In recent news, the Centers for Disease Control and Prevention reported that 73% of nurses hospitalized by COVID-19 were obese. In addition, a recent study found that obesity may affect the effectiveness of the COVID-19 vaccine.
Obesity correlates with a blunt immune response to COVID-19, and researchers worry that this could also blunt the effectiveness of the vaccine. https://t.co/lRcNupif1 October 25, 2020
I am an obesity specialist and clinician working in the first lines of obesity in primary care in the University of Virginia health care system. In the past, I have often come across warning patients that obesity can take years of their lives. Now, more than ever, this warning has become verifiable.
More damage than was believed
Initially, doctors believed that obesity only increased your risk of developing COVID-19, not your chance of becoming infected in the first place. More recent analysis now shows that obesity not only increases the risk of disease and death from COVID-19; obesity increases the risk of infection.
In March 2020, observational studies noted hypertension, diabetes, and coronary artery disease as the most common other conditions — or comorbidities — in patients with more severe COVID-19 disease. But it was the editors of Obesity magazine who first raised concerns on April 1, 2020, that obesity was likely to be an independent risk factor for the more severe consequences of COVID-19 infection.
In addition, two studies involving nearly 10,000 patients showed that patients who had both COVID-19 and obesity had a higher risk of death at days 21 and 45 than patients with a normal body mass index or BMI. .
And a study published in September 2020 reported higher levels of obesity in patients with COVID-19 who are in critical condition and require intubation.
From these studies and others, it is becoming overwhelmingly obvious that obese people face a clear and current danger.
Stigma and lack of understanding
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Obesity is an interesting disease. Many doctors talk about it, often disappointed that their patients cannot prevent it or reverse it with the overly simplistic treatment plan we were taught in our initial training; “Eat less and exercise more.”
It is also a disease that causes physical problems such as sleep apnea and joint pain. It also affects the mind and spirit of a person due to the bias of society and medical professionals towards obese people. This can even adversely affect the amount of your salary. Can you imagine the protest if the title reads “Patients with high blood pressure earn less”?
We doctors and researchers have long understood the long-term consequences of being overweight and obese. We currently recognize that obesity is associated with at least 236 medical diagnoses, including 13 cancers. Obesity can reduce a person’s life expectancy by up to eight years.
Although they know this, American doctors are not ready to prevent and reverse obesity. In a recent study, only 10% of medical deans and curriculum experts believe that their students have been “very prepared” for managing obesity. Half of the medical schools answered that the expansion of obesity education is a low priority or not a priority. An average of 10 hours were reported as devoted to obesity training throughout their medical school training.
And doctors sometimes do not know how and when to prescribe drugs to obese patients. For example, eight FDA-approved weight loss drugs are on the market, but only 2% of eligible patients receive prescriptions from their doctors.
What happens in the body
So we came to the clash of the obesity epidemic and the COVID-19 pandemic. And a question I find that patients are asking me more and more: How does obesity create more severe diseases and complications from COVID-19 infection?
There are many answers; let’s start with the structure.
Excess fat, which stores fat, creates mechanical compression in obese patients. This limits their ability to absorb and completely release a full breath.
Breathing requires more work in an obese patient. It creates a restrictive lung disease and in more severe cases leads to hypoventilation syndrome, which can cause a person to have too little oxygen in the blood.
And then there is a function. Obesity leads to excess fat or what we call “fat”. Over the years, scientists have learned that adipose tissue is harmful in itself. It can be said that adipose tissue acts independently as an endocrine organ. It releases many hormones and molecules that lead to a chronic state of inflammation in obese patients.
When the body is in a constant state of low-grade inflammation, it releases cytokines, proteins that fight inflammation. They keep the body alert, boiling and ready to fight disease. All this is good when they are controlled by other systems and cells. However, their chronic release can lead to an imbalance that can cause injury to the body. Think of it as a small but restrained forest fire. It is dangerous, but it does not burn the whole forest.
COVID-19 causes the body to create a new cytokine forest fire. When an overweight person has COVID-19, two small cytokine forest fires come together, resulting in a raging fire of inflammation that damages the lungs even more than patients with a normal BMI.
In addition, this chronic condition of inflammation can lead to something called endothelial dysfunction. In this condition, instead of opening, the blood vessels close and constrict, further reducing the oxygen in the tissues.
In addition, the increased adipose tissue may have more ACE-2, the enzyme that allows the coronavirus to invade the cells and begin to damage them. A recent study showed an association of elevated ACE-2 in adipose tissue rather than lung tissue. This finding further reinforces the hypothesis that obesity plays a major role in more serious COVID-19 infections. So in theory, if you have more fat, the virus can bind and invade more cells, causing higher viral loads that last longer, which can make the infection more severe and prolong recovery.
ACE-2 may be useful in counteracting inflammation, but if it otherwise binds to COVID-19, it may not help.[[[[Deep knowledge, every day. Sign up for The Conversation newsletter.]
The new SARS COVID-19 virus has forced the medical profession to face a reality that many American doctors know by nature. When it comes to preventing chronic diseases such as obesity, the US health care system is not doing well. Many insurers reward doctors by meeting indicators to treat the effects of obesity instead of preventing or treating the disease itself. Physicians receive reimbursement, for example, to help patients with type 2 diabetes reach a certain level of A1C or a certain blood pressure target.
I believe it is time to educate doctors and provide them with resources to fight obesity. Doctors can no longer deny that obesity, one of the strongest predictors of COVID-19 and at least 236 other medical conditions, must become the number one public enemy.
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