Even in young people, having a high BMI is a risk factor for health issues from COVID-19. Here’s how taking small steps can improve your weight and potentially your respiratory health.
Carrying extra weight is associated with various chronic diseases that may make you more likely to face complications from COVID-19.
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. Now preliminary data suggests there’s 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.”
Why Would Obesity Make COVID-19 More Severe?
Though researchers and public health experts can’t say definitively that obesity puts someone at greater risk of COVID-19 complications, there are factors in play with the condition that make adverse outcomes more likely.
A major issue is that many people with obesity tend to have underlying conditions, which are already associated with greater COVID-19 risk, according to the Centers for Disease Control and Prevention (CDC).
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. The CDC also lists severe obesity – defined by the National Heart, Lung, and Blood Institute as a body mass index (BMI) of 40 or higher – as a factor for severe illness from the virus.
The individuals without obesity had a better prognosis: In comparison, 64 percent of them required ventilation and 36 percent died.
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 and April 2020 was 33.2, and concluded that obesity should be considered a significant determinant of risk for severe COVID-related illness in African Americans. (Age and lung disease were two other risk factors linked specifically to 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.
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.“
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 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 Dr. Araque. ”When you have these underlying conditions, you’re at greater risk, so being younger is not protective,“ she says.
An analysis published May 4 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.
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.
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.
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. Bottom of Form
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.”