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Obesity Is America's 'Achilles Heel' When It Comes To COVID-19

A new study published in The Clinical Infectious Diseases Journal finds obesity is a risk factor in COVID-19 hospital admissions for people under 60. (M. Spencer Green/AP)
A new study published in The Clinical Infectious Diseases Journal finds obesity is a risk factor in COVID-19 hospital admissions for people under 60. (M. Spencer Green/AP)

A recent study finds obesity is a risk factor in COVID-19 hospital admissions for people under 60.

Published in The Clinical Infectious Diseases Journal, the observational research looks at the risk of hospitalization according to body mass index, or BMI. Researchers found obese adults under age 60 had a higher risk of admission to the hospital and the Intensive Care Unit compared to people who have a healthy weight, says lead author of the study Dr. Jennifer Lighter.

“When patients started arriving at our medical center, it was always shocking to see younger patients get intubated and admitted to the ICU with COVID-19,” says Lighter, a pediatric infectious disease specialist and hospital epidemiologist at New York University’s Langone Medical Center. “And it was remarkable that many of them were overweight.”

As to why obesity can increase someone’s risk of getting severely ill with COVID-19, Lighter says she has a few personal theories.

Obese people have more compromised respiratory function compared to people who are not obese, she says. Obstructive sleep apnea, asthma and restrictive lung disease or reflux are more common among people who are obese.

Another theory is that obese people might be further on the inflammation spectrum, she says. Even if these patients have not received a diagnosis of diabetes or cardiovascular disease, they could be experiencing hyperglycemia, hypertension, hyperlipidemia or other risk factors that lead to more severe COVID-19 cases, she says.

The virus attaches to ACE2 receptors located in not only the lungs, she says, but also fat cells. When the virus attaches to the ACE2 receptors, it enters the cell through a protein called TMPRSS2, which is sensitive to male hormones, or androgens.

Obese people and men have a higher likelihood of more circulating androgen, which gives the virus more opportunity to enter the cells, she says. This could explain why patients who are men or obese are experiencing more severe courses of the disease.

Different areas in the world face various regional vulnerabilities depending on location, Lighter says. In China, smoking and pollution could have made people more vulnerable. In Italy, much of the country’s large elderly population live in multigenerational homes, making older people particularly vulnerable.

Globally, about 13% of the world is considered obese with a BMI above 30. But in the United States, more than a third of people are obese — which she says poses a substantial risk.

“In the United States, our Achilles heel will be obesity,” she says. “I think we are vulnerable to having a larger population of moderate to severe courses due to obesity.”

The scope of the outbreak in New York City has more to do with population density than obesity, she says.

While obesity is a sensitive subject for many people, Lighter says it’s important to identify risk factors so those people can take the appropriate steps to protect their health.

Since this research implies obese people are two to three times more likely to become severely ill from COVID-19, they should isolate until the number of cases in their region is “extremely low,” she says.

Once therapies are discovered to treat COVID-19, patients with identified risk factors should receive the treatment to prevent the disease from progressing, she says.

“I think it’s important to sometimes take the emotional implications out of it when you’re just trying to identify risk factors of people that can have a more severe course of COVID-19,” she says. “I know it could be a sensitive topic, but it’s also important just to talk frankly and plainly identify the higher risk groups.”

Unlike patients receiving cancer treatment or people with compromised immune systems, obese people may not realize they’re at higher risk of becoming severely ill. In general, obese people are less healthy than people with a BMI under 30 and at risk of developing several kinds of diseases — not just a severe COVID-19 course, she says.

To lead a healthier, longer life, Lighter says everyone should stick to three recommendations often endorsed by the medical community: Eat healthier, exercise more and don’t smoke.

Julia Corcoran produced and edited this interview for broadcast with Peter O’DowdAllison Hagan adapted it for the web. 

This article was originally published on WBUR.org.

Copyright 2020 NPR. To see more, visit https://www.npr.org.