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OBESITY - The Latest Risk Factor Linked to COVID-19 Severity

One of the largest U.S. studies looking at hospitalisation risk from COVID-19 found obesity is associated with a stronger risk than smoking status. The study analysed data from more than 4,000 COVID-19 patients who sought care at NYO Langone Health between March 1 and April 2 and found obesity (Body Mass Index over 30) increased the severity of the infection even more than the factors now well-known thanks to mainstream media, of hypertension and diabetes.

In BariNutrics® last blog article, “COVID-19 in the context of weight loss surgery” we hypothesised that obesity could potentially increase the severity of the response to the infection, though no evident pattern had yet emerged (or more accurately, been reported on). Now the tides are turning and the hypothesis has started to grow some legs.

In addition to what has been reported in this group of New York patients, China and France have published similar findings in other pre-printed articles.

What is a ‘preprint’ and what are they saying?

The term preprints refers to studies that are intended for publication in peer-reviewed medical journals that have yet to undergo the peer-review process (a long process where a panel of scientific or medical experts assess the scientific rigour of the study). Due to the rapidly evolving nature of COVID-19 transmission and the subsequent flurry of information available as cases increase, the peer-review process can’t keep up – hence, a lot of the critical information circulating is coming from these preprints. What does that mean for you? The information presented in these preprints may contain some incomplete data, that hasn’t been thoroughly scrutinised by experts to ensure it is scientifically valid, that said, it is still indicative intel, that is worth much more than a grain of salt.

Here's what some other preprints are saying:

Shenzen, China: a preliminary report published this month found the risk of severe pneumonia as a complication of COVID-19 infection, was doubled in individuals with a high BMI compared to those with a low/healthy BMI.

Wuhan, China: A retrospective analysis of 112 patients who were admitted to the Union Hospital in Wuhan between mid-January to mid-February with both cardiovascular disease and COVID-19 infection, concluded that higher BMI’s were seen in critical patients and non-survivors. In fact, of the 17 patients who died, 15 were considered either overweight or obese.

Lile, France: Obesity was unexpectedly frequent in a group of patients admitted into intensive care for SARS CoV-2 (i.e. COVID-19 infection). Disease severity was associated with increased body mass index categories, and was seen to be much greater in patients categorised as having an ‘obese’ BMI. What’s more, the need for invasive mechanical ventilation was associated with severe obesity and was independent of age, gender, diabetes, and hypertension.

This suggests that just carrying extra body fat alone, regardless of whether or not your older or your blood pressure is elevated, is enough to put you at greater risk of experiencing more severe symptoms if exposed to COVID-19.

 Why the risk?

As discussed in our previous blog, one phenomenon that has been seen to date, is that COVID-19 symptoms may be more severe in those who have pre-existing inflammation. While obesity may not be as obvious a cause of inflammation as say, an inflammatory arthritic condition, or a chronic injury which causes an individual to be in visible pain (think of it like an inferno), unfortunately carrying excess body fat can cause an underlying chronic, elevation of inflammatory markers within the body (like a smouldering fire). Perhaps this is one mechanism to explain the impact of obesity on infectious response.

Additionally, some of these hospitals have seen that the sheer physical weight of the excess body mass, places extra physical pressure on the lungs (especially when lying down), which can ultimately effect breathing and the need for ventilation. 

What can you do?

 The New York Times recently published a similar summary of findings on the emerging links between obesity and COVID-19 severity, and quoted president of the American Society for Metabolic and Bariatric Surgery (ASMBS), the largest non-profit medical organisation dedicated to metabolic and bariatric surgery and obesity-related diseases and conditions, Dr Matthew Hunter. He said “we in the U.S. have not always identified obesity as a disease, and some people think it’s a lifestyle choice. But it’s not. It makes people sick, and we’re realising that now.”

Certainly, lifestyle factors are involved in the development of obesity. Poor dietary habits, lack of physical activity, stressful environments, intake of toxicants and more, have been shown to play a role. However for many, despite repeated weight loss attempts, the weight struggles to move or inevitably bounces back as if to a body weight set-point (look out for future issues on the topic of body weight set-point). In these cases, weight loss surgery has been a welcomed, and effective solution for many. This new evidence coming to light, confirms what plenty of research has shown before, losing the kilos regardless of the means – improves overall health and risk of other complications and health issues.