Obesity and COVID-19 Morbidity

"Although this study examines a variety of factors that may be associated with risk of death from COVID-19, our main objective in this paper was to understand risk related to obesity, and obesity-associated chronic conditions in our health care system."                                                                                                                "Our findings suggest that it is not race or ethnicity alone that increases risk of death, but rather other correlated factors, including access to health care, comorbidities, and obesity, that also play an important role."                                   Lead researcher, Sara Y. Tartof, PhD, MPH,  Kaiser Permanente Southern California Department of Research & Evaluation

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"By viewing the risk posed by obesity through the prism of COVID-19, this study advances the characterization of obesity as a disease that demands a public health and clinical response similar to that for diabetes or heart disease." "One pandemic is expanding our understanding of another, and we hope this work not only provides physicians and patients a better grasp of the risk obesity poses in the setting of COVID19, but also to overall health."  Senior author, Sameer B. Murali, MD, an internal medicine physician at Kaiser Permanente Fontana Medical Center

A new study on obesity and COVID-19 has been published in the peer-reviewed journal Annals of Internal Medicine. A team of researchers from Kaiser Permanente responsible for the paper, used data from the health-care body's insured patients to derive the results of their study from the health characteristics of 6,916 patients who had contracted the SARS-CoV-2 virus that causes COVID-19 in the period between when the epidemic struck the U.S. in March and the beginning of May.

The goal was to determine whether and how greatly obesity had an effect on the risk of dying from COVID complications. The Kaiser Permanente model verified that obesity is a dominant driver and an independent risk factor for mortality caused by COVID-19, factoring out hypertension. Issues such as sex, age, race, smoking status, heart failure, history of myocardial infarction, socioeconomic status, vascular disease, asthma and diabetes were all taken into account.

When all was accounted for, obesity stood out as uniquely dangerous in COVID-19. Risks linked to overweight and COVID were seen to increase morbidity by 81 percent higher as compared to people within normal weight parameters in COVID infection. Excess risk rose for those with a BMI in the 35 to 39 kg/sq.m range at 16 percent; a BMI of 39 equal to 288 pounds weight for someone six feet tall.

BMI in the range of 40 to 44 raises risk to 168 percent, and 45-plus BMI rises to 318 percent risk. Cardiologist David Kass of John Hopkins was invited to write an accompanying editorial by the journal; to envision how obesity affects mortality risk in COVID-19. Dr.Kass made the observation that obese individuals are endowed with weaker immune systems and poor endotheliums (cellular layer on the interior surface of blood vessels). Their breathing is impaired at night or while in a prone position.

A more elevated "docking" protein results from fatty tissue, which the COVID viruses makes use of to break into cells, according to Dr.Kass, conceivably permitting fat to "serve as a viral refuge and replication site, prolonging virus shedding."

Medical workers prepared to transport the body of a patient who died of Covid-19 at the United Memorial Medical Center in Houston.  Credit...Go Nakamura/Getty Images

• Patients who were severely obese had nearly 3 times the risk of death and those who were extremely obese had over 4 times the risk of death from COVID-19 compared to those of normal weight.
• Severely and extremely obese people who were 60 years old and younger had a substantially higher risk of death than severely obese people over age 60.
• Severely and extremely obese men had a very high risk of death, while women had no increased risk of death associated with obesity. searchers were able to control for a variety of risks previously reported in the literature and did not detect increased risk of death from COVID-19 associated with Black or Latinx race/ethnicity alone.