Obesity Linked to Severe Coronavirus

Disease, Especially for Younger Patients

Young adults with obesity are more likely to be hospitalized, even
if they have no other health problems, studies show.

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 A patient arrived at Elmurst Hospital Center in Queens, N.Y., this month. Kathy
Willens/Associated Press

By Roni Caryn Rabin

Published April 16, 2020 Updated April 17, 2020 152

Obesity may be one of the most important predictors of severe

coronavirus illness, new studies say. It’s an alarming finding for the
United States, which has one of the highest obesity rates in the
world.

Though people with obesity frequently have other medical

problems, the new studies point to the condition in and of itself as
the most significant risk factor, after only older age, for being
hospitalized with Covid-19, the illness caused by the coronavirus.
Young adults with obesity appear to be at particular risk, studies
show.

The research is preliminary, and not peer reviewed, but it

buttresses anecdotal reports from doctors who say they have been
struck by how many seriously ill younger patients of theirs with
obesity are otherwise healthy.

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 No one knows why obesity makes Covid-19 worse, but hypotheses
abound.

Some coronavirus patients with obesity may already have

compromised respiratory function that preceded the infection.
Abdominal obesity, more prominent in men, can cause compression
of the diaphragm, lungs and chest capacity. Obesity is known to
cause chronic, low-grade inflammation and an increase in
circulating, pro-inflammatory cytokines, which may play a role in
the worst Covid-19 outcomes.

Some 42 percent of American adults — nearly 80 million people —

live with obesity. That is a prevalence rate far exceeding those of
other countries hit hard by the coronavirus, like China and Italy.

Obesity is defined by a measure called body mass index, which is

based on a formula that divides one’s weight in kilograms by the
square of one’s height in meters. Someone who is 5 feet 9 inches
tall and weighs 203 pounds would have a B.M.I. of 30, which is
considered obese.

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 The new findings about obesity risks are bad news for all
Americans, but particularly for African-Americans and other
people of color, who have higher rates of obesity and are already
bearing a disproportionate burden of Covid-19 deaths. High rates of
obesity are also prevalent among low-income white Americans,
who may also be adversely affected, experts say.

More than half of Covid-19 deaths in the United States so far have
been in New York and New Jersey, but the new findings mean the
coronavirus could exact a steep toll in regions like the South and
the Midwest, where obesity is more prevalent than in the
Northeast.

“If obesity does turn out to be an important risk factor for younger
people, and we look at the rest of the United States — where
obesity rates are higher than in New York — that will be of great
concern,” said Dr. Roy Gulick, chief of infectious diseases at Weill
Cornell Medicine. “We may see a lot more younger people being
hospitalized.”

Dr. Gulick’s review of data from the first 393 Covid-19 patients
admitted to NewYork-Presbyterian/Weill Cornell Medical Center
and NewYork-Presbyterian Lower Manhattan Hospital identified

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 obesity as a risk factor for admission. He also found that among
adults under the age of 54, half live with obesity, though the New
York City obesity rate is only 22 percent.

One of the largest U.S. studies to identify obesity as a prominent

risk factor analyzed data from more than 4,000 Covid-19 patients
who sought care at NYU Langone Health between March 1 and
April 2.

“Obesity is more important for hospitalization than whether you

have high blood pressure or diabetes, though these often go
together, and it’s more important than coronary disease or cancer
or kidney disease, or even pulmonary disease,” said Dr. Leora
Horwitz, the paper’s senior author and director of the Center for
Healthcare Innovation and Delivery Science at NYU Langone.

Obesity also appears to be a factor for higher risk of death from

Covid-19, though to a lesser degree, Dr. Horwitz said

She cautioned that the findings were preliminary, noted that some
of the data was still incomplete and emphasized that the paper had
not been peer reviewed.

Scientists are still somewhat puzzled by the impact of obesity on

the course of the disease, but Dr. Horwitz said the implications for
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 patient care were clear.

“It means that as clinicians, we should be thinking a little more

carefully about those patients with obesity when they come in —
we should worry about them a little bit more,” she said.

Another NYU Langone study, which focused on patients under the

age of 60, found that those with obesity were twice as likely to be
hospitalized and were at even higher risk of requiring critical care.
The association between obesity and more severe disease was not
seen in patients over the age of 60.

The severity of the illness often comes as a surprise to younger

adults, and “provides another layer of shock to this disease,” the
paper’s author, Dr. Jennifer Lighter, said.

Studies highlighting the risks of obesity have been conducted in

other countries as well.

Though most of the early reports from China pointed to risk factors
like Type 2 diabetes and hypertension, which are common in
people with obesity, scientists in Shenzhen, China, posted a
preliminary report online this month finding that Covid-19 patients

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 with a high body mass index were at more than double the risk of
severe pneumonia than those with a lower B.M.I.

Another study from China, which looked at outcomes among a

group of 112 Covid-19 patients, reported that of the 17 patients who
died, 15 were either overweight or obese.

More recently, a French study reported that nearly half of 124

Covid-19 patients in Lille, France, had obesity, twice the rate of a
comparison group of intensive care patients hospitalized for other
reasons last year. The study also reported that the need for
mechanical ventilation increased with higher body weight.

At Ochsner Health, a system with 41 hospitals in Louisiana and

southern Mississippi, Dr. Leo Seoane, the company’s senior vice
president, said that 60 percent of patients hospitalized with Covid-
19 had obesity and that obesity appeared to nearly double their risk
of requiring a ventilator.

The Coronavirus Outbreak

Frequently Asked Questions and Advice

Updated June 2, 2020

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 • Will protests set off a second viral wave of coronavirus?
Mass protests against police brutality that have brought thousands of
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“We in the U.S. have not always identified obesity as a disease, and
some people think it’s a lifestyle choice. But it’s not,” said Dr.
Matthew Hutter, director of the Weight Center at Massachusetts
General Hospital and president of the American Society for
Metabolic and Bariatric Surgery. “It makes people sick, and we’re
realizing that now.”

Conventional wisdom has traditionally explained excess weight as

a simple caloric imbalance that can be addressed by eating less
and exercising more. Prominent medical groups have reconsidered
their approach, however, and now recognize obesity as a medical
disorder caused by a complex web of underlying factors, which in
turn predisposes people to other serious medical problems.

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 Some doctors consider obesity a marker of poor health associated
with poverty, reflecting a combination of social and economic
factors, from inadequate education and limited job opportunities to
impoverished neighborhoods where access to healthy food,
medical care and opportunities for exercise are scarce.

Obesity’s link to chronic diseases is well known, but the experience

with H1N1 influenza in 2009 revealed that people with obesity are
also more vulnerable to infectious diseases. Studies have also
shown that they do not get the same protection from influenza
vaccinations that others do.

Physicians say patients with obesity can be harder to manage in

the hospital setting. They require special beds and imaging
equipment, and they are harder to intubate and harder to assess
when removing a ventilator.

Advocates for people with obesity say they may also delay seeking
care, deterred because they have been treated poorly by health
care providers in the past.

“They worry: ʻIf I go to the hospital, am I going to be triaged based

on my body mass index? Is the skinny person next to me going to

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 get the ventilator, not me?’” said Dr. Donna Ryan, associate editor
in chief of the journal Obesity.

Doctors in the trenches treating critically ill coronavirus patients

say they expected to see old and elderly patients become acutely
and critically ill, but the young patients becoming severely sick
have unnerved them.

Of the 14 Covid-19 patients recently in Dr. Sanam Ahmed’s critical

care unit at Mount Sinai on the Upper East Side, she said, 12 were
at least 50 years old and had complex medical problems. The two
younger patients, who were in their 30s, had obesity and no other
diseases.

“It looks like, for them, obesity is the risk factor,” Dr. Ahmed said.

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