This week, Charles Lane from the Washington Post highlighted an uncomfortable truth: high obesity rates in the US have made the pandemic more deadly here than in many countries across the globe. Public health officials have known this since the early days of the pandemic. A literature review published in Obesity Reviews in July 2020 examined 75 studies conducted between January 2020 and June 2020 that explored how BMI affected the experience of COVID-19 patients. They concluded:

The majority of studies showed that obesity significantly increased the odds of death among COVID-19 patients with obesity. The pooled data (from 35 studies) showed that patients with obesity were more likely to have unfavourable outcomes with a 48% increase in deaths.

Because of this, the Centers for Disease Control (CDC) has long warned about the association between obesity and severe illness from COVID-19. Their website clearly states: “Obesity Worsens Outcomes from COVID-19.”

Unique to Lane’s assessment,
however, is that he rightly places some of the blame on the federal government.
He writes:

Though a crucial support to low-income families, the federal Supplemental Nutrition Assistance Program, which paid $104.5 billion worth of benefits in 2021, covers nutritionally counterproductive purchases of candy, cake and soda. Food-industry lobbyists have resisted proposals to change that.

This connection deserves some
explanation, especially since the federal government during both Democrat and
Republican administrations has failed to address the Supplemental Nutrition
Assistance Program’s (SNAP) contribution to rising obesity rates.

Approximately 12 percent of Americans receive SNAP benefits in the average month, including roughly one in five children. SNAP sent $107 billion to low-income households in FY 2021 to help them buy food. It is also one of the federal government’s only vehicles for promoting nutrition among low-income households. Why is this important? Research shows that SNAP households have poorer diets, on average, than other households do. A 2020 study using cross-sectional survey data on health found: “Like previous literature, we observed that the diet quality of SNAP participants, as measured by HEI, is poorer than income-eligible non-participants and income-ineligible non-participants.”

Studies of SNAP fungibility (whether households treat SNAP benefits the same as cash) suggest one possible reason SNAP contributes to poorer diets. If SNAP benefits are fungible with cash, households will not necessarily purchase less healthy food after receiving the benefits. But research suggests recipients do not treat SNAP benefits as fungible with cash. This leaves open the possibility that SNAP actually increases the consumption of unhealthy foods in low-income households.

For many years, public health officials and other leaders have tried to improve the diet quality of poor households by restricting the use of SNAP for certain food products. Other federal programs do this, such as the Supplemental Nutrition Program for Women, Infants, and Children (WIC), which only allows recipients to purchase an approved list of food items, and the National School Lunch Program, which only allows schools to serve certain foods. In 2010, I worked on a proposal from Mayor Michael Bloomberg requesting that the federal government allow New York City to pilot test a sugary beverage restriction in SNAP. They denied our request, and other requests that came after ours. More than a decade later, obesity rates continue to rise.

The link between obesity and COVID-19 is devastating for all Americans, and poor women in particular. The US has by far the highest obesity rates among OECD countries. Data show the obesity gap by income level remains large for women in the US. Almost 50 percent of women in households with income below 130 percent of the federal poverty line (approximately the income criteria for SNAP) were obese in 2011–14, while the rate for higher income women was below 30 percent. The trends for men differ, but obesity rates among low-income men still hover around 30 percent. Regrettably, a similar pattern holds for children, with CDC data suggesting a higher prevalence of obesity among children from lower income households (with some exceptions by race/ethnicity).

The list of reasons for Americans to wage a national battle against obesity is getting even longer. The connection between obesity and COVID-19 deaths is just the latest addition. The federal government can improve health by promoting better diets through SNAP restrictions. It is time for policymakers to make that happen.

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