New studies and information confirm doctors’ suspicions that this virus is taking advantage of a disease that our current US healthcare system cannot control.
In the latest news, the Centers for Disease Control and Prevention reports that 73 percent of nurses hospitalized for COVID-19 suffered from obesity. In addition, a recent study found that obesity can reduce the effectiveness of a COVID-19 vaccine.
I am an obesity specialist and clinical physician working on the obesity frontlines in the University of Virginia primary care health system. In the past, I often warned my patients that obesity could take years of their lives. This warning has become more verifiable than ever.
More damage than expected
Initially, doctors believed that obesity only increased your risk of developing COVID-19, and not your chances of getting infected at all.
More recent analyzes now show that obesity not only increases the risk of getting sick and dying from COVID-19. Being overweight increases the risk of infection.
In March 2020, observational studies found that high blood pressure, diabetes, and coronary artery disease were the most common other conditions – or comorbidities – in people with more severe COVID-19 illness.
But it was the editors of obesity Magazine that first raised the alarm on April 1, 2020 that obesity would likely prove to be an independent risk factor for more serious effects of COVID-19 infection.
Additionally, two studies of nearly 10,000 patients have shown that patients with COVID-19 and obesity on days 21 and 45 have a higher risk of death than those with a normal body mass index, or BMI.
A study published in September 2020 reported higher obesity rates in COVID-19 patients who are critically ill and require intubation.
Most of these and other studies suggest that obese people face a clear and present danger.
Stigma and incomprehension
Obesity is an interesting disease. It’s one that many doctors talk about, often frustrated that their patients can’t prevent or reverse it with the simplified treatment plan we learned 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 as society and health professionals speak out against people with obesity.
This can even adversely affect the size of your paycheck. Can you imagine the outcry when the headline says “Patients with high blood pressure deserve less”?
We doctors and researchers have long understood the long-term consequences of being overweight and obese. We currently know that obesity is linked to at least 236 medical diagnoses, including 13 cancers. Being overweight can shorten lifespan by up to eight years.
Despite this knowledge, US doctors are unwilling to prevent and reverse obesity. In a recent poll, only 10 percent of medical school deans and curriculum experts believe that their students are “very well prepared” on obesity management.
Half of the medical schools responded that expanding obesity education was a low priority or no priority. Throughout her medical school education, an average of 10 hours were given for obesity education.
And doctors sometimes don’t know how or when to prescribe medication for obese patients. For example, there are eight FDA-approved weight loss drugs on the market, but only 2 percent of eligible patients receive prescriptions for them from their doctors.
What’s going on in the body?
So here we are with a collision of the obesity epidemic and the COVID-19 pandemic. And a question that more and more patients are asking me: How does obesity lead to more serious illnesses and complications due to COVID-19 infection?
There are many answers; Let’s start with the structure.
Excess adipose tissue that stores fat creates mechanical compression in obese patients. This will limit their ability to take a full breath and let it out completely.
Breathing requires more work in an obese patient. It leads to restrictive lung disease and, in the more severe cases, hypoventilation syndrome, which can cause a person to have too little oxygen in their blood.
And then there is the function. Obesity leads to an excess of fatty tissue or what we colloquially call “fat”. Over the years, scientists have learned that adipose tissue is harmful in and of itself.
One can say that adipose tissue functions as an independent endocrine organ. It releases several hormones and molecules that lead to a chronic inflammatory state in obese patients.
When the body is in a constant state of inflammatory disease, it releases cytokines, proteins that fight inflammation. They keep the body on guard, simmer, ready to fight disease. That is all well and good when they are kept in check by other systems and cells.
However, when they are released chronically, an imbalance can occur that hurts the body. Think of it as a small but contained wildfire. It’s dangerous, but it doesn’t burn the entire forest.
COVID-19 is causing the body to create another cytokine wildfire. When an obese person has COVID-19, two small cytokine forest fires come together, creating a furious inflammatory fire that damages the lungs even more than patients with normal BMI.
In addition, this chronic inflammatory condition can lead to so-called endothelial dysfunction. In this condition, instead of opening, the blood vessels close and narrow, further reducing the oxygen levels in the tissues.
In addition, increased adipose tissue may contain more ACE-2, the enzyme that allows coronavirus to enter cells and damage them. A recent study showed an association between increased ACE-2 in adipose tissue and not in lung tissue.
This finding confirms the hypothesis that obesity plays an important role in more serious COVID-19 infections.
So when you have more adipose tissue, in theory, the virus can attach to and invade more cells, resulting in a higher viral load that lasts longer, which can make infection harder and take longer to recover.
ACE-2 can be helpful in counteracting inflammation, but if it’s otherwise linked to COVID-19, it can’t help with that.
The novel SARS-CoV-2 virus has forced the medical profession to face the reality that many US doctors are inherently familiar with. When it comes to preventing chronic diseases like obesity, the US healthcare system is not well positioned.
Many insurers reward doctors by meeting metrics to manage the effects of obesity rather than preventing them or treating the disease yourself. For example, doctors are reimbursed for helping patients with type 2 diabetes reach a specific A1C level or a set blood pressure goal.
I believe it is time to train 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 diseases, must become public enemy number one.
Cate Varney, Clinician, University of Virginia.
This article is republished by The Conversation under a Creative Commons license. Read the original article.
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