Obesity and covid-19, storms that come together in a pandemic 1:00
(CNN) -
Around Christmas time, when the average American can easily put on a few pounds, experts say there's another reason to pay attention to their weight: Covid-19.
People who are overweight or obese are at much higher risk for much more serious diseases and even dying from COVID-19, and a new study suggests that losing weight can lower that risk.
The obesity epidemic has been a threat to the health of Americans for years.
It is the second leading cause of preventable death, after smoking.
With covid, it becomes even more dangerous.
One study revealed that 30% of COVID-19 hospitalizations occurred in people with obesity.
The obesity clinic where Dr. Fatima Cody Stanford works in Boston has a waiting list of more than 1,000 people, which has increased greatly with the pandemic.
Even with more than a dozen specialists on staff, it is not enough to keep up with the demand.
"We are overwhelmed by the volume of patients who have really made the connection between obesity and covid and the need for them to receive proper care," said Cody Stanford, who is also an adjunct professor at Harvard Medical School.
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Obesity and the increased risk of covid-19
People with obesity have a 46% higher risk of contracting COVID-19, according to a study conducted in August.
In it, it was discovered that they are also at higher risk of becoming seriously ill, with a 113% higher probability of being hospitalized, a 74% higher risk of having to be treated in the intensive care unit and, perhaps most worryingly, a 48% higher risk of death.
"Risk goes up and up and up with every increase" in body mass index (BMI), said study co-author Barry Popkin, distinguished professor in the Department of Nutrition at the Gillings School of Global Public Health at the University of North Carolina. .
Dozens of studies have shown similar results.
An investigation by the US Centers for Disease Control and Prevention (CDC) also found that people with lower risk of COVID-19 had a BMI close to the threshold between healthy weight and being overweight in most cases, and the risk increased with a higher BMI.
Another study looking at the records of more than 6.9 million people in the UK found a direct increased risk of severe COVID-19, leading to hospital admission and death, in people who were in the hospital. top of what is considered a healthy BMI;
the risk increased as the weight increased.
"The covid exposed obesity as a complex disease," according to a nutritionist
Does losing weight reduce the risk of covid-19?
The increased risk has led many to wonder if losing weight could prevent them from catching or getting sick with Covid-19.
According to Johns Hopkins Medicine cardiologist Dr. David Kass, from an ethical point of view it would be almost impossible to conduct randomized controlled trials to determine this.
But scientists have seen how weight loss can help in trials for other diseases with similar problems.
"There is no doubt that, in controlled trials with obese people and with heart failure, if they undergo weight reduction or an exercise program or a combination, and you see this marker of how they are doing, the answers are yes , there is evidence that losing weight is a good thing, "Kass said.
A large retrospective study published last week in JAMA Surgery suggests that substantial weight loss makes a difference.
The study, which looks at the records of 20,212 people over more than six years, was funded by a grant from Medtronic, which makes devices for weight loss surgery.
Covid-19 positive test rates were similar in the surgical and control groups: 9.1% and 8.7%, respectively.
Weight loss among the group that underwent surgery was associated with a lower risk of hospitalization, need for supplemental oxygen, and severe symptoms of a Covid-19 infection.
This group of patients also had a 53% lower 10-year cumulative incidence of non-covid all-cause mortality compared to the control group.
"The results suggest that obesity may be a modifiable risk factor for the severity of COVID-19 infection," the study notes.
Dr. Steven Nissen, a cardiologist at the Cleveland Clinic and a co-author of the study, said it's important to understand that weight loss is the key to this study, not the surgery itself.
Surgery is simply an effective way to lose weight.
"Losing weight is completely reversible," Nissen said.
"So we can say that if you lose weight, the risk of severe covid and morbidity and mortality from covid decreases a lot."
Why is obesity a threat?
Obesity is a problem with COVID-19 for a number of biological reasons.
"Fat cells are living cells, and as soon as you start accumulating them they are essentially negatively impacting your immune system," Popkin said.
"From the first moment, they are inflamed."
Fat cells create chronic inflammation.
With obesity, the blood is also prone to clotting, the large mass of tissue under the diaphragm makes the heart work harder, and the fat in the abdomen and liver emits chemical cytokines that cause additional tissue damage and vascular problems. all of which can make covid-19 that much more serious.
People with obesity also do not breathe as easily as people with a healthier weight;
They can carry excess weight on the chest that can compress the lungs so that they cannot fill completely with air.
Therefore, obese people breathe less deeply, and the actual space where oxygenation occurs is less.
"It's like when you're lying down and breathing, and if I sit on top of your chest and try to breathe. It's much more difficult to catch your breath when your lungs are crushed," said Dr. Rekha Kumar, a specialist in Obesity Medicine and Associate Professor of Clinical Medicine and adjunct endocrinologist at Weill Cornell Medical College.
"If you start out with a compromised respiratory system and this is a respiratory disease, you are already at a disadvantage."
The importance of taking obesity seriously
Experts say that the problems of obesity in this pandemic have been greatly underestimated.
"There is no country in the world that has fewer than 20% obese adults," Popkin said.
Covid-19 death rates are 10 times higher in countries where the majority of adults are overweight, according to a March report.
The United States has one of the highest obesity rates in the world, with more than 42% of the adult population, according to the CDC.
And that's probably a conservative figure, because those statistics are from 2018. More than 73% of adults consider themselves overweight.
And although the numbers are not that high for children, more than 20% of those between the ages of 6 and 19 have obesity, and more than 13% of children between the ages of 2 and 5 have it.
"I think people don't see obesity for the disease that it is. They think of it as a lifestyle choice," says Cody Stanford.
"Many people think that these people just have to eat less and exercise more, but if that mantra worked, we would not have the prevalence of obesity that we have now."
Childhood obesity problem increases in pandemic 0:56
So what should people do?
Cody Stanford said that he tells his patients not to focus on losing a certain number of pounds.
Instead, they must think in terms of centimeters.
It even gives them a goal for waist circumference: less than 89cm for women and less than 102cm for men.
Obesity not only has to do with weight or BMI, but with the distribution of that weight.
In general, belly fat is one of the most dangerous types.
Fat in the stomach area grows inside the body and envelops vital organs.
The liver borrows this fat and converts it into cholesterol, which can creep into the arteries and begin to accumulate there.
When this happens, the arteries begin to harden, and this can lead to a heart attack or stroke.
This deep layer of belly fat is also what makes the body insulin resistant and keeps it in a constant state of chronic inflammation.
"When COVID inflammation is added on top, it can increase the risk of serious illness," Kumar said.
Better central weight distribution is the key, he added.
"If that was better, they would probably have fewer covid complications and fewer deaths," Cody Stanford said.
"Looking only at the weight itself, without looking at the big picture, would be the wrong way to think about it."
According to Popkin, based on studies of other diseases, even an overweight person who loses 2.5 kilos can see an improvement in their diabetes and hypertension.
"Any weight loss is positive at almost any weight level," he said.
"Only marginal weight gain can affect our health."
Popkin added that weight loss is not as protective as a vaccine or a booster.
"But it will certainly pay off," he said, especially coming out of the holiday season.
Covid-19 Obesity Overweight
