Obesity and COVID-19

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This blog was written by Michael Jones, DO, Centra Medical Bariatrics Services in light of the pandemic to accompany the release of his previously recorded podcast for Nutrition Month.

During this difficult time that for most of us is unprecedented in our lifetimes, we have been hearing about COVID-19, the condition caused by the novel SARS-related coronavirus from just about every angle imaginable. Well, here’s one more angle – the potential relationship between obesity and COVID-19 risk.

              We already have evidence for certain groups at significantly increased risk of severe disease and death resulting from COVID-19.[1]  These include those with:

  • Advanced age
  • Cardiovascular disease
  • Diabetes mellitus
  • Chronic lung disease
  • Hypertension
  • Cancer

So, where exactly does obesity come in? Obesity, it turns out, is a risk factor for and/or aggravated by at least 4 of the categories on that list. In a study of a group of COVID-19 positive individuals with cardiovascular disease in China, 45% of those who ultimately died from the illness had obesity (a BMI greater than 30), while in the same group only 3% of those who died had a BMI less than 25.[2] Further, if we may use the 2009 H1N1 “Swine Flu” pandemic as perhaps a historical parallel, a convincing association between obesity and the increased risk of death from the illness was found and reported in 2 separate studies[3],[4].

The question then becomes, why?! The following are several potential reasons, some of which have more supporting evidence than others.

  • Compromised lung function – those with obesity are at notably increased risk for obstructive sleep apnea, asthma, smaller lung volumes and worsened symptoms for those with COPD/Emphysema along with obesity.
  • Increased risk of Coronary Artery Disease and Congestive Heart Failure both serve to impair oxygen exchange. Specifically, this and compromised lung function worsen the prognosis, particularly for those that require mechanical ventilation.
  • Increased risk of Diabetes – noted above
  • Increased risk of Hypertension – noted above
  • Potential for increased inflammatory response in the lungs – this is thought to be as a result of the chronic, low-grade inflammatory nature of obesity.

Perhaps you find this information somewhat alarming…especially if you or a loved-one has obesity or any of the other conditions that increase your risk. However, as we have all been told repeatedly in recent days, there are things we can – and should – do to reduce our risk.

  1. Avoid Infection – to most this hopefully sounds obvious, though there are those not taking steps to avoid contracting or spreading the infection. These steps include:
  2. Social distancing – endeavor to keep 6 feet between you and those around you when you must be out of your home.
  3. Handwashing – frequently and vigorously with soap and water for at least 20 seconds. Use alcohol-based hand sanitizer only when soap is not readily available.
  4. Avoiding travel
  5. Covering coughs and sneezes – this should be done with a tissue, washing hands immediately afterwards.
  6. Avoiding touching your face – if you must, wash your hands as above first.
  7. Make sure your Flu and Pneumonia vaccines are up to date – you DO NOT want to be more likely to have to fight off more than one illness at a time.
  8. Self-isolate for 14 days if you suspect you have symptoms of illness.
  9. Exercise – this will provide a much-needed distraction and stress relief during this trying time. In addition, routine exercise helps with mental and physical health maintenance.
  10. Good Nutrition – Much has been written of the potential effects of good nutrition on immune function among other benefits. However, much of the evidence has been inconclusive. That said, there are certainly ways to use food to improve over-all health which can only help if one contracts COVID-19. Following are some possible areas of nutritional impact.
  11. Adequate protein intake – this can vary but for most adults 60-80 grams of protein per day should satisfy this recommendation. Sources of protein are meats, nuts, fish, etc.
  12. Avoid pro-inflammatory foods – if obesity indeed adds to lung inflammation in the setting of a lung illness, it will likely not be helpful to add “gas to the fire” by eating pro-inflammatory foods. A couple examples are…
    1. Processed meats
    1. Refined carbohydrates
    1. Trans fats
    1. Red meats
    1. Margarine
    1. Sugar/sugar-sweetened beverages
    1. Excessive alcohol
    1. Vegetable and seed oils
    1. Fried foods
  13. Consume more anti-inflammatory foods
    1. Tomatoes
    1. Fatty fish like salmon, tuna and especially the “tiny fish” – sardines, mackerel and herring.
    1. Nuts
    1. Olives/olive oil
    1. Avocados/avocado oil
    1. Green leaves – the darker the better
    1. Berries – especially blackberries, blueberries and raspberries.
  14. Adequate water intake – 64oz per day is generally adequate for most people. Do not count caffeinated drinks or sodas in this total. If your doctor has for some reason placed you on a fluid restriction, follow his/her advice.
  15. Supplements – though there is not a lot of clear evidence for most of the supplements currently on the market that may claim immune/infection-fighting benefits, here are a few of the more likely helpful options if you choose to spend your money this way – though I would recommend using an overall healthy diet to get these in their natural state when possible.
    1. Zinc
    1. Vitamin C
    1. Turmeric

Finally, it may be helpful to provide a few tips on shopping. These may be a good idea in general but may be particularly useful during this pandemic.

  1. Seek out the healthiest foods (see above for ideas). Thus far it has been my experience that the healthier foods are not so much where we are seeing shortages in the grocery stores. Use this time to begin altering your diet for a lifetime.
  2. Plan your meals ahead. This will help you better budget your money as well as your food intake. We tend to make much better decisions when they are not done spontaneously.
  3. Shop early in the day. Speaking of decision-making. There is the phenomenon known as “decision-fatigue” which has been shown to occur later in the day. In other words, our more sound and well-reasoned decisions tend to happen early. Your resolve to make healthier choices is less likely to break down the earlier you shop.
  4. Shop when store is less crowded. See number 3. Potentially related to a type of peer-pressure, shoppers tend to buy more and be less cautious in their purchasing when the store is crowded.
  5. USE curbside grocery pick-up. This has several potential benefits. First, it helps us to avoid impulse purchases of those comfort foods we would love to be comforted with in stressful days such as these. Secondly, it furthers our mission to stay relatively isolated so that we can “flatten the curve” (reduce rapid spread of the virus). Finally, it forces you to plan your meals, thus your shopping list, ahead of time (see #2) so you can place your order on that store’s shopping app.

Everywhere we look of late there are opinions as to what we should do and how we should live in light of COVID-19. There is much good advice though frequently one must wade through some ill-conceived notions and even scams that have arisen. It is my hope that these recommendations will serve a helpful purpose that adds something new to this discussion. Stay safe, be considerate of others, look for ways to serve those in need and let’s #flattenthecurve.

[1] Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html (accessed March 26, 2020).

[2] Peng YD, Meng K, Guan HQ, et al. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48(0):E004. doi:10.3760/cma.j.cn112148-20200220-00105

[3] A Novel Risk Factor for a Novel Virus: Obesity and 2009 Pandemic Influenza A (H1N1)

Louie JK, Acosta M, Samuel MC, et al.  Clin Infect Dis. (2011); first published online: January 4, 2011

[4] Morbid Obesity as a Risk Factor for Hospitalization and Death Due to 2009 Pandemic Influenza A(H1N1) Disease

Morgan OW, Bramley A, Fowlkes A, et al.PLoS ONE 5(3): e9694; 2010

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