Many of us are aware of the importance of social distancing, wearing masks, washing our hands and even self-isolating where necessary to protect against COVID-192. But for those who do become infected, startling research has emerged which shows that being obese or even slightly overweight can worsen the effect of this disease3.
COVID-19 poses a specific risk to people living with pre-existing conditions such as atherosclerosis, type 2 diabetes, and hypertension, conditions also common in people with obesity4. While initial data pointed towards the older population being particularly vulnerable, as well as those with these comorbidities, an increasing number of reports have now also linked obesity to more severe COVID-19 illness and death5.
What has been termed “the elephant in the room” when it comes to this pandemic, is the fact that overweight and obesity are already major global healthcare problems, now just making a really serious global health situation that much worse1. In fact, data from the first 2 204 patients admitted to 286 National Health Service Intensive Care Units with COVID- 19 in the United Kingdom reveal that 72.7% of them were overweight or obese1.
Research has found that patients with type 2 diabetes and metabolic syndrome might have to up 10 times greater risk of death when they contract COVID-191. Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels5.
Given the extremely high rates of overweight and obese people around the globe, a high percentage of the population who will contract coronavirus are expected to also have a BMI over 253
Lockdown Weight up
To add fuel to a growing fire, for many people staying at home, consumption of more sugar and refined flour, along with less mobility and physical activity, has put even many people at an increased risk of metabolic disease3. An additional health challenge during the coronavirus crisis seems to be the consumption of a varied, nutrient-rich diet and keeping calorie intake under control2.
What’s more is that this current crisis and the need to stay home is prompting many people to rely on processed food with longer shelf life, instead of fresh produce, and canned food which is generally higher in salt. We might well see an increase in weight if this persists for a longer period of time3. Cause for even more concern is that the resultant economic downturn caused by this pandemic might well worsen obesity, especially amongst the most vulnerable5.
A local perspective
Dr Gary Hudson, a Specialist Physician practising in Betty’s Bay in the Western Cape, with a special interest in weight management, says that we are facing a pandemic on top of an obesity epidemic, and reiterates that there is a definite link between the more obese areas of the world and those that are being severely affected by this disease7,8.
He says that COVID-19 is spreading amongst a global obese population that numbers 2.4 billion people, which means that more than 30% of the world’s population is at risk of severe disease and even death7,8. “This is creating the perfect storm6,7.,” he says.
Hudson cites an example that in France, the highest death rate due to COVID-19 was in North Eastern France, the same region with statistically the largest overweight and obese population.
In fact, BMI was found to be the most important independent risk factor, and a special guideline was introduced for anyone with a BMI of over 27.9 to be tested and isolated7,8.
Similar patterns were found in Italy. “Once again the map of severe disease and obesity completely overlap” he says. Conversely, Singapore and South Korea had comparatively low death rates but also have populations with a general low BMI7,8.
More about BMI
BMI is a simple calculation using a person’s height and weight and calculated as BMI = kg/m2.
Although it is not the most accurate measurement, it is the widely accepted global definition of obesity as per the World Health Organisation, that defines a BMI of over 25 as overweight and over 30 or more as obese7,8.
“It is a very important clinical measurement,” says Dr Hudson who says that even a BMI of over 25, which is literally just above the normal weight range, seemed to correlate with a higher incidence of serious disease, particularly when combined with a comorbidity such as hypertension7,8.
Dr Hudson says that it is important to stress that the presence of abdominal fat is associated with a high risk of severe complications due to COVID-19. This is relevant for people with a mild increase in weight, and not only for the extremely obese7,8.
Furthermore, in a French study, the risk for invasive mechanical ventilation in patients with COVID-19 infection admitted to Intensive Treatment Units was more than seven-fold higher for obese patients with a BMI over 355.
In South Africa, 70% of women, 35% of adult men and 13% of children fall into the obese and overweight category. Only 30% engage in regular formal physical activity and 82% consumer high calorie low nutritional and processed fast foods6. “Don’t wait. More than ever, it is important to lose weight,” Dr Hudson says7,8.
Where to from here?
The bottom line is that lifestyle can have a major impact on a person’s immune system. The basic weapons against many diseases, and now also against serious COVID-19 illness is diet and exercise, weapons available to most of us but not nearly enough of us take advantage of them2.
Now that there is a deeper understanding about the relationship between obesity and COVID-19, therapeutic interventions such as proven weight loss medication and low calorie diets might well be some of the tools that could potentially reduce the risk of developing severe COVID-19 illness as well as other lifestyle related diseases5.
More than ever before, eating real foods and exercising might help save lives. 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 decrease adverse reactions to these types of viral pandemics5.
If you are worried about your weight, or for any further information, speak to your doctor for advice about how to lose or manage your weight. Go to www.ilivelite.co.za for more information, to check your BMI and weight circumference and access to professionally developed dietary guidelines which feature different meal plans to suit various lifestyles and energy requirements.
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Content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional.
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References: 1: European Scientist – COVID-19 and The Elephant in the Room (April 2020) at https://www.europeanscientist.com/en/article-of-the-week/covid-19-and-the-elephant-in-the-room/ (website accessed on 17 June 2020) 2: The New York Times – To Fight Covid-19, Don’t Neglect Immunity and Inflammation (May 2020) at https://www.nytimes.com/2020/05/25/well/live/to-fight-covid-19-dont-neglect-immunity-and-inflammation.html (website accessed on 17 June 2020) 3: World Obesity – Coronavirus (COVID-19) & Obesity (2020) at https://www.worldobesity.org/news/statement-coronavirus-covid-19-obesity (website accessed on 17 June 2020) 4: Chiappetta, S et al. COVID- International Journal of Obesity. COVID-19 and the role of chronic inflammation in patients with obesity. May 2020. 5: Sattar et al. Obesity – A Risk Factor for Severe COVID-19 Infection: Multiple Potential Mechanisms (Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre) 11 May 2020 6: Mayo Clinic – Metabolic Syndrome (2019) at https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916 (website accessed on 17 June 2020) 7: Pandemic on Epidemic – Dr Gary Hudson June 2020 8: Webinar by Dr Gary Hudson 4 June 2020 (link to webinar available on request)