Obesity Linked to Severe Coronavirus Disease, Especially for Younger Patients

Obesity Linked to Severe Coronavirus Disease, Especially for Younger Patients

Roni Caryn Rabin

Obesity may be one of the most important predictors of severe coronavirus illness, new studies say. It’s an alarming finding for the United States, which has one of the highest obesity rates in the world.

Though people with obesity frequently have other medical problems, the new studies point to the condition in and of itself as the most significant risk factor, after only older age, for being hospitalized with Covid-19, the illness caused by the coronavirus. Young adults with obesity appear to be at particular risk, studies show.

The research is preliminary, and not peer reviewed, but it buttresses anecdotal reports from doctors who say they have been struck by how many seriously ill younger patients of theirs with obesity are otherwise healthy.

No one knows why obesity makes Covid-19 worse, but hypotheses abound.

Some coronavirus patients with obesity may already have compromised respiratory function that preceded the infection. Abdominal obesity, more prominent in men, can cause compression of the diaphragm, lungs and chest capacity. Obesity is known to cause chronic, low-grade inflammation and an increase in circulating, pro-inflammatory cytokines, which may play a role in the worst Covid-19 outcomes.

Some 42 percent of American adults — nearly 80 million people — live with obesity. That is a prevalence rate far exceeding those of other countries hit hard by the coronavirus, like China and Italy.

Obesity is defined by a measure called body mass index, which is based on a formula that divides one’s weight in kilograms by the square of one’s height in meters. Someone who is 5 feet 9 inches tall and weighs 203 pounds would have a B.M.I. of 30, which is considered obese.

The new findings about obesity risks are bad news for all Americans, but particularly for African-Americans and other people of color, who have higher rates of obesity and are already bearing a disproportionate burden of Covid-19 deaths. High rates of obesity are also prevalent among low-income white Americans, who may also be adversely affected, experts say.

More than half of Covid-19 deaths in the United States so far have been in New York and New Jersey, but the new findings mean the coronavirus could exact a steep toll in regions like the South and the Midwest, where obesity is more prevalent than in the Northeast.

“If obesity does turn out to be an important risk factor for younger people, and we look at the rest of the United States — where obesity rates are higher than in New York — that will be of great concern,” said Dr. Roy Gulick, chief of infectious diseases at Weill Cornell Medicine. “We may see a lot more younger people being hospitalized.”

Dr. Gulick’s review of data from the first 393 Covid-19 patients admitted to NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian Lower Manhattan Hospital identified obesity as a risk factor for admission. He also found that among adults under the age of 54, half live with obesity, though the New York City obesity rate is only 22 percent.

One of the largest U.S. studies to identify obesity as a prominent risk factor analyzed data from more than 4,000 Covid-19 patients who sought care at NYU Langone Health between March 1 and April 2.

“Obesity is more important for hospitalization than whether you have high blood pressure or diabetes, though these often go together, and it’s more important than coronary disease or cancer or kidney disease, or even pulmonary disease,” said Dr. Leora Horwitz, the paper’s senior author and director of the Center for Healthcare Innovation and Delivery Science at NYU Langone.

Obesity also appears to be a factor for higher risk of death from Covid-19, though to a lesser degree, Dr. Horwitz said

She cautioned that the findings were preliminary, noted that some of the data was still incomplete and emphasized that the paper had not been peer reviewed.

Scientists are still somewhat puzzled by the impact of obesity on the course of the disease, but Dr. Horwitz said the implications for patient care were clear.

“It means that as clinicians, we should be thinking a little more carefully about those patients with obesity when they come in — we should worry about them a little bit more,” she said.

Another NYU Langone study, which focused on patients under the age of 60, found that those with obesity were twice as likely to be hospitalized and were at even higher risk of requiring critical care. The association between obesity and more severe disease was not seen in patients over the age of 60.

The severity of the illness often comes as a surprise to younger adults, and “provides another layer of shock to this disease,” the paper’s author, Dr. Jennifer Lighter, said.

Studies highlighting the risks of obesity have been conducted in other countries as well.

Though most of the early reports from China pointed to risk factors like Type 2 diabetes and hypertension, which are common in people with obesity, scientists in Shenzhen, China, reported in The Lancet this month that Covid-19 patients with a high body mass index were at more than double the risk of severe pneumonia than those with a lower B.M.I.

Another study from China, which looked at outcomes among a group of 112 Covid-19 patients, reported that of the 17 patients who died, 15 were either overweight or obese.

More recently, a French study reported that nearly half of 124 Covid-19 patients in Lille, France, had obesity, twice the rate of a comparison group of intensive care patients hospitalized for other reasons last year. The study also reported that the need for mechanical ventilation increased with higher body weight.

At Ochsner Health, a system with 41 hospitals in Louisiana and southern Mississippi, Dr. Leo Seoane, the company’s senior vice president, said that 60 percent of patients hospitalized with Covid-19 had obesity and that obesity appeared to nearly double their risk of requiring a ventilator.

“We in the U.S. have not always identified obesity as a disease, and some people think it’s a lifestyle choice. But it’s not,” said Dr. Matthew Hutter, director of the Weight Center at Massachusetts General Hospital and president of the American Society for Metabolic and Bariatric Surgery. “It makes people sick, and we’re realizing that now.”

Conventional wisdom has traditionally explained excess weight as a simple caloric imbalance that can be addressed by eating less and exercising more. Prominent medical groups have reconsidered their approach, however, and now recognize obesity as a medical disorder caused by a complex web of underlying factors, which in turn predisposes people to other serious medical problems.

Some doctors consider obesity a marker of poor health associated with poverty, reflecting a combination of social and economic factors, from inadequate education and limited job opportunities to impoverished neighborhoods where access to healthy food, medical care and opportunities for exercise are scarce.

Obesity’s link to chronic diseases is well known, but the experience with H1N1 influenza in 2009 revealed that people with obesity are also more vulnerable to infectious diseases. Studies have also shown that they do not get the same protection from influenza vaccinations that others do.

Physicians say patients with obesity can be harder to manage in the hospital setting. They require special beds and imaging equipment, and they are harder to intubate and harder to assess when removing a ventilator.

Advocates for people with obesity say they may also delay seeking care, deterred because they have been treated poorly by health care providers in the past.

“They worry: ‘If I go to the hospital, am I going to be triaged based on my body mass index? Is the skinny person next to me going to get the ventilator, not me?’” said Dr. Donna Ryan, associate editor in chief of the journal Obesity.

Doctors in the trenches treating critically ill coronavirus patients say they expected to see old and elderly patients become acutely and critically ill, but the young patients becoming severely sick have unnerved them.

Of the 14 Covid-19 patients recently in Dr. Sanam Ahmed’s critical care unit at Mount Sinai on the Upper East Side, she said, 12 were at least 50 years old and had complex medical problems. The two younger patients, who were in their 30s, had obesity and no other diseases.

“It looks like, for them, obesity is the risk factor,” Dr. Ahmed said.

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  • Updated April 11, 2020

    • When will this end?

      This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities. More than 30,000 coronavirus-related GoFundMe fund-raisers have started in the past few weeks. (The sheer number of fund-raisers means more of them are likely to fail to meet their goal, though.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • How do I get tested?

      If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

    • How does coronavirus spread?

      It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

    • Is there a vaccine yet?

      No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.

    • What makes this outbreak so different?

      Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.

    • What if somebody in my family gets sick?

      If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.

    • Should I stock up on groceries?

      Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.

    • Can I go to the park?

      Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.

    • Should I pull my money from the markets?

      That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.

    • What should I do with my 401(k)?

      Watching your balance go up and down can be scary. You may be wondering if you should decrease your contributions — don’t! If your employer matches any part of your contributions, make sure you’re at least saving as much as you can to get that “free money.”

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