The Blunt Truth About COVID-19 and Obesity
'Politically-incorrect' comedian Bill Maher holds a number of kooky, anti-science views, but in a recent monologue on his popular HBO talk show Real Time, he shared a candid, evidence-based truth: obesity in America is a major driver of COVID-19 illness and death.
"America fighting COVID is like a boxer who went into the ring, out-of-shape and is taking a beating for it... I think so many lives could have been saved at the very beginning of this crisis if the medical establishment had made a more concerted effort to tell Americans, 'while you're in lockdown, getting free money for not working, you need to do something, too... A national campaign to get in shape would have dramatically improved our chances against this disease..."
America's obesity rate currently stands at an astounding 42.4%, up from 30.5% just twenty years ago. Obese individuals have a body mass index of 30 or greater. To fall into this category, someone who stands 5'9" (the average height for a male) must weigh at least 203 pounds. Similarly-tall individuals tipping the scales at 237 pounds have a body mass index of 35. People in this category suffer vastly more from the effects of COVID-19. A study in France found that they are twice as likely to require mechanical ventilation after entering the intensive care unit compared to healthy-weight individuals. A systematic review discovered that obese COVID-19 patients were 2.3 times more likely to have severe disease. Public Health England recently shared the most glaring data. "For people with a BMI of 35 to 40, risk of death from COVID-19 increases by 40% and with a BMI over 40 by 90%, compared to those not living with obesity."
Johns Hopkins cardiologist David Kass offered three explanations for why obesity significantly worsens the effects of COVID-19.
"People with substantial obesity... are carrying a lot of excess weight mostly in their abdomen, below the diaphragm. You move your diaphragm toward your feet every time you breathe, and if you have an extra 80 pounds or more to move, that makes breathing harder."
Inflammation is another key factor, he said.
"Fat itself... produces a fair number of pro-inflammatory molecules called cytokines, which are a type of immune protein. It's as if your body is kind of battling itself continuously... producing a low level of background inflammation. So if you are obese, this is the baseline. Now you superimpose a bigger battle with a novel virus that the immune system has not seen before, and it becomes hyper-activated. That's not going a good combination."
Kass also referenced the ACE2 protein.
"This protein is key for the COVID-19 virus, since the virus must bind to it in order to gain entry into a cell. It turns out fat cells express ACE2 at fairly high levels, and there are some past data on this idea related to other respiratory viruses that they can attack fat, last in fat, and shed more slowly from fat."
COVID-19 isn't the only disease to be exacerbated by obesity. Obesity also abets certain types of cancer, heart disease, stroke, and osteoarthritis. In 2009, obesity drastically worsened outcomes during the H1N1 pandemic.
However, given it's stark impact on COVID-19 mortality, some doctors are now calling for obesity itself to be recognized as a disease, and treated with pressing urgency on individual, cultural, societal, and political levels.