About It

Dariush Mozaffarian, cardiologist, dean of the Tufts Friedman School of Nutrition Science and Policy, and professor of medicine at Tufts Medical School

Is Mackey right? Does the American diet make us more vulnerable to Covid-19?

Barry Popkin: He’s right and he’s wrong. We showed that the risks are so much higher for obesity than for diabetes, hypertension, or individual diseases. The obese are 113 percent more likely to go to a hospital, 78 percent more likely to go into an ICU, and 48 percent more likely to die. But our obesity is not so different than several other countries. Mexico’s not that different from us. A bunch of Latin American countries and Egypt are not that different, and Saudi Arabia’s worse. Our incidence per hundred-million of Covid cases isn’t because we’re fatter. 

Rita Nguyen: Those who have diabetes, or obesity, or a number of other health conditions, have been correlated to a higher risk of severity. But it’s too simple to say it’s just because of our diet. You have to look at the social and economic fabric of the US, compared to other developed nations with more robust safety nets. You have to look at income inequality: the greater the difference is, the worse the health outcomes are. We see a lot of inequities in health outcomes, and that is not as simple as not eating well. 

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