A July 25, 2021, article1 by Joel Hirschhorn on Trial Site News highlights what he refers to as a “missed public health opportunity.” Hirschhorn is a full professor at the University of Wisconsin, Madison, a senior official at the Congressional Office of Technology Assessment and the National Governors Association, and a member of the Association of American Physicians and Surgeons, and America’s Frontline Doctors.
Even though we’ve known for well over a year that obesity is one of the most common and most significant risk factors for COVID-19 (aside from age, which you have no control over), public health authorities have ignored the issue and failed to provide guidance on how to reduce excess weight.
“Would not fighting obesity qualify as a valid prevention approach to curbing the ill effects of the COVID pandemic?” Hirschhorn asks. “Could the reason for government’s lack of aggressively pursuing an anti-obesity campaign be a bias for promoting vaccines? It seems a likely explanation.”
He points out that studies suggest vaccines tend to be less effective in obese individuals,2 and if that holds true for injected gene therapeutics against COVID, then the shots may turn out disappointing results, seeing how 42.4% of Americans are obese.3 This, Hirschhorn says, would be all the “more reason to have the public health system deal more directly with obesity to curb serious impacts of COVID.”
Charting the Obesity-COVID Connection
The U.S. Centers for Disease Control and Prevention, while slow to put some of this information out, has in fact detailed the connection between COVID-19 severity and obesity. On its “Obesity and COVID-19” page,4 the CDC frankly admits that obesity is associated with worse COVID-19 outcomes. The agency also lists obesity and excess weight as a risk factor for severe COVID-19 infection on its medical conditions known to worsen COVID outcomes page.5
Its March 12, 2021, Morbidity and Mortality Weekly Report6 (MMWR) also addresses obesity and the risk for hospitalization, ICU admission, mechanical ventilation and death.
In summary, obesity increases your risk of severe illness and triples your risk of hospitalization. It impairs your immune function, decreases your lung capacity and increases your risk of ending up on invasive mechanical ventilation — a treatment strategy shown to kill more than half of all patients. Obesity is also associated with chronic inflammation that can disrupt thrombogenic responses to pathogens.
According to the CDC, modeling suggests 30.2% of all American adults hospitalized for COVID-19 up until November 18, 2020, could be attributed to obesity,7 and the greater your body mass index (BMI) the higher your risks for a poor outcome gets. The connection between obesity and COVID-19 is particularly strong in people younger than 65.8
In its March 12, 2021, MMWR,9 the CDC reports that the risk for hospitalization, ICU admission and death were lowest among patients with BMIs of 24.2 kg/m2, 25.9 kg/m2 and 23.7 kg/m2 respectively, increasing sharply with higher BMIs. (Overweight is defined as having a BMI of 25 kg/m2 or greater, while obesity is defined as a BMI of 30 kg/m2 or greater.) The risk for invasive mechanical ventilation increased in tandem with BMI, starting at 15 kg/m2.
Although BMI is the classic research tool to assess obesity, it has limited clinical value as it can be seriously off, especially if one has loads of muscle mass, as it will be incorrectly interpreted as body fat. An accurate body fat assessment is likely a far better tool to use. The key, however, is accuracy, as many inexpensive bioimpedance devices that determine body fat are not that accurate.
Why Has CDC Not Issued a Public Health Anti-Obesity Plan?
Based on the available data, the CDC could issue detailed guidance on how to not become a statistic, but has not yet done so. As noted by Hirschhorn:10
“How does CDC address the question of what can be done to address the obesity-COVID connection? Mostly with generalities and platitudes with the emphasis on what individuals can do. Consider this statement where the words government and public health or pandemic management do not appear:
‘This will take action at the policy and systems level to ensure that obesity prevention and management starts early, and that everyone has access to good nutrition and safe places to be physically active. Policy makers and community leaders must work to ensure that their communities, environments, and systems support a healthy, active lifestyle for all.’
There is no hint of how the government is going to address the pandemic with a major commitment to use public health efforts to reduce the negative impacts of obesity.”
Similarly, in the March 12, 2021, MMWR, the CDC notes that “These findings highlight clinical and public health implications of higher BMIs, including the need for … continued vaccine prioritization and masking, and policies to support healthy behaviors.”11
Could the reason for government’s lack of aggressively pursuing an anti-obesity campaign be a bias for promoting vaccines? It seems a likely explanation. ~ Joel Hirschhorn
At the time this report was published, the injectable COVID gene therapeutics had only been out for about three months and safety data were still sorely lacking. Yet the CDC opted to prioritize vaccination while providing no public health plan whatsoever on how to address obesity.
“What is clear is that CDC thinking is mostly about considering obesity in the medical management of pandemic victims, not preventing COVID serious infections in the first place by curbing obesity at the population level,” Hirschhorn writes.12
Recent Research Strengthens Obesity-COVID Link
Studies showing the association between obesity and poor COVID-19 outcomes date back to the earlier days of the pandemic. As reported by The New York Times in mid-April 2020:13
“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.”
A study published April 9, 2020, reported that obesity doubled the risk of hospitalization in patients under the age of 60,14 even if the individual had no other obesity-related health problems. Since then, many more studies have been published showing the same trend.
One of the most recent ones was published in June 1, 2021, issue of The Lancet.15 This was a prospective community-based cohort study looking at the associations between BMI and COVID-19 severity in 6.9 million British adults over the age of 20. According to the authors:16
“Among 6,910,695 eligible individuals … 13,503 (0.20%) were admitted to hospital, 1,601 (0.02%) to an ICU, and 5,479 (0.08%) died after a positive test for SARS-CoV-2.
We found J-shaped associations between BMI and admission to hospital due to COVID-19 (adjusted hazard ratio [HR] per kg/m2 from the nadir at BMI of 23 kg/m2 … and a linear association across the whole BMI range with ICU admission …)
We found a significant interaction between BMI and age and ethnicity, with higher HR per kg/m2 above BMI 23 kg/m2 for younger people … in 20–39 years age group vs 80–100 years group …
The risk of admission to hospital and ICU due to COVID-19 associated with unit increase in BMI was slightly lower in people with type 2 diabetes, hypertension, and cardiovascular disease than in those without these morbidities.”
In their interpretation, the authors note that, starting at a BMI above 23 kg/m2, there’s a linear increase in the risk of severe COVID-19 leading to hospital admission and death. There’s also a linear increase in ICU admission across the entire BMI range that “is not attributable to excess risks of related diseases.”
In other words, it’s not related to other chronic diseases commonly associated with obesity; rather, it appears to be directly related to obesity. They also point out that “The relative risk due to increasing BMI is particularly notable people younger than 40 years and of Black ethnicity.”
Few Obese Britons Have Been Referred for Weight Management
Despite clear association between obesity and COVID severity, government action in the U.K. was found lacking.
“[S]ince most other obesity-related risks are improved with weight loss, weight-loss interventions might reduce COVID-19 disease severity,” The Lancet authors state.17
“Although we originally planned to investigate this hypothesis in our protocol, we were unable to because the number of participants reported to have been offered referrals to weight management programmes was low and weight change was poorly recorded … In the longer term, our findings highlight the need to work towards a healthy weight at a population level.”
Other Studies Showing Obesity-COVID Link
In a Canadian paper18 published July 19, 2021, that discusses treatment approaches for obese individuals, Diana Duong writes:
“There is no doubt that people with higher body mass index (BMI) suffer worse outcomes from COVID-19. One meta-analysis that pooled data on more than 399 000 people with COVID-19 found that those with obesity were 113% more likely to be hospitalized, 74% more likely to need intensive care and 48% more likely to die than those with lower BMIs.”
Similarly, an April 2021 review article19 from The Netherlands published in the journal Cells pointed out that:
“A large number of patients severely ill with COVID-19 arriving at the ICU are overweight or suffer from obesity. Obesity is associated with chronic inflammation, resulting from immune cell activity in dysfunctional (visceral) adipose tissue.
Of the eleven studies investigating the association between BMI and mortality in hospitalized COVID-19 patients, ten studies observed an increased mortality rate in patients that were overweight (BMI ? 25 to http://articles.mercola.com/sites/articles/archive/2021/08/05/obesity-and-covid-19.aspx
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