A common refrain about COVID-19 is that the virus is most dangerous to the oldest people among us.
But growing research, including some being conducted on Galveston Island, is showing that the risk from COVID is amplified far more by one factor that has nothing to do with age: being overweight.
Researchers at the University of Texas Medical Branch are developing a calculator that could help people determine their individual risk factor. In developing that tool, researchers said they are finding results that don’t match some of the common perceptions about COVID risk.
“Out in the whole scientific community, there was a lot of emphasis on age by itself, but age doesn’t move the needle a whole lot,” said John Davis, a doctoral student who is developing the calculator.
What does make a big difference in how bad a person’s COVID experience could be is their body mass index. A body mass index that classifies people as overweight was a big indicator of how sick they might get, Davis said.
Body mass index is a measure calculated from a person’s height and weight. A person with a BMI of 30 is considered obese.
“We found that it actually increased the odds of needing ventilation or a comparable oxygen demand by 200 percent,” Davis said. By comparison, a person’s age, when controlled for other factors, only increased a person’s chance of a bad outcome by a couple percentage points, he said.
Davis analyzed the outcomes of 450 people who were treated at medical branch hospitals during the pandemic. He focused on the characteristics of people who needed ventilators because that correlates with other poor outcomes, including deaths, he said.
The information could be something worth bearing in mind in coming months, Davis said. While the United States is slowly moving toward being vaccinated, it will still likely be months before there’s widespread community immunization.
There’s also the rising threat of mutated COVID strains that could be resistant to vaccinations, Davis said.
The Galveston County Health District has reported 242 deaths connected to COVID-19 since April 2020. In every case, the health district has said the person who died had a pre-existing condition that contributed to their death. The district hasn’t released more detailed information.
Of the people in Galveston County who died, 207 people have been older than 61 years old, according to the district. That’s 85 percent of total deaths.
Generally, most of the people who have died were overweight or had conditions related to being overweight, including heart disease and cancer, said Dr. Philip Keiser, Galveston County local health authority.
The reason that being simply overweight is dangerous for people with COVID-19 can come down to physics, said Dr. Shawn Nishi, a pulmonologist at the medical branch who supervises one of its COVID units. The virus attacks the lungs, and people who weigh more have to work harder to breathe if they become ill.
“When you’re talking about COVID and you’re in the ICU, there’s a lot of weight on those lungs,” Nishi said. “There’s a lot of changes that occur with obesity with the function of your lungs and your heart. That makes it a lot harder to take care of a patient.”
Of the 11 people who were intubated in the intensive care unit at the medical branch on Jan. 26, seven were obese and three more were just under the BMI definition of obesity, Nishi said.
The number of people who appear in the hospital and are obese isn’t surprising, health officials say.
Obesity already was considered an epidemic in the United State before the COVID pandemic, Nishi said. Three-quarters of the U.S. population older than 20 years is considered overweight and 42 percent is considered obese. Obesity rates are even greater in the Houston area, Nishi said
The prevalence of overweight people in the community might make people less aware of how big a risk they are to themselves. While health organizations have long warned about the dangers of obesity in overall health, the message hasn’t really stuck, Nishi said.
“We joke a little bit about whether a person is obese or whether they’re ‘Texas-sized or just a little overweight,’” Nishi said. “I think we’re a little more accepting of being overweight and of obesity because we’re just surrounded by that.”
Nishi has little hope the pandemic would change those attitudes, she said.
Keiser was skeptical that people could be convinced to change their diet and exercise habits because of the pandemic, given how difficult it has been for people to take far less life-altering measures, like wearing a mask around others, he said.
But Keiser was hopeful that, when the world comes out of the pandemic, public health entities would be able to put a greater emphasis on addressing issues like obesity.
“Every year, initiatives get made that are very noble and aspirational, but when you really get down to it, there’s not a lot of money to implement them,” Keiser said. “I’m hopeful that as we get out of the pandemic, we’ll have funding to not just do future pandemic preparation but also on noncommunicable diseases. That’s the big deal in America right now.”