A pandemic meets a pandemic

Most of us living in the industrialized world now recognize that obesity and its related diseases such as diabetes and heart disease have been an ongoing global health burden for several decades and show no signs of slowing down. In fact, world obesity rates have risen to a record high with 13% of global citizens having a BMI of 30 or greater and are predicted to continue to increase. Furthermore, in the US, Adult obesity rates have more than doubled since the 1980s — obesity affects over 42% of adults and almost 18% of youth. It is safe to say that we have been living in an obesity pandemic, many of us for nearly our entire lives.

In this context, we have now unfortunately been subjected to a second pandemic of COVID-19. Being forced to live through both of these maladies and their adverse effects on our physical and mental health can be hard enough. But is there a more sinister association between obesity and COVID-19?

We can look to our last viral pandemic for some clues. During the 2009 H1N1 flu pandemic, obesity was linked to higher rates of hospitalization, mechanical ventilation, and death. In fact, over half of adults with severe or fatal H1N1 in California were found to have obesity or severe obesity.

As data from hospitalized COVID-19 patients comes in, we are also seeing that obesity can increase the risk of hospitalization and intensive care unit admission, particularly in younger patients i.e. those under the age of 60. What could be cause for the correlation?

There are several possible mechanisms:  It is well established that obesity is associated with chronic inflammation throughout the body, which can impair the function of the immune system. In addition, obesity can impair breathing, both through mechanical mechanisms (more weight = more restriction during inhalation) and central (brain) pathways, resulting decreases in respiratory function. These may be some of the mechanisms by which respiratory infection leads to more severe illness in patients with obesity.

Although obesity in and of itself is considered a factor that makes a patient with COVID-19 more vulnerable to serious illness, there are also a number of obesity-related diseases that can also put patients at risk. These conditions often co-occur with obesity and can increase a patient’s vulnerability, typically by weakening their immune systems. These conditions include, but are not limited to:  diabetes, hypertension (high blood pressure), cardiovascular disease, asthma, certain cancers, liver disease, and lung disease.

As we witness the spread of COVID-19 and watch the death toll approach 300,000 in the U.S., it should be remembered that obesity results in approximately 300,000 deaths annually as well as significant disability for millions of Americans. What’s more, obesity rates may be rising more quickly than expected, as stay-at-home orders, and social distancing measures influence many to stay sedentary indoors and rely on ultra-processed food.

Yet while there are proven and (relatively) easily adoptable measures to mitigate the risk and spread of COVID-19 such as wearing a mask, social distancing and hand hygiene, navigating obesity can be more complicated. But there are steps we can take. Maintaining a diet based on whole foods and plants is a good first step to minimizing inflammation in the body. Continuing to move every day, even within the house with dance or calisthenics also helps.

In the end, even in these crazy times, we should not forget about the pandemic that has been amongst us all along. Any steps we can take to lose weight and keep it off will help us to lower inflammation, improve our immune systems, and lower our risks from disease. For those who are seeking more help with weight loss and improving metabolic health, engaging in a comprehensive weight loss program may be the way to go. In addition, treatments such as weight loss medications and endoscopic sleeve gastroplasty can help to accelerate results and boost weight loss outcomes with sustained effects.