Obesity and COVID-19: How One Epidemic Makes Another Deadlier

Check-ups rescheduled. Surgeries postponed. Exercise regimens lapsed.

In a middle of a pandemic, it can be easy to lose focus on the other medical conditions so many of us live with every day. But it’s never been more important to address those conditions, because improving our underlying health can dramatically improve our outcomes if we do fall sick. Obesity is a prime example.

My last article discussed the fact that communities with high rates of co-morbidities such as obesity are experiencing higher rates of mortality from the virus. According to the U.S. Centers for Disease Control and Prevention, those with a body mass index of 40 or over are at much greater risk of severe illness from COVID-19. So what is it about obesity that raises that risk?

COVID-19’s deadliness is due in part to how our bodies fight infection: through inflammation. Normally, it’s a regular part of the healing process, and one of the ways our immune systems clear damaged tissue to begin repairs. But for some COVID-19 patients, that response goes into overdrive, and as inflammation gets out of control, it can cause serious damage throughout our body, including our lungs. People suffering from obesity already experience higher rates of inflammation, so this added intensity of the response becomes even more dangerous. Coupled with inflammation is oxygen deprivation, another symptom that frequently demands hospitalization in COVID-19 patients and is already prevalent in those suffering from obesity.

Once obese patients get to the hospital, they face greater challenges to care than patients with a lower BMI. Intubation, or the insertion of a tube into the airways to enable breathing assistance via respirator, is more difficult, as is moving patients during emergencies. This is especially true for under-resourced healthcare systems: the World Obesity Federation has warned that “Special beds and positioning/transport equipment are available in specialized surgery units, but may not be widely available elsewhere in hospitals and certainly not in all countries.”

Coronavirus is only the latest “secondary” disease to be exacerbated by obesity, and it won’t be the last. From diabetes to coronary and respiratory illnesses, these diseases take the focus while the condition that either causes them or makes them far deadlier does not get the same attention from the patient or their caregiver. How can we change this?

Recognize obesity as a disease.

Both doctors and patients need to approach obesity the way they would any other life-threatening condition, even if secondary diseases such as hypertension or diabetes have not yet been diagnosed. The worldwide rates of obesity are growing at a rate that would never be tolerated were it a more conventional disease. It’s time to start thinking about and reacting to it the same way we do other life-threatening illnesses.

Remove the stigma.

As I’ve discussed in a previous article, the stigma surrounding obesity can mean people are less likely to seek treatment and less likely to continue it if they feel shamed by their medical professionals and communities. Care must be provided in a supportive, judgement-free environment for it to be most effective.

Change the model.

One of the reasons why the treatment of obesity has been such a challenge in the modern world is the fact that our model is incentivized to treat the secondary diseases in a stop-gap manner rather than the root cause in a preventive approach. From research to medication, it is more profitable for the medical industry to manage diabetes or hypertension than it would be to solve the condition that causes them. Changing this will require a fundamental shift in the model, but the results will be worth it for patients and our healthcare system.