TREASURE COAST ― Dr. Diego Maldonado, a pulmonologist at Cleveland Clinic’s Indian River Hospital, wants the community to know that there is one important COVID-19 risk factor that is in their control: weight.
According to Dr. Maldonado, obesity makes it more likely that you will be hospitalized if you get COVID-19, and you will have a much more difficult time with the virus. It even makes it more likely you will die.
Dr. Maldonado says that obesity is a factor in about 40% of the patients admitted to the hospital who have a poor outcome and complicated course of COVID-19.
Studies in Europe and the United States, Dr. Maldonado told Hometown News, “identified several risk factors, one of which they found to be obesity, a BMI of more than 30. They also found that the more obese patients with a BMI greater than 35-40, severe obesity, have a higher risk of more complications from the COVID-19 infection. That means an increased risk of severe disease, hospitalization, ICU admission, intubation and mechanical respirator support.”
“They found that, independently of other risk factors such as diabetes, hypertension, chronic heart condition, which are also risk factors for a complicated course of COVID-19 infection, obesity was a factor regardless of those other comorbidities. That’s what the retrospective cohort studies have shown.”
Following those initial studies, Dr. Maldonado said researchers were uncertain why obesity was such a great risk factor for COVID-19. So follow up studies were conducted to find the reasons, one of which was published in July in the Annals of Internal Medicine.
“That study included almost 2,500 patients, and they found that obese patients have an increased risk of intubation and death. When they divided it in age groups, they found that patients younger than 65 years old were a higher risk than the ones older than 65 years old, regardless of sex, ethnicity, or other comorbidities. That confirmed that obese patients are at a higher risk of severe disease and even death.”
Dr. Maldonado said researchers then looked deeper, at the molecular level.
“What they found is that obesity complicates a COVID-19 infection, because when you have an increased fat mass, you have an overreaction of the inflammatory cascade (the body’s response) when confronting the infection. The inflammation can start to cause organ failure in these patients.”
“They also found the receptors in the fat cells that the COVID-19 likes to bind to are over-expressed in these patients because of the fat tissue. That creates a reservoir where the virus can replicate easily in the fat tissue because of the high level of receptors in these patients. So you will need a prolonged time to clear the virus from these patients.”
That aspect of the problem makes obesity a danger not only to the obese person, but to others they come into contact with, as they carry the virus around longer.
“Fat tissue increases the level of receptors to bind to the virus. That prolongs the virus - it takes longer for the virus to leave that host. You become a danger to other people for a longer period of time.”
Another problem researchers found was a three times higher risk of developing clots in patients with a BMI higher than 30. Obese patients also can have a restriction of the diaphragm, making it harder to expand their lungs to breath deeper, leading to lower levels of oxygen, another risk factor.
If the obese patient has an additional risk factor like diabetes, a COVID infection is normally even worse.
“They do interact. If you are obese but you don’t have any other comorbidities, you have a higher risk factor of complications and death. But if you also have another risk factor like diabetes, hypertension, chronic heart disease, kidney disease, that adds on to your risk.”
“Patients with obesity are usually associated with these other comorbidities. So obesity is the tip of the iceberg. Then there are also other comorbidities that increase with aging that add on to this problem.”
Our conversation turned to a recent segment by the comedian Bill Maher on HBO, in which Mr. Maher argued that Americans should do their part in the fight against COVID-19 by confronting the country's obesity epidemic. Mr. Maher said that America’s eating habits are a main reason we can’t beat COVID. Dr. Maldonado agreed.
“Absolutely. There is no cure for COVID, and there is no treatment for COVID. Science is working hard on that. There are things we cannot control, like age. I cannot make myself younger.”
“But obesity is a reversible situation. (Bill Maher) is absolutely right, because you can reverse obesity. There is a study that shows that even losing five percent of your BMI could be enough to prevent a lot of these complications.”
“People should get in shape. Exercising, changing your eating habits, can decrease your risk, not just of COVID complications, but even death. We have very strong data on that. To survive this pandemic, lose weight. A patient needs to take that seriously, make some changes in lifestyle.”
“If your BMI is very high, 35-40, you are at even higher risk, so you should be applying more prevention measures such as increasing social distancing and strict use of masks. Everything that CDC recommends is even more important in this population because of the risk that they have.”
In other words, Dr. Maldonado said, the need to wear masks and social distance, which he endorses for everyone, is even more important for obese people.
Obesity is such an important risk factor for COVID-19 that Dr. Maldonado says convincing people to lose weight is even more important than convincing them to quit smoking.
“Surprisingly, patients with chronic lung conditions are at higher risk for complications with infections of the lungs like pneumonias, but the data with COVID so far is not supporting that these patients get sicker with COVID. There are studies of this going on right now.”
Dr. Maldonado emphasized that, other than wearing masks and social distancing, the single most important thing we can all do to combat COVID-19 is to lose some weight.
“You don’t need to be a scientist to understand that wearing a mask and social distancing is important. But if you are overweight, you must do something about it, or it can kill you. It has to be in your COVID prevention measures to change your lifestyle and lose weight, and exercise. That’s not going to just affect the course of COVID, it’s going to affect your health overall, preventing other diseases. It is very important to educate our community in that regard.”
Dr. Diego Maldonado is board-certified in Critical Care Medicine, Internal Medicine and Pulmonary Disease. He is a former Chief Fellow in Critical Care and Pulmonary Medicine at the University of Miami-Jackson Memorial.