Bigger by the day/Craig Medred photo

As the SARS-CoV-2 pandemic rolls on with many fretting about how some have chosen to avoid vaccination, the country’s other epidemic remains a largely unmentionable that appears to worry few.

Almost wholly overlooked amid the fear of COVID-19, the disease caused by the latest coronavirus to emerge from nature or a Chinese laboratory, was the year-end report from the U.S. Centers for Disease Control (CDC) on the ever-increasing layers of fat accumulating on the frames of Americans.

The good news, if it can be called that, is that the number of overweight Americans has decreased slightly since the start of the new millennium. But that’s only because the numbers of obese and severely obese Americans have skyrocketed.

According to the CDC, somewhere around “42.5 percent of U.S. adults aged 20 and over have obesity, including 9.0 percent with severe obesity, and another 31.1 percent are overweight.”

Given that these numbers are based on “body mass index,” a less-than-perfect measure of stored body fat, the numbers could be biased a little high. 

Still, if one applies to obesity the definition the late U.S. Supreme Court Justice Potter Stewart applied to pornography – “I know it when I see it” – there is little doubt most Americans are overweight and often frighteningly so.

Were this simply an issue of appearance, it would be one thing. The U.S. is a free country and in a free country, people have the right to look any way they want to look.

But this isn’t just about appearance; it’s about life, death and medical costs, which just happen to be the issues that have so many in a tizzy as regards COVID-19.

If you want to tax the limits of the country’s medical system and possibly die because you don’t want to get vaccinated, it appears to be a big deal.

If you want to tax the limits of the country’s medical system and possibly die by spending most of your day on the sofa stuffing “Domino’s delivers” pizza in your face, it’s apparently OK.

The genetics copout

And yes, some people are genetically predisposed to gain weight, this writer among them. As a one-time serious, recreational marathon runner looking to go under and stay under that three-hour bar that somehow makes someone a serious runner instead of just some jogger, weight was a constant battle.

To run sub-3-hour marathons, I had to get my weight down near 170 pounds. As a high school football player, I struggled to get my weight up to 170, but by middle age, it was a struggle bordering on a nightmare to get it under 175.

I literally had to go on a starvation diet. Thankfully, I could tell when the training was going well because friends and acquaintances would warn me I looked “gaunt.”

In and of itself, that is a commentary on how the body shape of Americans has changed over time. When watching old movies now, it is hard to avoid being struck by how lean the actors look.

There’s a reason. They were skinnier.

According to the CDC, the average American male in the period 1960 to 1962 weighed 166.3 pounds. The heaviest cohort – men age 30 to 39 – weighed 169.9 pounds (just a hair under that aforementioned marathon goal) with younger and older men slightly leaner.

By 2015-2016, the average was up over 197 pounds, again according to the CDC, and there has been no indication of any downward trend since then.

The bathroom scale put my weight at 189.2 today, but a quick trip to Costco to grab some groceries made me feel skinny compared to the others in the warehouse. It’s almost as if you don’t qualify as an American anymore unless your gut hangs over your belt.

What the country would most appear to need is a vaccination against obesity, which raises the risks of all sorts of death including that from COVID-19.

Get outside and exercise

Personally, the pandemic proved a bit of a blessing for me in regards to weight. It encouraged an increase in exercise to the levels of old and 10 pounds disappeared seemingly without effort, or at least seemingly without effort for someone conditioned to believe that hiking, biking, running, snowshoeing, skiing and paddling to a point of healthy fatigue is a fun and good thing, not a punishing and bad thing.

The 10-pound weight loss made my doctor happy as well it should in these times because being fit and healthy is protective not just against the main diseases that have been killing Americans for decades –  heart disease and various cancers – but against COVID-19 as well.

The CDC, which these days describes obesity as a “chronic metabolic disease,” reports that more than half of almost 150,000 “Premier Healthcare Database” patients diagnosed with COVID-19 between March and December of last year were suffering from obesity.

Another more than 28 percent were overweight, with the total number of COVID-19 patients with weight issues thus reaching 79 percent of the study group or about eight out of every 10 patients.

“Obesity was a risk factor for both hospitalization and death, exhibiting a dose-response relationship with increasing BMI category,” the study said.

Underweight individuals were at greater risk from COVID-19 as well as those who were overweight, leading the study’s authors to describe “a J-shaped (nonlinear) relationship” with weight putting those who are neither too skinny nor too fat at the lowest point on that curve.

With about 800 hospitals spread all across the U.S. participating in the Premier database, the data would appear broadly representative of the country as a whole.

And it should make one wonder how many lives might have been saved from COVID-19 if, at the start of the pandemic, someone had simply told Americans to “get outdoors away from others and get some exercise with a goal of upping your fitness and reducing your weight.”

Instead, as has become the 21st-century norm, the country and most of the rest of the world took the easy route.

Better living

Technology is our friend, when it works. And today’s still experimental mRNA vaccines appear to be working amazingly well.

They are not perfect, but there is little doubt they significantly reduce the chances of developing COVID-19 and especially serious COVID-19.

Given this, why would anyone not get vaccinated? Possibly because the tiny risks of complications from the vaccines don’t look much different from the risks of dying from COVID-19 for those under the age of 40.

The latest study out of Stanford University puts the infection fatality rate (IFR) for those in the under 40 to 30 age group at 0.031 percent with those under age 29 at 0.014 percent.

For those under the age of 19,  it falls to 0.0027 percent.

CDC data put the IFR for flu just shy of 0.1 percent for the 2018-2019 flu season, which was described as a year of “moderate severity.” The deadliness of the flu varies year to year, and it, like COVID-19, is more dangerous for the old than for those in the prime of life.

The CDC data for 2018-2019 put the death rate for those age 18 to 49 at near 0.021, slightly lower than the rate Stanford now suggests for COVID-19 sufferers under the age of 40.

But “older adults…accounted for 75 percent of influenza-associated deaths” in 2018-19, the CDC added. The data reflects an IFR that grows to near 0.8 for those over age 65.

Age, however, is only part of the issue. The death rate with age goes up in part because older people tend to have more co-morbidities – heart disease, diabetes, high blood pressure and, too often obesity. These things make them more vulnerable to any disease.

This remains true even after they are vaccinated. Researchers studying vaccine breakthrough infections in Israel, where the vaccine uptake has been high, reported that about a third of the post-vaccine infected individuals there were clinically obese.

The study published in the peer-reviewed journal Clinical Microbiology and Infection earlier this month did not report how many were overweight, but did note the same associations with co-morbidities that have become common among the unvaccinated dying from the disease.

“…The cohort was characterized by a high rate of co-morbidities predisposing to severe COVID-19, including hypertension (71 percent), diabetes (48 percent), congestive heart failure (27 percent), chronic kidney and lung diseases (24 percent each), dementia (19 percent) and cancer (24 percent), and only six (4 percent) had no co-morbidities,” they reported. 

Nearly all of those co-morbidities, it must be noted, have been linked to excess body weight and/or lack of physical exercise which are, in turn, associated to some degree with aging,”

“Hippocrates in 400 BC said that exercise is man’s best medicine, but his message has been lost over time, and we are an increasingly sedentary society,” Professor Janet Lord, director of the Institute of Inflammation and Ageing at the University of Birmingham in England told Science Daily after completing a study of aging and exercise in 2018.

The study found that among a group of serious, lifelong cyclists, the loss of muscle mass and strength normally associated with aging did not occur, nor did the increase in body fat or cholesterol levels associated with aging.

On top of that, the testosterone levels of the men in the group also remained high,  and their immune systems seemed not to have aged. The latter is highly notable in wake of the pandemic.

“An organ called the thymus, which makes immune cells called T cells, starts to shrink from the age of 20 and makes less T cells. In this study, however, the cyclists’ thymuses were making as many T cells as those of a young person,” Science Daily summarized.

Healthy T cells have been found to be a prime, natural defense against COVID-19.

That T-cell immuntiy declines with age is largely part of the natural burden placed on the elderly who are destined by design to die at some point. The only question is when.

The social and ethical question in the face of the latest pandemic is now is this: How much should younger people be expected to gamble on vaccines, which may or may not have significant consequences over the long term, in order to protect old people?

I’m vaxed. For someone over 65, the decision was simple. The short-term benefits outweigh any long-term consequences.

For the young on the the other hand, an editorial in The BMJ, formerly the British Medical Journal put at least one of the possible future problems well: