A prime candidate for COVID-19/Wikimedia Commons

The way Chinese scientists are portraying obesity in these times of COVID-19, one could almost come to view it as a new chronic disease.

“Obesity,” they wrote in a peer-reviewed paper newly published in the International Journal of Obesity, “…is characterized by a chronic, low-inflammatory state, which may lead to the production of exhausted immune cells, and the organism becomes more vulnerable to infections and less responsive to vaccinations…..”

The researchers at the Huazhong University of Science and Technology in Wuhan – where the SARS-CoV-2 virus that causes potentially deadly COVID-19 was first identified early this year – were studying obesity in an attempt to identify why so many overweight people are falling victim to the disease now raging as a global pandemic.

The paper was posted on the Nature website over the weekend. 

Part of the reason the obese face a higher risk for death from COVID-19 is obvious. They are prone to all sorts of what have come to be considered normal medical conditions in a world where medicine can manage many diseases.

These so-called “co-morbidities” have been identified in 80 percent to more than 90 percent of the people dead from COVID-19.

The Centers for Disease Control (CDC) has reported that 94 percent of the people who died of COVID-19 in the U.S. were reported to be victims of at least one other disease as well.

Thankfully the vast majority of people survive the disease even if they are hospitalized.

“Most patients with COVID-19 are mildly ill and have a flu-like upper respiratory symptoms, such as fever, dry cough, fatigue, and muscle soreness and so on,” the Chinese researchers wrote. “However, some patients may progress to acute respiratory distress syndrome, metabolic acidosis, or coagulation dysfunction, even leading to death.

Obese patients are most likely to fall into the latter group in part because of the comorbidities associated with being overweight. Obsese patients among 95 people studied after admission to the Wuhan Union Hospital with COVID-19 displayed what is a normal disproportion of co-morbidities, the researchers reported.

“Demographics data showed obesity patients have more underlying diseases such as cardiovascular diseases (41.7 percent vs. 22.0 percent), endocrine system abnormalities (22.2 percent vs. 10.2 percent), respiratory diseases (5.6 percent vs. 1.7 percent), and neurological diseases (2.8 percent vs. 1.7 percent) compared to non-obesity group,” the team of doctors wrote.

More than co-morbidities

But even the obese free of these diseases were physically compromised, they added.

“Chronic inflammation in obesity is characterized by a condition of adipocyte hypoxia and dysfunction that results in an exuberant secretion of pro-inflammatory cytokines and the recruitment of immune cells including macrophages, T-cells and B-cells, and ultimately an auto-regenerating inflammation loop will be formed,” they wrote.

“An excessive immune response to SARS-CoV-2 is thought to be the major reason of disease severity and death for patients with COVID-19.”

Of the 95 patients in the Wuhan study, 36 were obese. Two of them – 5.5 percent – died. All 59 of the non-obese patients survived.

Obesity is still a rather small, but growing problem in China. It is an epidemic in parts of the Western world.

More than a third of U.S. citizens are now reported to be obese. That’s about six times the rate in China.

The CDC blames sedentary lifestyles and poor diet, though genes might also play a part.

“Rarely, a clear pattern of inherited obesity within a family is caused by a specific variant of a single gene (monogenic obesity),” the CDC says. “Most obesity, however, probably results from complex interactions among multiple genes and environmental factors that remain poorly understood.”

The biological reality is simple: All animals are driven to get fat but their ability to do so is naturally regulated by caloric intake and caloric output. The more calories a mammal takes in and the fewer calories it burns, the fatter it gets.

There is no argument about this basic reality. No matter a human’s genetic makeup, no one put on a true starvation diet will survive.

In Alaska, the best illustration of the importance of calories consumed versus calories burned might be displayed by bears which can in a few short months of summer take in enough calories to build up fat reserves that will sustain them through hibernations lasting up to seven months.

Bears evolved to survive this way. Humans didn’t.

Still, obesity has increasingly come to be an accepted norm in the modern, Western world. Sports Illustrated’s famous “Swimsuit Edition” is this year celebrating “plus-sized model” Hunter McGrady, who is promoted as the magazine’s “curviest model ever.”

Costly before COVID

Although obesity was estimated to cost the nation $1.4 trillion per year in medical costs and lost productivity before the pandemic began, any discussion of the country’s obesity epidemic inevitably runs into a “fat-shaming” debate.

The New York Times headlined the “Shame of Fat Shaming” in 2016, but reported “the situation is better than it was a decade ago….Now there is widespread public support for anti-bullying laws that include protection for fat children and for laws prohibiting discrimination against obese people in the workplace. But there is still a long way to go.

“Even the public health campaigns meant to prevent obesity can contribute to the stigma, researchers say, because the implicit message is that anyone who really wants to — anyone who eats well and exercises regularly — can be thin.”

There are not a lot of thin people in the U.S. today.

According to the website Healthline, the average American man now weighs 197.9 pounds, has a 40.2 inch waistline, and stands just over 5 feet 9 inches tall. That’s an inch taller than the average in 1969, but outward growth far outweighs the upward growth. 

The average American male circa 1969 weighed 166.3 pounds – more than 30 pounds less than today.

A peer-reviewed study published at PLOS One in 2011 blamed a lot of the waistline growth on the changing nature of work.

“In the early 1960’s almost half the jobs in private industry in the U.S. required at least moderate-intensity physical activity whereas now less than 20 percent demand this level of energy expenditure,”’ the study reported. “Since 1960 the estimated mean daily energy expenditure due to work-related physical activity has dropped by more than 100 calories in both women and men.”

When the researchers calculated the longterm results of such a daily drop in caloric expenditure, they found it pretty much accounted for the difference in weight between men in the 1960s and men today.

“Given that it is unlikely that there will be a return to occupations that demand moderate levels of physical activity; our findings provide further strong evidence of the public health importance of promoting physically active lifestyles outside of the work day,” the study said, before conceding the country is going nowhere in that regard.

Only one in four Americans reports getting the government recommended 150 minutes of moderate exercise per week, the study said, “(and) it is important to note that when physical activity is assessed with accelerometers, the number of Americans that achieve the physical activity recommendations falls to one in 20.

Everyone wants to drive

Meanwhile, efforts to promote more active lifestyles among the nation’s youth to help them stay both fitter and thinner are going backward not forward.

“In 1969, the National Household Travel Survey found that roughly 41 percent of school-age children/teens got to school by ‘active travel’ (i.e. walking and biking, though mostly walking, which then and now is more than 10 times more prevalent than biking),” writes Eric Morse at Freakonomics.

“In 2001 the walk/bike share was down to roughly 13 percent, a pretty spectacular drop. For elementary school children the change was even more stark. Today, even students who live within one mile of school have a less than 50 percent chance of walking; about 86 percent of similarly situated students walked in 1969.”

A 2019 study found the number of kids getting to school under their own power was down to 9 percent, Bloomberg City Lab reported. Almost 70 percent arrived in a motor vehicle.

The health consequences have largely been ignored. Streets and sidewalks (or the lack thereof) as now designed in the newer parts of many cities and in the suburbs make it unsafe for kids to walk or bike to school.

Efforts to make up for active travel by encouraging a daily 60 minutes of active play or exercise for children and teenagers don’t seem to be working. Colorado State University researchers who followed 561 high school students for four years found only 9 percent met current exercise recommendations.

“The study is far from the first to show that most U.S. teenagers need to move more,” WebMD noted when it reported the study in 2016.

“Communities could create more walkable environments, public parks, bike trails, or low-cost or free exercise programs,” one of the studies authors,  Kaigang Li, told the website at the time, but few American communities have devoted serious efforts to institute such changes.

The lack of action now appears to be contributing to the country’s high COVID-19 death toll, and still there is little discussion about how to stem the epidemic of fat that proceeded the pandemic of viral infection.

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