Those who deal with obesity are considered at greater risk for a range of health issues, from chronic disease and infection to slower wound healing. These days, there is another health risk to be aware of: increased complications from COVID-19, the respiratory disease caused by the novel coronavirus. “Obviously, there’s a great deal we’re still learning about this virus, and these are preliminary studies,” says Katherine Araque, MD, an endocrinologist and the director of endocrinology at the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California. “But anecdotally, we’re hearing that patients with obesity are experiencing more severe complications at a younger age, and that’s a concern.” RELATED: 10 Diabetes Care Tips During the COVID-19 Pandemic Obesity is defined by body mass index, or BMI, which takes a person’s weight and height into account. A BMI of 25 to 30 is considered overweight, 30 to 39 is considered obese, and 40 and up is considered severely obese, according to the Centers for Disease Control and Prevention (CDC). “Because it’s a simple formula of height and weight, BMI as a measurement tool has its limitations compared to factors like body fat percentage, muscle mass, and especially where you’re storing your fat,” says Dr. Araque. For example, higher amounts of belly fat have been associated with health risks like cardiovascular disease, she adds. That said, using BMI can be useful as a shorthand for categorization, and it has been correlated with worse COVID outcomes. Even moderately excess weight can be a risk factor for severe COVID-19, according to a recent warning by the CDC. In an update posted on March 8, the agency noted that there is a relationship between higher weight and COVID-19 severity. Researchers analyzed the health data of about 150,000 people receiving care in 238 U.S. hospitals from March 2020 to December 2020. According to their BMI, 50 percent of the participants had obesity, while 28 percent were considered overweight. Compared with their normal-weight counterparts, individuals who were overweight or obese were at a higher risk for needing ventilation and experiencing premature death. Those risk factors were especially pronounced among those older than 65, and the risks increased as BMI rose. RELATED: What Are the Flaws of BMI?
Why Would Excess Weight Make COVID-19 More Severe?
In the recent CDC report, researchers singled out several potential factors with obesity that make adverse outcomes more likely. They noted that obesity tends to increase chronic inflammation, which disrupts immune system function, especially in response to pathogens such as a virus. Another issue is that many people with obesity tend to have underlying conditions, which are already associated with greater COVID-19 risk, according to the CDC. Visceral fat has emerged as another potential variable. Usually presenting as belly fat, this type may have more receptors for COVID-19 than subcutaneous fat, which is the kind of fat you can pinch. A study published in February 2021 in Metabolism found that visceral fat accumulation could predict severity of COVID-19 outcomes. Having additional underlying conditions is another huge factor. The CDC points out that people who have heart disease, chronic lung disease, diabetes, and liver disease are among the individuals who fall into this category. Even before the recent report, the CDC had listed severe obesity as a factor for severe illness from the virus. According to the CDC, among the U.S. adult population, 9.2 percent have severe obesity, 42.4 percent have obesity, and another 32 percent are overweight. This means that in total more than three-quarters of the U.S. population could be at risk. And obesity rates may be increasing — although the CDC doesn’t have statistics yet for last year, 2019 data showed that 12 states now have adult obesity rates above 35 percent. That’s up from nine states in 2018. RELATED: BMI in Adults: A Complete Guide Research is still ongoing, but there are indications that excess weight may be a significant concern. A research review published in June 2020 in the Journal of Medical Virology looked at nine studies conducted in China, France, and the United States, and found that obese patients were more likely to develop severe complications with COVID-19, with a higher proportion put on a ventilator. Another study, published in Obesity in August 2020, examined obesity as a risk factor for severe COVID-related illness in an African American population. The study found that the average BMI among 158 African American participants with COVID-19 between March 2020 and April 2020 was 33.2, and those who had higher BMI were more likely to be admitted to the ICU for needing a higher level of care. Study authors concluded that obesity should be considered a significant determinant of risk for severe COVID-related illness and ICU needs in African Americans. (Age and lung disease were two other risk factors associated with ICU admission in this population.) Per the CDC, the average BMI among non-Hispanic Black Americans is higher than the average BMI for white Americans, at 38.4 percent to 28.6 percent, respectively. This disparity may help account for not only the severity but the disproportionate prevalence of COVID-19 in Black people as compared with the white population — a statistic the CDC has noted. Indeed, in a May 2020 study in Health Affairs, which looked at 1,052 confirmed cases of COVID-19 in Northern California, about 53 percent of Black Americans with the coronavirus were hospitalized, compared with about 26 percent of white patients. RELATED: COVID-19 Is Hitting Black Americans Hardest One reason obesity raises the risk of serious illness from COVID-19 is that extra weight compromises the lungs’ ability to do their job, says Jennifer Lighter, MD, a specialist in pediatric infectious disease at NYU Langone Health in New York City. “Any disease that has a respiratory element to it, like flu or pneumonia, tends to be more severe with obesity,” she says. Another issue is that obesity raises inflammation levels in the body, says Stacy Brethauer, MD, a general surgeon specializing in bariatric surgery at The Ohio State University Wexner Medical Center in Columbus. “Those with obesity tend to have more inflammatory cytokines, which are small proteins that get released during an infection,” Dr. Brethauer says. “That inflammation is associated with other disease processes that are found with obesity, and it all ties together to increase risk, because it’s impacting immune function.” RELATED: What to Know About Being Immunocompromised During the Coronavirus Pandemic Type 2 diabetes and high blood pressure are the most common comorbidities in patients infected with the new coronavirus, according to another commentary, published in April 2020 in Nature Reviews Endocrinology. In that paper, the authors reported emerging evidence of a direct link between these issues and the virus. “These patients often don’t have a lot of immune resources in reserve, so the response can be dramatic,” Brethauer says. “Certainly there are lean people who have a significant cytokine issue, but we just see it more often with those who are obese because they tend to have more underlying health conditions.” These factors can affect those with obesity at younger ages, and that may be a major reason why hospitals are seeing younger patients with severe COVID-19, says Araque. “When you have these underlying conditions, you’re at greater risk, so being younger is not protective,” she says. RELATED: 10 Misconceptions About the Coronavirus An analysis published on May 4, 2020, in The Lancet reported that the younger an ICU patient with severe COVID-19 is, the more obese that patient is likely to be, and that applies equally to men and women. Many studies suggest obesity is an independent risk factor for COVID-19 complications, and yet there are some differing perspectives on how strong this association is in the academic literature. For example, authors of an article published in June 2020 in Circulation state that more studies are needed to learn whether obesity can increase health risks without other underlying conditions present. The takeaway: In many studies in a variety of populations and ages, obesity is associated with worsening COVID-19 risks and complications, but individual differences seem to vary greatly. RELATED: Heart Disease and COVID-19: What You Must Know
Should You Get a Vaccine When You’re Next in Line?
Because being obese, or even overweight, seems to have such a profound impact on COVID risk, it’s crucial to get the vaccine when it’s available to you, says David Cutler, MD, a family medicine physician at Providence Saint John’s Health Center in Santa Monica. That’s particularly true if you have additional conditions such as high blood pressure or diabetes, or you’re over age 65. “Authorized vaccines are proven safe and effective, and the longer you wait to get a vaccine, the greater your risk for COVID,” he says. “Everyone, including those with a high BMI, should get a vaccine as soon as they are eligible.” He adds that there is no advantage to getting one vaccine over another — for instance, the shot from Pfizer won’t protect you more than the one from Moderna or Johnson & Johnson — as all three have been shown to reduce complication rates and mortality significantly if you do happen to get COVID after vaccination. RELATED: COVID Vaccines and Treatment: Where They Stand Now
If You’re Dealing With Obesity, What Can You Do?
Whether or not you have other conditions, getting your weight to a healthier place is a worthwhile effort, since having a healthy BMI is associated with lower overall health risks, both mental and physical, notes the CDC. Right now, with widespread stress and anxiety, as well as limited mobility because of social distancing recommendations during COVID-19, it may seem more challenging to adopt healthy behaviors that are associated with weight loss. Think of extra precautions — like staying home when you can — and weight management as self-care, suggests Christine Carter, PhD, a sociologist and senior fellow at the Greater Good Science Center at the University of California in Berkeley. “This could be a time when you have the opportunity to change habits in a way you may not have had before,” she says. “That might mean stocking your pantry with healthy foods and cooking more than you ever have, or it could mean moving more or getting more sleep. All of these add up to benefits.” A study published in May 2017 in the American Journal of Preventive Medicine found that people who cook more often at home tend to have healthier overall diets without an increase in costs. RELATED: 9 Science-Backed Steps for Lowering Your BMI Sleep quality is another important factor, especially because people with obesity often have sleep disorders such as sleep apnea and insomnia, previous research has found. That can run in the other direction as well, with some past research associating poor sleep with impaired appetite regulation and metabolism, making you more prone to gain weight. It’s also important to address any underlying health conditions that may be related to obesity, such as high blood pressure and respiratory issues, says Brethauer. Talk with your doctor about managing these conditions, and stay on top of your treatment, for instance, adhering to medication schedules. RELATED: The Connection Between BMI Numbers and Obesity Levels Obesity is a complex disease that may be associated with both nature and nurture, according to the Obesity Medicine Association (OMA). That means you may have grown up in an environment where highly caloric meals were the norm, and emotional eating could have come into play. But there are also some genes that have been associated with obesity — usually severe obesity — such as one known as the “fat mass and obesity-associated gene,” or FTO. The OMA notes that this gene is found in up to 43 percent of the population and can trigger increased calorie intake, reduced control in eating, and even a greater likelihood of sedentary behavior and storing of body fat. But keep in mind that genetics are not destiny. Just because you have a certain gene doesn’t mean it will express itself, and even if it does, there can be ways to minimize the impact. For example, a study published in August 2019 in PLoS Genetics suggests that regular exercise can lower obesity risk, even for those genetically predisposed to weight gain. What’s more, addressing mental health hurdles associated with excessive eating can also help, as authors of a January 2016 Obesity study on the link between emotional eating and obesity note. “Genetics and your food environment growing up are powerful factors when it comes to obesity, but they’re not insurmountable,” says Araque. RELATED: 21 Tips for Weight Loss That Actually Work One more thing to keep in mind: Taking these small steps is worth it. It doesn’t take much weight loss to make a difference in lowering your health risks. “Just 10 percent loss of your body weight is enough to have an impact on some of that inflammation,” Brethauer says. “That’s the point where we start to see some real changes and momentum.” No matter what your weight, taking steps like these — especially exercise, which may reduce risk of COVID complications — can be helpful for lowering inflammation and improving immunity. As the pandemic is ongoing, that can be a big plus for keeping yourself healthy and strong.
