We are in the midst of two clashing pandemics, both with dire consequences: COVID-19 and obesity. The negative health impacts of obesity are well known; however, as more data becomes available about COVID, the additional risk factor of obesity has come to the forefront.

The Link Between Obesity and COVID

Having obesity, which is defined as a body mass index (BMI) of 30 or above, increases the risk of a more severe illness in those who contract COVID-19. A recent study by Kaiser Permanente and published in the journal Annals of Internal Medicine shows patients with severe obesity face a greater risk of death from COVID-19 than other high-risk factors, such as diabetes or hypertension (high blood pressure).

Better Overall Data

Kaiser Permanente’s study gathered data on almost 7,000 patients treated from February 13, 2020 to May 2, 2020. A key difference in this study compared to previous studies is that Kaiser had access to comprehensive patient data—information about their whole life, not just data on patients in the hospital. This factor allowed the authors to completely separate the effect of obesity from many different individual factors, both medical and socioeconomic.

The study also accounted for 20 vastly different comorbidities (coexisting factors that impact COVID), including prior medication use, alcohol use, tobacco use, amount of healthcare accessed, household income above and below a certain amount (median income), household education level and the number of residents of each neighborhood in the study.

Researchers even went so far as to adjust for time, because healthcare professionals and officials shifted their pandemic response from week to week.

Obesity is an Independent Risk Factor with COVID

Some argument has been made that obesity is common in severe cases of COVID-19 because it is prominent in the general population. However, this study along with prior research shows this is not the case. Obesity itself is an independent risk factor for severe cases of COVID-19 disease.

Obesity was shown to be a much more severe risk than other highly correlated risk factors for severe COVID disease and death. Startlingly, severe obesity in younger male patients, not older patients, outweighed the risk of death from COVID presented by other obesity-related conditions, such as:

  • Diabetes
  • Hypertension (high blood pressure)
  • Hyperlipidemia (too many fats in the blood)
  • History of heart attack (myocardial infarction)

This information suggests a major link between the body’s physiological processes in dealing with disease and excess adiposity (fat) and severe COVID-19 illness.

Minority Status with Obesity and COVID

Unlike the overall link between Black or Hispanic race/ethnicity or lower socioeconomic status and risk of contraction and death from COVID, the Kaiser study did not find a statistically significant link to higher risk of death or severe disease due to obesity in minority communities. This is not to say there isn’t one, only that it warrants more data. The study authors noted that patients in this study simply may have had more access to healthcare than communities in other areas of the US.

Risk Factors and Complications of Obesity

  • Increased risk of death. The increase in the risk of death from COVID is one of the most disturbing findings from the study. Risk of death more than doubled for patients with a body mass index (BMI) of 40 to 44 kg/m2 compared to patients with a normal BMI (18 to 24). More frightening was the discovery that the risk doubled again in patients with a BMI of 45 or more.
  • Increased risk of contraction. Adipose (fatty) tissue provides physiologic responses that act like magnets for SARS-CoV-2, the virus that causes the COVID-19. One specific mechanism affected is expression of a particular protein (angiotensin-converting enzyme 2/ACE-2) in adipose tissue that also happens to be a “dock” for SARS-CoV-2 to enter a cell. Fat cells have much higher levels of this protein than the lungs, offering a place for the virus to hide and replicate itself, prolonging the virus.
  • Younger age and male gender. Obesity is especially dangerous for men and younger patients who contract COVID-19, and that obesity stood out from racial, ethnic, or socioeconomic disparities when isolated from those factors. “This risk was most striking among those aged 60 years or younger and men,” the authors wrote.
  • Breathing difficulty. COVID-19 makes it hard to breathe. Excess fat only makes breathing even harder for COVID sufferers.
    • When a substantial amount of fatty tissue lies below the diaphragm, more muscle force is required in order to push the diaphragm downward to breathe.
    • Lying face down (prone) is known to improve breathing ability in patients with COVID; however, abdominal obesity also makes it more difficult or impossible to lie prone.
  • Similarity to obesity and heart failure. Many of the same mechanisms that are discussed in reviews of obesity risk and heart disease are the same ones appearing in reviews of obesity and COVID-19, such as sleep apnea and increased inflammation, which damage the lungs, in particular the air sacs that do the major work of breathing.
  • Vaccine ineffectiveness. A future COVID-19 vaccine may not be as effective for patients with obesity. The study was unable to determine why, exactly, but had many hypotheses that still are being investigated. One possibility is that obesity may impair a part of the immune system that must be activated for a vaccine to work. However, wearing a mask remains the best way to avoid contracting or transmitting the virus.

Actions to Take if You Suffer from Obesity and Contract COVID-19

  • Take your medicines for any underlying health conditions exactly as prescribed.
  • Follow your healthcare provider’s recommendations for nutrition and physical activity, while maintaining social distancing precautions.
  • Call your healthcare provider if you have concerns or feel sick.
  • Talk with your doctor about severe obesity as an independent risk factor to be sure that appropriate interventions take place.

While fighting COVID-19 must be the immediate task, the link between obesity and COVID has only furthered the need to confront and combat obesity, which is equally devastating. Bariatric surgery has been shown to be the most effective long-term weight-loss treatment for people suffering from obesity. The health benefits of bariatric surgery are tremendous. ALA offers many weight loss surgery options. Request an appointment and one of our expert surgeons will discuss your case and recommend the right procedure for you. And, we’ll be with you every step of the way, from initial consultation to recovery and long-term monitoring.

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