 Hey folks, welcome to the podcast. So we're doing a special series of podcasts which I'm recording over Google Hangouts. So we're doing audio and video because for some unknown reason people don't want to come see me face to face right now. But there's always opportunity and the cool thing is I'm able to now podcast with people from all over the world. So we're going to get an amazing eclectic mix of people from different industries, different perspectives to share this story and tell us you know their thoughts and feelings on what's going on right now and all of that cool stuff. Hope you enjoy it. Please subscribe in all the usual places and enjoy. Awesome and we're live folks. Thank you very much for joining me on the podcast. Today it's a pleasure to be joined by Professor Navid Satar who's a professor of metabolic medicine at the University of Glasgow and an expert in prevention and management of diabetes, obesity and heart disease. And he's recently contributed to Public Health's England report on Covid-19 and obesity. So he's not doing a huge amount by the sounds of things. Navid, welcome to the podcast. Yeah, thanks Louis. No pleasure to be here. You sound busy. Yeah, it's been a busy few months. I think when Covid first hit I thought my work would go down but if anything it's gone up and partly because Covid is affecting all of the disease areas that I'm sort of working on. So I've been having lots of opportunities to engage in relevant research around Covid and risks which is a good thing and you know to try and contribute at this time. Yeah and you've been specifically looking at obesity? Or actually no we've been looking at more than that. So it started off we you know because I know about risks you know I do lots of work on what's known as cardiovascular risk. So we're familiar with generating risk scores for diseases and different outcomes. So you know I'm familiar with the lots of risk factors. So there's been other areas. So for example one of the first questions that came out of Covid was is it a link to Vitamin D? Yes. And as part of that you know there's a fantastic data source that many researchers around the world are now using called UK Biobank which I think probably you're familiar with and some of the listeners may be you know half a million people arrive at 2006 to 2008 had lots of measurements done and their disease outcomes have been followed up in definitely thereafter. And so we quickly had a quick look at Vitamin D levels in UK Biobank and then subsequent Covid outcomes when they manifested about 10 years later. And although we show that Vitamin D levels were lower in people who developed Covid, once you adjust for all the factors that also lead to Vitamin D there was no real clear association. So our work probably suggests that Vitamin D is unlike the Davia storm risk factor for severe Covid but it was preliminary. Having said that the mice guidelines updated used our data which is kind of nice. Okay interesting and then I think there's still there's still more studies and research going on into Vitamin D I believe. So we've... Well no absolutely so you know there's different levels of evidence Lewis as you're familiar with you know one of them is for example just what's known as an observational study where you have measurements and you look to outcomes but because many things change together so lots of risk factors can interact with each other it's very hard to work at cause and effect from those type of studies and an ideal study and I think we're familiar with this is actually do a randomized trial. So I'm now aware that there are a couple of randomized trials there may be more that have been set up to look at Vitamin D to see whether it protects against Covid and the way that researchers would do that would be for example take a population give half of them a Vitamin D tablet the other half a placebo no one knows who gets what because it's all blinded and then hopefully you know follow these people up and if there's a second wave look at people who develop Covid and severe Covid and then try and link it back to who got the Vitamin D tablet versus the placebo and if there is a link that those who got Vitamin D tablets should have had lower risk of Covid and low infections and that's the way you do randomized trials and that's by far the best evidence base that we have for all these areas and it you know this really important in this particular scenario and and I think many listeners have been familiar with the use of randomized trials where they worked at Dexamethasone was a very good treatment for Covid and that would you know lead out of Oxford but included many hospital centres and centres around the UK and it was big and it was definitive and what's a big trial that would really need to change the what's what's a decent size trial that can be relied upon the size of the trial really depends on how many outcomes you expect okay so for example the power of a trial is not so much so you know if we did a trial in a million people say a million a million teenagers but you only expected five people to develop the outcome that's not powerful enough right so the trials power is the dependent on the number of people who develop an outcome so again as an example is if we did it's like the vaccination trials that are going on at the moment so yeah out of Oxford and other places at the moment you know they originally planned to do them in UK but as the number of infections have gone down in the UK they would have to do it forever to really get an answer unless we get a second wave so what they've done is diversified and they've gone out to Brazil and the US right and many people are getting infections to get the power so power of us any trial depends on the number of outcomes you expect right interesting and with the vaccines obviously here you're you're injecting healthy people so I mean presumably you've got to be very very certain that there's not going to be any any adverse effects from from this well yeah so you're completely correct Louis so the the benefits of a trial or two-fold one is to know that does the intervention actually do what it hopes to you know says on the tin does it actually give you benefit the second question is is there any evidence of harm yeah yeah so the placebo or the in the vaccine trials not necessarily a placebo I think it's a vaccine against meningitis that they're using which they know is safe right okay so they're trying to refashion like refashion a an old drug to use for for Covid rather than a novel no no no so so the so the comparator is the meningitis okay right because it's not safe and the reason they're doing that is because it it may mask that you know some people sometimes know that they get an early they've got the sort of the proper vaccine as if they develop some kind of symptoms but my guess is with the you know with the with another active comparator meningitis although no one knows who gets what they might the early symptoms are the same so they can't work out oh I definitely got the vaccine because I feel a bit fluid the next day right yeah yeah so normally a placebo is either a dummy tablet with nothing in it as if it's a tablet or you know but in the vaccine world you know they obviously have to have a another comparator which is relatively safe and doesn't cause harm and might mask the fact that some people are getting a true vaccine versus not so the way you actually blind a trial is very important in the sense that the person who gets it can't guess what they've been given the doctors can't guess what they've been given even though you know the coding and you only break that code at the end of the trial once you've collected enough people who've had the outcome to give you the power for the trial interesting it's great I mean I mean it's interesting because Covid I mean obviously not a great thing to happen to the world but it's it sounds like that the scientific community's really really got I don't know whether it's better faster I don't know what it is but there seems to be some amazing things going on you know I've heard also like vaccines usually take like 10 years 10 years or so to to produce and here we're looking at a couple of years maybe I mean well I mean the I think that we're looking at even faster can't lose if it comes off I mean so that you know our colleagues from Oxford who are you know I think it's a professor Gilbert is leading this is very cautious in the way she says this now they had a lot of experience from previous you know SERS and you know types of diseases and I think based on that experience they were able to quickly develop a vaccine which they thought might work using new technology but they've already gone past the first phase and they published in the Lancet that their vaccine in the kind of early phase trial was shown to produce antibodies against you know SARS-CoV-2 COVID-19 so they've got early indication that their their drug might be beneficial and with that kind of evidence and that it was safe they've now gone on to do the bigger trial I think I heard Dr Professor Gilbert on the on the TV we will you know last night there was a there was a nice show on channel four and she she was you know she was a bit cagey because I don't think she wants to promise that it's definitely going to work yeah there's also a bit cagey on the timing because and the really the timing of the outcome depends on how many people get the virus so yes that's true so that's a bit uncertain um so it could be my gut feeling is it could be as early as uh you know October November December but I don't think she said that she said let's just wait and see interesting I heard um I watched a great video there's the CEO of Novartis I'm sure you know there's a guy called Vicent Nara Simhan um sorry for pronouncing something wrong um great guy and he does some great content on on LinkedIn he shares videos and his thoughts and stuff so for those that don't know it's really worth watching and he was talking about vaccines and you know I think that's that's his uh his background and he said you know 10 years usually to make a vaccine right because you need to make sure that it's not going to have adverse effects you don't want the the population losing faith in vaccines um which is a critical thing and he felt earliest we'd have something end of 2021 which I thought was interesting but then you hear different things from different people then you know again and you hear different things coming out of different companies and different universities and you're not sure whether it's PR or you know it's quite interesting stuff well no I think and it's very interesting stuff and I think one is because there's no 100 guarantee that it's going to work number two is even if it does work um maybe there'll be some degree of harm and that doesn't mean to say it won't necessarily be useful it may be that um you know they've got to then work out who do we give it to maybe we give it to the people at the very highest risk where the benefits outweigh the potential harms yeah and number three I think in normal circumstances um they would want at least few years of safety to make sure there's no latent harm as it works yeah but that's that's usually diseases which are much less prevalent and much you know often um you know the defined reasons to to give this here we're talking about a pandemic which is affecting the whole world and it's affecting the world in a huge number of ways including the economies so that they may be able to make you know I think I think the goalposts have changed so it may be that if a vaccine comes up as 90 beneficial not 100 yeah but it's 10 harmful they might still be able to give it to certain people um at the highest risk if that makes sense so I think all these things have to work out as things go ideally it's going to be 100 successful yeah and zero you know and 100 safe but I don't and I have no idea if that's going to be the case and I don't think I don't think any of the vaccine makers want to commit themselves to this either they're just not yeah what's the what's the the herd immunity herd immunity is an interesting one and I mean you know they talked about it a lot at the beginning um but what what actually is it and do you think I think we'll actually get there or is this just a kind of phrase that whoever whoever it was came up with it and no no no I think it's a I think it's a real fruit you know I think it's you know I'm obviously not an immunologist or a biologist but from my understanding and I think if you think about it from a simple uh numbers game it's really if around about I think it's something like 60 or 70 percent of the population have now developed had had COVID-19 and then developed some degree of immunity should it last in all of them at the same time yeah um that that means that those people are no longer able to get severe disease or perhaps even get you know and that means there's only a small proportion that you can mix with who could get it right okay the chances of people getting it are far less yeah who have not exposed exposed to the virus and the chances of spreading it are far less because most people you would encounter have had it an immune okay so so after this so if there's a second peak or if ever the first peak ended uh who knows if the first peak even ended anyway um but we'll we'll be at a certain level where so many people have had it was it 60 70 percent of the population that then it will start to naturally kind of manage itself well exactly that the number of people who potentially could get and get severe disease would be substantially less therefore our hospitals will not be overwhelmed and so on and so on now the caveats of course are they don't quite know about how much immunity this virus is you know once you've had the virus that you're actually getting does it depend on how severe you get the virus does it depend on having you know sustainable antibodies which is the kind of one usual measure and what they have published so far is that people who've had the virus usually have antibodies detectable but they those antibodies are falling over time yeah yeah but but there may be a second level of protection which is what's known as the memory in certain cells of the body called T cells T cells yeah and if that memory if that's sufficient to give you some degree of immunity so you don't get severe disease anymore then that might be enough but we just don't know so i think there's loss you know and that's the problem with this virus is there's far too many unknowns oh it's crazy i've had a friend of mine um got tested last week um there's a swab test she was going on holiday had the virus devastated no no symptoms there's been the most careful person i know probably hasn't been out then got another test a few days later came out negative and then you've had you know people that i've heard that have had the antibodies and then a month or two later to your point no antibodies detectable so it's a very it's a it's a strange one um but i think and this is one that hopefully for me at silver lining to this is is i think it feels like now we're able to talk about physical health because you know before certainly in the workplace you know people talk about mental health a lot but you can't really talk about people's physical health you know you couldn't go up to someone and say hey you know you need to start thinking about you know losing weight or your diet and stuff like that it just you just couldn't do it um but i know the work you're doing and i think people are starting to talk about it more and your so the study that you participated in so to correct from one so you were looking at specifically um people who are overweight or have obesity uh and comparing them to people with a healthy weight and whether they had an increased risk of of contracting covid or getting covid seriously with complications it we did both actually so we're getting used to seeing data source called uk biobank um and and just for those that don't know can what is the uk biobank exactly okay so uk biobank is a study that led by uh you know one of our senior colleagues in the uk professor rory collins uh who's um who's you know he's a fantastic man and he's done lots of the statin trials you know and various other things um so um he um in oxford they recruited around about uh well just over half a million people around the uk hope they try to do it in a representative way so that they captured um and it was between 40 and 70 so people and they didn't go for younger people because most people are going to develop adverse outcomes when they get older so again it's back the same way that if you did you know if we if we recruited half a million people the age of 10 to 20 we would have to wait for a long time before we develop disease outcomes and that you know it's just simply not going to happen so 40 to 70 um that's when you know often prevention and treatments and all these things happen around the uk um included uh lots of you know they tried to make it represented in terms of the ethnic mix so sufficient number of south asians african abeans chinese that were represented in uk now they didn't quite match what was represented in the uk so it was always a bias because for every sort of around about 20 people who are offered to be in maybe only five percent took up so there's a slight you know there's a slightly healthy cohort bias and then these people were invited in for a one day visit uh into a laboratory where they had lots of tests done questions asked blood samples taken uh they did some physical measurements including their body mass their weight their height um they did some things like grip strength where they measured how strong their their grips were um and you know some of most of the fitness tests on bicycles so they collected all that all of that data did blood samples cleaning genetics you know enough to do genetics and everybody and then they all gave permission that they could be followed up every year right through their routine routine nhs records and through you know anytime something happened to them that would be reported back to uk by bang so for example say if you were in it lewis um i think you're clean you're too young at the moment but um say for example you are just okay you know if you were in it um anonymously we wouldn't know your name but everything's anonymized which is really important um you would have given permission to use your data including your vitamin v levels at the time that you got blood your blood fitness you know your fitness levels and relating to your health outcomes follow it forever on for the rest of your life now people have the ability to withdraw permission small numbers have but the vast vast majority kept that going and the cost is half a million people and because lots of people are getting outcomes you can see the power has now been substantial instead of a normal study like for example that we could run in Glasgow might be two three thousand people yeah this is this is more than a hundred times bigger that means within three or four years you you have maybe not just one or two hundred people developing heart attack you have perhaps a thousand two thousand people developing heart attack over ten years twenty thousand developing heart attack that means that the power to look at risk factors in relation to outcomes is that much greater and also diseases where there hasn't been enough power because the studies have never been big enough you know where the disease you know the outcomes are rarer are able to be looked at if that makes sense yeah so the power is in the number of events and because you've got half a million people you get lots of outcomes within short period so that's what's happened brilliant so you've used that data for your your recent study yes we have and it's not just our group but that data is available to any researcher around the world would you believe for a small fee yeah so it's it's completely open so if you've got a bright idea you can look at that so that's another beautiful thing about UK Biobank and the funny thing about it was was when when the Biobank first released lots of UK researchers were familiar with it and started using it I think people around the world were scratching their head thinking that's fantastic resource that UK have got wouldn't be great if we had that and they didn't realize that they could apply for it as well that penny has dropped and that there's now several hundred maybe thousand set you know groups around the world who've now got free access to that data and they're unable to apply their brain power to look at important questions amazing yeah so that's it's a fantastic resource and and we and many several of the groups have looked at that data in relation to COVID yeah and that's going on both using genetics and the risk factors in relation to can we discover what factors are related to getting COVID or dying from COVID and help the overall research agenda around the world to try and uncover who has the greatest risk and also uncover are the clues about the genes of certain people who get most severe COVID or not so those are the kind of things that are ongoing at the moment amazing and what have you found then because there's been I'd say anecdotal evidence my wife has been working in intensive care with COVID patients and so you know from what I hear the majority of people in intensive care are overweight, obesity, diabetes what are the what is the data saying is that matching with yeah I know a hundred percent so I've spoken to several of my colleagues who work in ITU and they said that pretty much and I think in one weekend pretty much nearly every patient was overweight or obese and so I've spoken to three or four colleagues in different hospitals around Glasgow and the vast majority had an effect you know you know we're overweight or obese now that's and so what did the data show our data suggested that progressively increasing BMI was linked to high risk of having severe COVID and dying from COVID now the public health England report that you mentioned right at the beginning Lewis has collated lots of data and by and large data that came from New York or from Italy or from France from big cohorts from small cohorts were broadly consistent those people had higher body mass indexes in the level of obesity or severe obesity at higher risk from getting into ITU going on to ventilation or dying from COVID so the evidence is broad is consistent and then when you're adjusted for all the various factors that travels with higher weight there seems to be an independent association between higher BMI and higher risks and why is that is it the immune system or do we know what the that's a very good question so the evidence I think is robust it's very strongly suggested that obesity is causing worse outcomes over and above other risk factors because one of the things might be that people who are more overweight might maybe it's their composition of their diet or maybe they're not physically active enough that those are the factors and obesity is a risk factor you know is a marking adverse lifestyle but it pays as if it is there's also an effect of having too much weight per se on COVID risk so why is it well we all we know already that some of the ways that the virus is affecting or increasing the risk is for example in certain people you get what's known as a hyperimmune response is that the body goes into overdrive it almost makes too many proteins that try to target the virus that and those proteins then leads to lots of body changes that makes the blood thicker right normally that's it normally that's it you know if I get hit by a bus tomorrow and I'm bleeding everywhere making my blood thick is normally trying to protect me by stopping blood bleeding but this is exaggerated blood thickness so if you if you end up with this hyperimmune response and you've already got risk factors that lead to a thicker blood to begin with then you may get into trouble and guess what obesity increases blood thickness to begin with equally clearly COVID is affecting your breathing so if you go into get an infection and you've already got an impairment in your ability for your lungs to to take in oxygen then your your capacity to buffer against the COVID harms and the COVID effects on breathing are diminished and guess what with age and with obesity particularly people are more overweight their breathing ability or their ability to draw an oxygen into lungs is more rapidly diminished with obesity okay yeah the same way that if you know when you become really unwell how you deliver nutrients to the body to different organs to fight infection really matters and if you have diabetes or even if you've got you know obesity your ability to deliver sugars and fats to the right places is diminished you're less efficient at doing that and that's a problem and in the same way obesity might also affect the ability of the heart to pump blood around the body the kidneys to to extract you know to to to help extract toxins out the body all these things are affected by obesity and we know that from a whole host of research in the way that obesity affects kidney function lung function heart function blood thickness immune function so in a sense being more overweight or obese just rap potentially diminishes your buffering capacity against all the harms that COVID does so in a sense you're closer towards having something really bad happening when you're closer to that threshold to begin with as it were fine and then obesity itself so genetic or or not that's a brilliant question Lewis and I think one of the things we really must say is that we mustn't shame people about this I think I think this this association of obesity to COVID-19 has set a new light on on the adverse effects of obesity we've always known that these effects many diseases like diabetes you know over the last 10 years cancer risk heart disease we've started to understand about heart failure we now know that actually affects the risk of certain conditions like skin conditions like psoriasis uh breathing conditions you know it's so on and so on but those are many of those things are long-term conditions COVID of course has brought this to many people's minds in a way that wait a second this is really important this has given me a job I want I don't want to be a beast anymore I want to be able to you know improve my health but for many people it's really hard so the thing that makes it the hardest is the environment potentials obesity i.e. it's too much calories in society they're very cheap they're easy to get there's too easy to not engage in physical activity in the way that we did 30 40 50 years ago there's more you know cars and so on and so on and and actually we've traveled in the UK I think we've traveled along that you know worsting environment a bisogenic environment than many countries which is why we've got more to be seeing this country that's not to say that there isn't individual changes that people can make but certainly one of the big changes what we in the sense we've got to have and we said this and the public health they're going to say this really nicely that there is a need unless there is a deep meaningful and sustained intervention to reduce the drivers on excess calorie intakes and the low levels of physical activity impact on health is likely to wash them i.e. we have to improve the food environment we have to improve the physical environment so that many people without much conscious effort are eating less calories and better content and without much conscious effort are being more physically active that's what we have to do hundred percent hundred percent I mean I yeah I mean I completely agree the problem the problem I think is right now and I speak to a bunch of different people from different backgrounds and stuff I think the education isn't there like not all calories are made the same for example you know like eating eating fresh food versus canned stuff going to mcdonald's going to kfc whatever like you know I think and certainly you know you hear a lot in like fast food they say is cheaper right like you can get you can feed your family and mcdonald's especially with the government's 50 percent off monday tuesday wednesday for like three quid right you can get a big mac for atp times that by four some chips and you know but but you can you know you can eat healthy on the budget but it's just you know it doesn't feel like it's taught at school um it doesn't filter through and you know there's an awful lot of people who are you know finding finding life pretty tough um you know more and more people are losing their jobs right now and so I mean Boris has just has just started this obesity campaign I'm not sure he's quite nailed it yet but I just think it needs to be like some real education and I mean remember Jamie Oliver did the the healthy school meals thing uh like they're probably years ago now but there's just it doesn't feel like there's been there's much stuff recently on that it's not been talked about as much and I think it just you have to talk about it now whether you want to talk about it or not you just got to you got to improve your health and that goes from eating and exercise and and sleep absolutely no no you're right about sleep as well I mean if you if you ask let me I think there's a number of layered things that you've said they lose which are really important um you know if you ask many people who are overweight or obese particularly in the beast category would they want to be lighter and leaner the answer is yes they would love to be um would if you asked many of them does it affect the quality of life and the answer is yes it does in a bad way so improving weight would be good they would rather they never got to that stage they would rather they stayed lean um but and many of them have tried to lose weight but they can't they just don't know what to do and as you say there's so many temptations of cheap calories out there that they find it difficult to resist and I you know and many of people who are experts in area absolutely realize that one of the things that we need to change is the is the food environment so that when somebody goes shopping they are far less unhealthy options which are cheap and they're far better healthier options which are cheap and it's changing that dynamic now the food industry can make healthier choices which are cheaper but they will have to take a hit on their profits they still have to be remained profitable for them to be you know interested in making them but the reality is the food industry for years have been making big profits increasingly so because sugar and fat have been cheap they put that into lots of foods sugar and fat you know taste nice and salt taste nice and people have been buying it lots of cheap stuff consuming it and the food industry made more and more profits but they now need to take a hit so they are they better quality foods and they can do it they've got they've got the intelligence to do it and but they need to just take a slight hit in the profits but the reality is if they work with us the government and community the food industry can be part of the solution but you know the problem is you're completely right but I just the education it's like you know like you say to people you know people think eating fat is bad for example right or or you eat fats I know like a nice avocado with some good fats in there you think you're going to get fat right it's it's the processed carbs and the sugars you know the combination of the two you're going to store store fat and look at that classic American diet you know people have been eating that for years and only recently that people started to realize actually probably not the way to go it's it's also it's also a complete um it's a minefield like eating well I mean you really have to like do a lot of research to work out what you should eat um you know talking about companies it's actually like I think it's you know making your own food is the best like fresh produce but it's hard to do it takes time yeah yes or no I mean let me give you some simple examples for the listeners actually so the best step in the state based on terms of what you know foods are linked to obesity it's if I was to put it in an out shell it's it's probably high dense calories yeah and so the low hanging fruits of what improved people can improve is certainly cut out refined sugar but but in terms of calories you know is it the type of calories in part it is but it's actually total calorie intake that matters you lots of people are getting that from too much fat and most people who get it you know becoming overweight are also eating too much refined sugar and carbohydrate they're often linked so for example if I now go downstairs I'm hungry and I go and have myself a biscuit lots of biscuits have lots of fat you know saturated fat but they also have lots of sugar so it's a combination of things crisps loss of excess fat pizzas excess carb and fat and cheese do you mean I'm not seeing these things are bad individually we all need sugar we all need fat we all need protein now you made it correct the the the the the choice isn't the following I the way I could probably best explain it is the kind of the changes in diet that I had to affect because I've got a family history of diabetes so when I was 20 I was a bit heavier but maybe one or two stored I soon discovered a family history of diabetes at that time I was drinking sugary drinks I was having I'll tell you what else I was having frosties every day yeah I was having chips at the the hospital canteen every day and eating you know plenty of crisps gradually over time I've changed that and I've retrained my palate I've cut out my sugar in my tea I no longer have sugary drinks I'm very very rarely I have diet drinks of water I've got used to eating a fiber rich cereal I love shredded wheat would you believe now I add a bit of fruit on it my palate has adapted slowly to enjoy that and I really love it now yeah I very really have crisps my average intake at breakfast is shredded wheat and some and brown bread with you know toast but lunchtime I'll have soups or salad or a sandwich and I try to avoid the dense calories you know tuna egg mayonnaise fine with a bit of salad we have a salad every mule evening and I've got used to eating salads cucumbers tomatoes peppers again I had to retrain my palate to enjoy those I've enjoyed I've got to now start eating fruit every day instead of having but having said all of that I still have occasional pizza I still have occasional curry I still have occasional crisps but they become less frequent and my more often is that I'm having foods that are less dense more fiber rich yeah less calorie dense and I enjoy them as much as I enjoy the previous food but but but they're because you're less calorie dense they're filling me up I lost initially a couple of stone and I've stayed the same weight for 25 years and I've increased my physical activity that I enjoy we've got dog as well as you know she really helps yeah so I ideally would like people to get that early on before they become overweight or obese because it's easier it's easier to make lifestyle changes when you're not overweight or when you're not obese than it is to become obese and be trained reduce that it's far easier yeah so for many people imagine so some of those foods I told you about I'll say for example crisps were more expensive some of the calorie dense options were more expensive and some you know ideally we want fruit and veg to be less expensive and we want a range of healthy options which food industry can make the drinks can make and as an example would be the sugar tax has led to healthier drinks because the sugar industry has got rid of a lot of those things because they didn't want to make you know we could do the same with foods and that is the direction of travel that we need it and the food industry can be part of the solution they might need to make slightly less profits for a period of time until they make better quality foods but we're still going to eat yeah and I think that's the direction of travel we need to have definitely I try to I try and think of it as like you know if it grows in the grounds or if it was if it was living it's probably healthy if it's got a nutrition label on the back of the pack you can avoid it yeah but one of the questions you might ask me this and I think you will probably you know you mentioned the beginning how do we do that is is is what Boris has tried to do enough the answer is it's not but it's stepping the right direction I would love that we had a big label on every food that told you total calorie content so that people didn't have to go and work it if you go to most you know calorie contents it says per 100 grams is this number of calories you're trying to work it out and you're trying to work it out and it's they deliberately make it hard so you cannot work out how many calories you're putting in your mouth now say they said you know for this for this chocolate bar there's 250 calories or for this drink there's 300 calories and then and then you suddenly work out wait a second if I have that bar and that you know drink I'm having 500 calories which is roughly a quarter of my intake and you know and if you're told roughly than average you know meal at night times of 800 calories you're thinking my god that's close to a full meal maybe I'll just have a cup of Tina banana which is 90 calories as an example yeah yeah well be great to see a lot of people are using these apps now you know on your phone so you can you can keep track of your calories it'd be good to see little QR codes on on the back of some of some video you can slap you know you can scan the codes and tot it up and I went through a little bit of using the apps it's it's it takes a bit of discipline you know to keep this is the thing like I went through a few phases of you know tracking my macros what what nutrients I've been having how much fat protein etc etc I just couldn't keep it up for a sustained period of time it's difficult and listen that's really important sustainability is everything you're an intelligent man you tried it you're interested in your health and even you couldn't manage it so it's not going to work out in the community the thing about obesity is there is a strong social deprivation gradient the thing about covid there's a strong social deprivation gradient what's there likely to worsen it's likely to worsen the beastly levels in the people who are the hardest hit to begin with the poorer the less affluent the ones who have less ability to look at you know to use apps and understand so that's again why we need to actually change the food environment fundamentally so that without much conscious effort people couldn't eat healthier without having to even think about it is the way that it's going to improve the whole of society I completely agree I mean definitely I mean look at the plastic bag you know they they charge one p no one cared two p you know something suddenly I think they hit 10p no one takes the plastic bags anymore you know so you're right I mean it really you're right if it starts from the the providers so that the food manufacturers and stuff the government do their part schools do their part hopefully collectively we can all you know pull together on this no you're absolutely correct and the same thing is now starting to happen there's early evidence from from in Scotland from alcohol pricing that as alcohol pricing unit per unit pricing has you know has been put in some alcohol beverages have gone up in price and the intake has come down slightly right and there's early evidence for sugar taxing intake of sugar beverages have come down in various countries because of it so it does work so it's I don't quite remember all of them it's like it's like the five p's you know pricing packaging promotions yeah you know you know those kind of things that really matter and and that's where we've got to work and ideally again if we can get the foods and drinks industry on our side saying look we understand you've got to make a profit otherwise you're not going to exist but if you work a little bit hard to make cleverer foods and better quality and better ingredients put the calorie content down and you know the prove the pricing you can help cut the obesity you know problem in the UK give it lead to a healthy society and be part of the solution of this of this pandemic wherever long it goes on and improve the health of future generations and that's what we've got to work towards and it's got to be it's got to be you know and if they're not going to do it off their own back it's got it's got to be enforcement it's forced definitely it's got to be forced definitely thank you so much Naveed it's been great to speak to you um um yeah I mean I'm super excited let's work towards that and I think now you know more as more people discuss this hopefully it gets it gets okay to talk about it because some people you know they don't like talking about weight they don't like talking about obesity they're a bit yeah you know kg on it and stuff so hopefully it just gets a bit more acceptable the conversation starts more and I think it will help everyone no loose I think and I must say I'll finish on this point you've you've hit the nail on the head we've got to have that conversation we've got to have it in a friendly environment environment we've got to have in a way that actually says to people we're not here to to criticize or judge you we want to help you and that's got to come from society it's got to come from media it's got to come from the health profession and that conversation is really important people want help and we've got to help them and that's really important so I completely agree with this brilliant thank you so much thank you for joining me absolute pleasure take care