Since the early days of the pandemic, conventional wisdom has been that our salvation from COVID-19 lies in a vaccine. But it’s becoming increasingly clear salvation might require something few people have been willing to do, which is take a deep, hard look at themselves, the health of this nation and the more deadly epidemic of obesity.
America’s obesity epidemic threatens the effectiveness of any COVID-19 vaccine, Sarah Varney reported Aug. 6 in a health news item for Kaiser Permanente, one of the nation’s largest not-for-profit health plans.
“Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that COVID-19 vaccines will be any different,” Varney reported.
The harsh reality is two epidemics are colliding. More than 107 million American adults are obese, and their ability to return safely to work, care for their families and resume daily life could be curtailed if the coronavirus vaccine delivers weak immunity for them, according to Varney’s report.
Through the pandemic, much focus has been on older adults in frail health and people with underlying health conditions, such as diabetes and heart disease, who are more vulnerable to developing severe cases of COVID-19.
But as the pandemic has dragged on, health care providers have gleaned more about COVID-19 patients and outcomes.
What doctors have learned is that obesity itself, not just underlying diseases often associated with it, is a risk factor for poor COVID-19 outcomes.
“In fact, obesity is the number-one risk factor for developing a severe case of COVID-19 in people under the age of 55,” warns Dr. Kyle Stephens, weight loss surgeon at Houston Methodist Hospital.
As intensive care units in New York, New Jersey and elsewhere filled with patients, the U.S Centers for Disease Control and Prevention warned people considered morbidly obese — a body mass index of 40 or more or about 100 pounds overweight — were among the groups at highest risk of becoming severely ill with COVID-19. About 9 percent of American adults are in that category.
But as weeks passed, a clearer picture of who was being hospitalized came into focus, prompting federal health officials to expand their warning to include people with a body mass index of 30 or more. That vastly swelled the ranks of the most vulnerable to 42.4 percent of American adults, Varney reported.
Obese patients face greater risk of respiratory failure, the need for mechanical ventilation and higher mortality, according to the Mayo Clinic.
Anyone can get infected with the new virus that causes COVID-19. And it’s still unclear why obesity puts a person at higher risk, but there are some theories, Stephens said.
“One thought is that the infection may exacerbate the breathing difficulties that overweight people often experience, even if they don’t know it,” Stephens said. “Another theory is that obesity may increase the chance of a person experiencing ‘cytokine storm’ — a life-threatening immune-related complication of COVID-19. Lastly, having more fat may help the virus stick around longer due to molecular properties of both fat cells and this particular virus.”
Severe obesity puts those with coronavirus disease at particularly high risk of death, more so than related risk factors such as diabetes or hypertension, according to a study of patient records Kaiser Permanente’s researchers published earlier this month.
The study, appearing in Annals of Internal Medicine, showed obesity is especially dangerous for men and younger patients who contract COVID-19 and that obesity stood out from racial, ethnic or socioeconomic disparities when isolated from those factors.
The good news is that obesity is preventable and reversible. The bad news is it has become so common in society no one notices anymore and in some cases people celebrate it.
“People don’t always see obesity as abnormal, since it’s quite prevalent, but it’s important to know if your weight is putting you at risk for COVID-19, as well as other health conditions,” Stephens said.
Fat-shaming is reprehensible, but there’s a grave danger in “normalizing” obesity as so many advertisers have tried to do, probably with good intentions. While such movements have discouraged holding up rail-thin models as ideal, they also have made a dangerous shift to campaigns that assert it’s fine to be overweight with such slogans as “fat pride.”
Obesity isn’t just a cosmetic concern. It’s a medical problem that increases risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers, according to the Mayo Clinic.
People struggle with obesity for many reasons, including food addiction. Dietary changes, increased physical activity and other behavior changes can help.
Ultimately, salvation from COVID-19 hinges on the individual, but reducing obesity must become a serious national health priority.
“Will we have a COVID-19 vaccine next year tailored to the obese? No way,” Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill told Kaiser Permanente’s Varney.
“Will it still work in the obese? Our prediction is no.”
• Laura Elder