We are receiving a lot of questions from both HOBS’ members and the public about obesity in relation to COVID-19. On this page we will continuously summarize and update with your questions and the answers from our experts. (2020-04-08).
Kajsa Järvholm, Psychologist, Skånes Universitetssjukhus, Malmö, Sweden
As soon as I open the newspaper and read the news each morning my worry and anxiety grows big. I am terriefied to get infected by the virus. I am older, 60+, BMI 45 and can’t barely take walks. I need someone to talk to and I need help.
Kajsa Järvholm answers:
“It is important to accept how you feel and that feeling worried in these times is only a natural reaction. Worrying fills a function and helps us to react and to protect ourselves, and it is not good when people worry too little as they put themselves in danger at times. It is a thin line and a great balancing act to worry just enough and not get overwhelmed. Too much worrying can be paralyzing.
Try to accept the fact that you are feeling worried right now. If you notice that the anxiety takes over then try to schedule your worry. This means that, instead of forbidding the worry, you allow yourself to worry on certain time slots. If you, outside of this schedule that you have set up for yourself, keep getting thoughts and feelings of worry, then you reflect and acknowledge it but you say to yourself “ok, here is that thought”, maybe write it down or just “ok, I will think about this again later in my dedicated time slot when I should worry”. Try to find a balance between worrying and doing other things.
Regarding the news and the information that is at hand can very much increase our worry. Finding accurate information is to some extent a good thing. But one would think it is enought to update yourself about this situation once a day. You will not miss out if you update yourself less. Decide in advance that today I will be collecting the news from this source, if you want to read it in the paper, listening to the radio or watching the TV. Set a time and only get the news on that that preddecided time from that specfiic news source. The rest of the day can be spent doing other things. It can be advised to reflect over what time that is best for you to collect the news. If you normally wake up very worried in the mornings or fall asleep filled with anxiety in the evening, then maybe to watch the news in the middle of the day is the best, when you are more in tune with your rational self.
Allow yourself to think that if you are following the recommendations from the authorities then that is enough. Often when being worried you can start thinking about figuring things out that noone else has and that noone else knows about. But, the people with the best competence to know how to react in a situation like we are in today are all ready assigned to that job. They are fully dedicated, they have experience and they advice the authorities that hands you the information. So just follow their advice on their web page about people at risk for COVID-19. nd keep yourself updated
You do not have to do more than that, trust that you are getting the best advice and that you are safe. Social distancing, washing your hands etc.
It is unfortunate that we talk about social distansing, as it is not really the social contacts we need to remove from our lives at the moment but only the physcial contacts. That we shouldn’t meet, face to face. You can still be social in other ways if possible. Either with people you all ready know or new acquaintances using the phone, digital forums, face time. There are phone lines you can call if you need to talk to someone, maybe support phone lines for your specific age group or so. Try to find people to connect to maybe online in areas outside of COVID-19. As an example maybe you have a big interest in gardening or cultivating and finding a forum online regarding that could be a great idea to chat to people about things that brings joy to your life.
Another thing that is good for all people and the mental health, and also to peole working with weight issues, is to stick to routines. Sleeping, eating regularly and finding some sort of a physical activity that is possible to do during these special times.
And again, try to do other things. If you get very caught up in your anxiety instead of thinking “as soon as my anxiety passes I will get on to do the other things that I normally enjoy doing, or things I need to be doing”. Research shows that sometimes it is better to just do the things instead of post poning even though you might feel unmotivated and hard. Here a list could be a good thing. A list where you write down the things you would have done instead of being worried. Maybe it is reading a book that you wanted to read for a long time, fix some clothes that needs buttons sewed in. Do things that will let you get on with the everyday life.
In regards to people who worked a lot with their weight then maybe a list of things to do regarding weight loss. In these ties I would think that eating regularly and try and move as much as possible is the only thing you need to do in regards to your weight right now. If you want to do things to work with your weight now then focus on very positive things. Try things that are very hands on and easy and that you wanted to try anwyay. For example trying a new vegetable every week. Do not set up hard goals regarding the work with the weight that will just add to worry and disappointment if not reached. Focus on other things. Do things that you feel are good for you at home, maybe practical things like clearing out your wardrobe and also just allow yourelf to do things that you enjoy doing around the house."
Ata Ghaderi, Ph. D., Psychologist, Stockholm's centre for eating disorders, Research and development unit, Sweden
How should I relate to the food intake now when I sit at home, isolated? I have always been binge eating but feel like it is getting worse now. I am at risk for COVID-19 with a BMI over 40, I think I am stressing about this and I feel so bad. What can I do?
Ata Ghaderi answers:
“We as humans want to get rid of negative thoughts and emotions. We want to stop worrying and we want to feel good. Due to this, we enter a struggle between our undesired thoughts and feelings, often resulting in that we just give the negative feelings and thoughts more time and energy. An alternative is that we sometimes do things to distract us in order to avoid situations that awaken the worry and bad feelings. Unfortunately this coping strategy is not good in the long run (for example when the coping method is overeating), which isn’t necessarily something we aim to do, but while doing, it it feels better than feeling the worry or anxiety.
One alternative to overeating or binge eating is to fill your days with other things. Determined to fill your day with things that feel meaningful, joyful and maybe at some point in your life gave you meaning and felt like good things to do, but in the present maybe do not feel appeal to you as much. But you can do things without feeling the lust or urge to do it. When starting to do it it can often start to feel joyful again and this is a way to dampen the anxiety and worry as well. It is a bout finding activities that are fun, meaningful, rewarding and that include eleements of self care, caring for others and developing.
To minimize the worry connected to COVID-19 try to follow the news with some sense of control. Try to avoid notifications from news apps and don’t watch the news several times. Updates a few times a week would suffice. Other than that, actively protect yourself withoug exaggerating and fill your days with meaningful activities."
Lua Dandara Rangel, nutrionist, Skånes Universitetssjukhus, Malmö, Sweden
I am in qurantine due to COVID-19 and I cannot exercises or move as much as I normally do. What should my diet look like?
Lua Dandara Rangel answers:
"Since I do not know you, it is hard for me to say exactly what you should be eating. I would however recommend you to set up a plan for your day with all your routines, activities and meals. Make sure you eat 3 main meals (breakfast, lunch and dinner) and 1-2 in snacks if you feel more hungry or the need for it between meals.
Make sure you look at your fiber intake in each meal. Choose bread/cereals/pasta/rice marked with “nyckelhålet” (note: in Sweden the food that is a healthy option and approved by Livsmedelsverket get the green key hole stamp). Other good sources of fibre are fruit and vegetables. Fresh fruit is better than for example jam or yoghurt with fruit flavours. For lunch and dinner, go ahead and vary between different vegetables: root vegetables, broccoli, cabbage and legumes. They contribute with great amounts of vitamins and minerals as well as fibers that will help to fill you up.
Don’t forget about your protein intake each meal. Maybe for breakfast add an egg or yoghurt or quark. Choose the non sweetened, natural ones. If you eat sandwiches, chose whole grain or crispbread and pick a topping that has the “keyhole stamp”. For lunch and/or dinner include sources of protein like chicken, fish or turkey. Red meat is ok but restrict it to 500 grams per week. If you are non meat eater, choose eggs, cottage cheese or other plant based sources of proteins like legumes, tofu, humus, soy protein or similar. Also, if being a meat eater you could of course choose the plant based alternative.
Avoid fast food, sugary drings or snacks."
Carl Magnus Brodén, doctor and CEO at GB Obesitas, Malmö, Sweden
Question: One of the most common complications for patients who have had bariatric surgery is a low hemoglobin and iron deficit. A few patients have mentioned that they at times have to go into the emergency to get an iron infusion. Is this a risk due to the hightened infection sensitivity. Should a person do it or should he/she wait?
Carl Magnus Brodén answers:
"If you are having very low iron levels and if a transfusion is normally the only thing that works then you should just do it. Iron defficiency in itself and anaemia on that is very bad for the immune system. Pottentially it could lower your resistance if you get infected. This is a typical example of where a boost of supplemements is needed due to the fact that your body needs it."
Jovanna Dahlgren, Chief Physician, Drottning Silvia's Barn-och ungdomssjukhus, Professor in Paediatric Endocrinology at Sahlgrenska Akademin, Gothenburg, Sweden
Question: Are children with a BMI over 40 at risk?
Jovanan Dahlgren answers:
"We do not know about the mechanisms behind the fact that children seem to be protected from the Corona virus' more serious impact, but it has been stated that children do not have a well developed receptor on the cellular surface (ACE2 receptor). Thus, the virus results in a mild cold and not the aggressive reaction shown in adults, further down the lungs. This is confirmed by the fact that we have only seen three confirmed cases, globally, of children fatalitly due to the corona virus."
Lua Dandara Rangel, (2020-04-17)
Dietist, Region Skånes Universitetssjukhus
Lua answers questions on eating habits while in quarantine.
Lua answers questions about different diets and immune system.
Lua answers questions on iron deficiency and binge eating and treatment
What is a coronavirus?
Coronaviruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes coronavirus disease COVID-19.
What is COVID-19?
COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019.
How dangerous is an infection with COVID-19, in comparison with a seasonal influenza?
It is difficult to compare a completely new illness, such as COVID-19, with the seasonal flu. Based on the current knowledge, the two diseases show some similarities in terms of symptoms. Most people develop mild symptoms, but some get seriously ill and some people die.
However, COVID-19 will affect many more people in a population where it spreads. The rapid spread of disease is due to the lack of immunity against the completely new virus. Therefore, more people will fall ill from it, and more people will need to be cared for in a hospital.
Different versions of the seasonal flu appears every year, and it has been present for a long time. Therefore, some immunity has had time to build up in the population. There is also a vaccine and other medications against seasonal flu.
What are the symptoms of COVID-19?
The reported symptoms are mainly fever and cough. Other commonly reported symptoms are breathing problems, runny or blocked nose, sore throat, headache, nausea, muscle and joint pain. Most of those infected get mild symptoms that can be managed at home. Some people become severely ill with breathing difficulties and pneumonia.
The time between getting infected and developing symptoms (the incubation period) seems to be between 2 and 14 days. Most people develop symptoms after 5 days. Individual cases may deviate from this time frame.
It is very important that you stay at home if you feel ill. If you can no longer manage the illness on your own, please call 1177 for medical advice (available in several languages).