HealthMay 14, 2020

Obesity and COVID-19: 10TT counseling for rural patients

The Covid-19 outbreak continues to challenge healthcare providers across the nation. Many urban centers have begun to shift the curve, but rural areas of America could soon see a dramatic increase in the number of positively diagnosed individuals.

That’s reason for providers to be concerned. Many studies link rural populations with more obese individuals—and healthcare workers on the front lines are learning that obesity is a major risk factor for serious complications and poorer outcomes from COVID-19.

Rural populations linked to obesity

According to the Centers for Disease Control and Prevention 2016 Behavioral Risk Factor Surveillance Survey, approximately 34.2 percent of adults in rural areas of the United States are obese. Rural areas, defined as having populations of 2,500 to 50,000 (depending on the definition used), make up approximately 97 percent of the country’s land mass.

Amid the COVID-19 crisis, scattered rural communities have so far fared better than urban centers. But as the virus spreads into less populated areas, many worry about the ability of the nation’s rural healthcare facilities to effectively manage the disease. As noted by The Washington Post, rural hospitals already suffered from financial strain long before the emergence of the new coronavirus. Additionally, a lack of intensive care unit (ICU) beds and provider shortages means COVID-19 patients in rural areas may not receive the care they desperately need.

Obesity raises risk of poor Covid-19 outcomes

Emerging research into Covid-19 suggests those people with a body mass index (BMI) equal to or greater than 40 are at higher risk for significant complications related to the virus. A study in the Journal of the American Medical Association shows that 41.7 percent of hospitalized Covid-19 patients in the New York City metro area were obese.

And while the research hasn’t found a direct causal relationship between obesity and COVID-19 complications, it’s thought that excess adipose tissue increases inflammation while also weakening the immune system. This could be why so many obese individuals ultimately require ventilator support compared to people at healthier weights.

The 10TT counseling study

Now is the perfect time for providers to help rural patients lose weight. A new study published in Family and Community Health reviews the Ten Top Tips (10TT) weight loss counseling method, which may help patients lose weight and possibly prevent Covid-19 complications. The Ten Top Tips represents a quick and easy intervention for clinicians to use with overweight and obese patients in rural areas.

The 10TT counseling method helps overweight and obese patients develop healthy habits to support weight loss. In summary, the 10 tips include:

  1. Develop a meal routine
  2. Eat reduced fat foods
  3. Walk for weight loss
  4. Pack a healthy snack
  5. Look at food labels
  6. Be mindful of portion sizes
  7. Get up on your feet
  8. Remember that drinks have calories
  9. Focus on food when eating
  10. Eat at least five portions of fruits and vegetables daily

In this study, 47 percent of selected participants were obese, compared to 29 percent who were overweight. At an initial office visit, each person received brief counseling from a healthcare provider—generally between two and four minutes. Also, take-home leaflets detailing 10TT were provided to all participants. Providers used the Weight Control Strategies Scale to capture each study participant’s self-reported weight loss behaviors after their initial counseling session. Participants were contacted at week four and eight of the study and were asked to report their weight that day.

At the study’s end, researchers found that a statistically significant increase in weight-loss behaviors occurred, although there was not a statistically significant decrease in weight among the study volunteers. However, these results could be reflective of inaccurate self-reporting, the timing of the study, and factors such as the consumption of salt or alcohol.

While this study didn’t directly correlate 10TT with weight loss, it can be used by providers as a method to help patients adopt weight loss habits and behaviors. The authors of the study also note that, since the study was only a few months in duration, studies of six months or more may actually show significant weight loss among participants.

The 10TT is one tool in the fight against obesity and, by extension, Covid-19 complications. If used regularly in practice in rural areas, this intervention may help many patients avoid poorer outcomes associated with viral infection.

Lippincott Solutions note: for the latest coverage on Covid-19 by the Lippincott Nursing team, please visit

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