CDC Reports Increased Risk With Higher BMI’s
What’s obesity got to do with COVID-19? Actually, a lot and that is why I want to examine this important issue more. See part 1 for background information on obesity. As this virus has continued to wreak havoc it is becoming increasingly clear that obesity puts people at risk for significant disease. In April 2020 there were hints that obesity might be a factor. By June it was apparent that there was a strong connection and the CDC updated their guidance, stating that a body mass index (BMI) of 30 or greater is a risk for severe disease. In October CDC again updated guidance stating that being overweight might increase risk as well.
Researchers Weigh in
Researchers are weighing in on this issue worldwide. A paper reviewing 75 studies with a total of 399,461 people from across the world (meta-analysis), collectively showed that people who were obese:
- were 46% more at risk to be COVID-19 positive
- had 113% greater risk for hospitalization
- 74 % higher intensive care unit admission
- were 48% more likely to DIE
The U.S. is especially concerned about this issue due to high rates of obesity. Recently we see our Nation’s President infected with the virus. He has weight challenges (his BMI is in the obese range) and has been rather lax about wearing a mask. This can be a lethal combination. He also appears averse to practicing social distancing and, who knows if he washes his hands for the specified time. As a leader of a Nation with more than 215,000 deaths he needs to set a better example.
The Skinny on Obesity
Obesity is not just about eating too much. It is a complex interplay of genetics, diet, physical activity levels, metabolism, stress, and social determinants of health. The graphic above provides a summation of the impact obesity has on the body, the causes of obesity, and preventive measures. I am going to expand on some of these concepts.
Obesity Equals Inflammation and Fat Cells are Reservoirs for Infection
What is it about obesity that puts a person at risk for COVID-19 infection and complications? Obesity is generally considered a chronic disease. Scientists believe that obesity leads to chronic low grade inflammation, impaired immunity with elevated levels of pro-inflammatory cytokines (small proteins, immune cells), and a hypercoagulable state – the blood is more prone to clot.
Here are a few details about obesity:
- Fat cells secrete several inflammatory substances which trigger cytokines and more immune cells (macrophages). This leads to tissue damage.
- Fat cells invade or infiltrate the organs where immune cells are produced and stored- spleen, bone marrow, liver, and thymus. Immunity is weakened in people with obesity partially due to this effect.
- Obese people have an impaired immune response to infections and increased viral loads when infected by viruses.
- Adipose (fat) tissue is an important viral reservoir.
- Fat can also physically compress parts of the lungs which can impede respiratory excursion (can’t maximize deep a breath).
- Studies have shown that people with obesity do not respond as well to antiviral medication and vaccinations.
- Obesity also puts people at risk for various chronic diseases, like diabetes, high blood pressure, metabolic disease, cardiovascular disease, and chronic kidney disease. These diseases also increase the risk of COVID-19.
COVID-19 and Obesity
COVID-19, as a novel virus, teaches us something new every day. Initially we thought only older people were getting it, but then we learned that this virus does not discriminate. It infects everyone, but there are some factors that increase a person’s risk.
The CDC and others report that as body weight increases so does the risk of COVID-19 infection.
COVID-19 is primarily a respiratory disease that enters the body and makes its way to the lungs where it starts creating damage. The spike (S) protein binds to the Angiotensin-converting enzyme (ACE 2) receptors. These receptors are abundant in fat cells. In fact, the ACE 2 expression in fatty tissue is higher than in the lungs. Fatty tissue is a COVID-19 reservoir.
As we discussed in the last post, obesity is stigmatized in our society. Because of the stigma, people who are obese with COVID-19 infection may avoid medical care. This can lead to advanced COVID-19 infection when they finally access the health care system.
Does COVID-19 Disproportionately Affect African Americans/Blacks?
“Hispanic and non-Hispanic Black adults have a higher prevalence of obesity and are more likely to suffer worse outcomes from COVID-19.”
Centers for Disease Control and Prevention(CDC)
As more racial and ethnic COVID-19 data became available, it highlighted disparities. The early thoughts were that these disparities were related to social determinant issues and higher rates of chronic diseases like hypertension, diabetes, lung disease.
Black Americans are more likely to die from COVID-19. The current view is that obesity plays a significant role in the increased COVID-19 death rates in Blacks. Recent studies in Louisiana and Chicago confirm the impact of obesity on COVID-19 in Black populations.
Social Determinants and Obesity
A multitude of factors contribute to excess weight in Blacks. This includes system factors and other social determinants of health. Systemic racism affects overall health and health outcomes for Blacks. The stress of racism has been tied to increased risk of obesity in Blacks, especially Black women. Thus, Black women have the highest rate of obesity in the U.S.
Many societal factors that have existed for decades contribute to high rates of obesity in Black Americans- food deserts (limited access to nutritious food), poverty, environmental hazards, discrimination, and more.
One lesson from the pandemic of COVID-19 is that not treating obesity is not an option.”
Franceso Rubino, obesity expert of metabolic and bariatric surgery, King’s College London
Fitness, Fiery Vigilance, and Foods are key
Obesity and COVID-19– seem all doom and gloom? Actually the situation is not hopeless. There are measures to reduce your risk. These three F’s are key to being safer from COVID-19, especially if you are overweight or obese.
Fitness
Studies have found that physical fitness is an important ingredient in maintaining health even if there is not significant weight loss. Walk, dance, cycle. Just try to do something active 30 minutes, about 5 days per week. Fat and fit is a healthy combination.
Fiery Vigilance
Be fired up and vigilant to get the upper hand on this disease. This means knowing the increased risk, taking extra precautions to avoid getting sick with this virus. People who are obese should continue to wear masks even if others aren’t and physically distancing as much as possible. Even if you are having work done on the house or deliveries, make these people accountable by requesting they wear a mask. I have heard of and personally seen outside workers trying to enter houses without mask.
Advocate strongly for yourself if you develop symptoms and need to access the health care system. I have heard stories of people being turned away and later having bad outcomes. Don’t accept NO we won’t see you, if you are feeling bad.
Foods that help
Do you know which foods are best for inflammation? Eat these foods to reduce inflammation and decrease your risk of COVID-19 infection.
Foods that fight inflammation( partial listing):
Olive oil
Green leafy vegetable-spinach, kale, collards
Other vegetables- red cabbage, broccoli, avocado
Fatty fish- salmon, tuna
Nuts: almonds, walnuts
Fruits: strawberries, blueberries, cranberries
Others: Turmeric, chia seeds
Check out the CDC website for more tips.
COVID-19, can we VOTE it AWAY?
The COVID-19 virus does not play! We know that it will be here for a while. We know that certain chronic diseases including obesity increase the risk of getting the disease and doing poorly. Now is the time to literally exercise but also exercise your right to vote. It is time to make sure that we have a leader that is going to take this disease seriously as if his life and our lives depend on it. We need to know that if we are sick we will have health insurance and support for paying the bill. I am not really all that political but this COVID-19 pandemic has rocked my world just as much as others and it is time for me to become woke and get busy to educate myself and others. Be sure to vote!
Dr.TeaNT 