How long have doctors been warning us about the risks of obesity?
Long before the SARS-CoV-2 pandemic, they were cautioning against a dangerous epidemic tied to our visibly spreading waistlines.
“Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic,” researchers from the John Hopkins Bloomberg School of Public Health titled a 2008 study of our fatness.
If the trend that begun in the 1970s and continued through the 2000s continued, the study warned, “by 2030, 86.3 percent of adults will be overweight or obese; and 51.1 percent obese….Total health‐care costs attributable to obesity/overweight would double every decade to $860.7 (to) $956.9 billion by 2030, accounting for 16-18 percent of total U.S. health‐care costs. We continue to move away from the Healthy People 2010 objectives.”
The scientists unfortunately failed to predict how nature would exploit our behavior with a microscopic pathogen which is now blowing health care costs through the ceiling, killing tens of thousands in the Western world, and threatening to make a shambles of the U.S. economy.
In England, “data from the first 2,204 patients admitted to 286 National Health Service ICU’s with COVID- 19 reveal that 72.7 per of them were overweight or obese,” Dr. Aseem Malhotra observed in a mid-April story in “European Scientists” headlined “COVID-19 and the elephant in the room.”
“…The elephant in the room is that the baseline general health in many western populations was already in a horrendous state to begin with. In the UK and USA more than 60 percent of adults are overweight or obese. How is this relevant to COVID-19?
“OBESITY, THE REAL KILLER BEHIND COVID
“It is well known in the medical literature that excess body fat induces immune dysregulation and chronic inflammation which is directly linked to the cytokine storm that is responsible for Acute Respiratory Distress Syndrome seen in influenza and other respiratory viruses.”
The Indian-born Malhotra is something of a lightning rod in the medical community for promoting a fad diet and a war on sugar, and for denouncing what he considers a government “obsession” with cholesterol.
But on the subject of COVID-19 and obesity, he is in lockstep with the data and rest of the medical community even if they don’t put the issue in terms as blunt as those used by Mahotra.
Noting studies from France, where obese patients admitted to hospital with COVID-19 faced a seven-time greater risk of ending up on a ventilator, and New York, where obese individuals who contracted the disease were nearly two to more than three-and-a-half times more likely to end up in an intensive care unit (ICU), English doctors today warned that people worldwide need to be “encouraged to improve their lifestyle to lessen risk both in the current and subsequent waves of COVID-19.”
“In addition to increasing activity levels, there should be improved messaging on better diet, focusing on simpler advice to help people adopt sustainable changes,” they wrote in a journal of the American Heart Association. “This is particularly challenging with current stay-at-home rules limiting activity levels – the ‘lockdown cost of weight gain.’ Even more worrying, the resultant economic downturn may worsen obesity, especially in the most vulnerable, a risk that governments need to address when we come out of the current pandemic. Indeed, this pandemic has highlighted that more, not less,
must be done to tackle and prevent obesity in our societies for the prevention of chronic disease and greater adverse reactions to viral pandemics.”
A study of almost 17,000 COVID-19 patients in English hospitals led doctors in that country to conclude that even after adjusting for “problems such as lung, heart and kidney disease that are already known to cause poor outcomes, being male or obese (with a Body Mass Index (BMI) over 30) is a significant factor associated with death in UK hospitals, a feature not seen in China, where it is thought that fewer people are obese,” Hayley Dunning writes at the website of the Imperial College of London.
“Although the reasons for why obese people are suffering such severe COVID-19 and dying more than other groups are not clear, the researchers believe it could be because they have reduced lung function and possibly more inflammation in adipose tissue – the fatty tissue under the skin and around internal organs.
“According to the researchers, this might contribute to an enhanced ‘cytokine storm’ – a potentially life-threatening overreaction of the body’s immune reaction which causes harm.”
Cytokines are proteins that move through the body to allow immune cells to communicate.
Defenders turned enemies
“In systemic viral infections, cytokines can induce an inflammatory response which is beneficial until their production becomes uncontrolled.”
What has been happening in the case of COVID-19 patients is that when the cytokines storm out of control they create so much inflammation that the pressure of swelling causes organs to start failing, which is often fatal.
The connection between obesity, cytokine storms and death has been known for some time. During the influenza A pandemic of 2009, California doctors examing records of people hospitalized in that state found that in 92 cases of “patients who died, 56 (61 percent) had BMI greater than or equal to 30 and 28 (30 percent) had BMI greater than or equal to 40.”
People with what is considered a normal weight have a BMI of 18.5 to 24.9. A BMI of 25 to 29.9 is considered “overweight.” Over 30 is obese. Over 40 is morbidly obese.
Though obesity appears to have become a factor in COVID-19 deaths, age remains the real killer. Most of the dead are beyond middle age or older. Ninety percent of the dead in New York City were 45 or older with more than 72 percent age 65 or older, according to data compiled by Worldometers. In China, where Nthe SARS-CoV-2 outbreak began, most of the dead were even older.
In Italy, the average of those who died was 79.5 years, according to the Centre for Evidence-Based Medicine. In all countries reporting age-related mortality, case fatalities rates are generally at or under 1 percent below age 60 and then quickly climb to more than 20 percent for those over age 80.
Unlike with the Spanish flu of 1918 that killed mainly children and young adults, Our World in Data notes that “for COVID-19 cases the opposite seems to be true. The elderly are at the greatest risk of dying if infected with this virus.”
Older people are vulnerable to SARS-CoV-2 because of their declining strength with age and the so-called “co-morbidities” – high-blood pressure, heart disease, diabetes and more – that tend to accumulate as people get old.
But there are an increasing number of doctors thinking obesity might be the key co-morbidity problem for the much smaller number of younger people the disease is killing.
“I don’t think obese people are as prevalent in China compared to the U.S., so they didn’t have much data on this” when the pandemic first started developing in Wuhan, New York University Langone Health Dr. Jennifer Lighter told WebMD last week. “But for us, it was very obvious and noticeable, even in those few first days, that there were a lot of young people in the ICU, and what stood out among the group of younger patients was their body weight. You couldn’t help but notice that they were all heavier-set.”
Lighter and Anna Stachel, the assistant director of the Department of Infection Prevention and Control at Langone, promptly organized a study of 3,615 patients under the age of 60 who tested positive for COVID-19. The results showed:
- Patients with a BMI of 30-34 were twice as likely to get admitted to the hospital or to be admitted to acute care.
- Patients with a BMI of 35 or higher were twice as likely to be admitted to the hospital and three times as likely to end up in the intensive care unit.
“Patients who are obese are coming into the emergency department and presenting for medical care more because they are sicker,” Lighter told WebMD. “Once here, those with a higher BMI are also more likely to be admitted and more likely to end up in the ICU.”
An estimated 42 percent of the U.S. population today has a BMI over 30. The Lighter and Stachel study indicated the while BMI does not significantly increase the risks of COVID-19 for people over 60, but it makes the disease much more dangerous for those under 60.
So we’ve been warned yet again. Will anyone listen this time?