Obesity Most Significant Risk Factor to Covid-19 Hospitalization after Age

A new large-scale preliminary US study[1] looking at data from more than 4000 Covid-19 patients who sought medical care at Langone Health Hospital in New York City found that outside of older age (> 75 years of age), obesity was the single most significant risk factor that contributed to requiring hospitalization and critical care, such as requiring being on a ventilator. This is a different study than the one that I wrote about yesterday [2] which found that in people under the age of 60, obesity poses a significant risk factor of hospitalization, especially with respect to requiring Acute Care or Intensive Care (click here to read that article).

We Need to “Get” This

Taken together, these two large-sample US studies find that being obese (which is having a Body Mass Index (BMI) of 30 or more) puts those under 60 years of age at significantly greater risk of being hospitalized and requiring critical care than any other factor, including high blood pressure (hypertension), diabetes and cardiovascular disease (CVD) [2], and having a BMI of 40 is the most significant risk factor after older age[1]. Old or young, being obese is a significant risk factor to requiring medical intervention in Covid-19. What many don’t realize is that 2/3 people in the US and Canada are either overweight or obese. 

How Big an Issue is Obesity?

One in three adults in the US are obese and one in four adults in Canada are obese. Not just overweight, but obese.

We have become used to this being common place, so much so that many of us consider “average weight” what is actually overweight (BMI between 25 and 30) and consider someone to be “overweight” when they are actually obese.

As mentioned in an article from earlier this week, recent US data found that 90% of patients hospitalized due to Covid-19 had underlying medical conditions including hypertension (high blood pressure), obesity, diabetes and cardiovascular disease and as noted in that article, only 12% adults are considered metabolically healthy as defined as having a healthy waist circumference and normal systolic and diastolic blood pressure, blood glucose and HbA1C and cholesterol such as HDL, as well as triglycerides.

Looking at this information together, we need to understand that something as straight-forward as losing weight, particularly the weight that we carry around our middles can significantly improve our outcome should we become infected with Covid-19. 

With many experts suggesting that it is only a matter of time until we are all exposed to Covid-19, it would seem that it ‘s not a matter of “if”, but “when” and while we can’t change our age, but if we are overweight or obese, we can lose weight. If we are carrying excess fat around our abdomen (the risk of having an increased waist circumference) — even at normal body weight, we can lower that. It takes being willing to make dietary and lifestyle changes and it take some time, but in a matter of weeks, someone who is currently in the class I obesity category can be re-categorized as overweight and with persistence can achieve a healthy body weight and waist circumference.  Previous studies indicate that significant risk factors such as high blood pressure and abnormal blood sugar can be normalized in as little as 10 weeks with a well-designed diet of whole, real food and by making these changes now we can significantly lower our risk in a fairly short amount of time. Why would we not want to do so now given there is currently no vaccine for Covid-19 and no consistently effective medication yet?

[Note: If I hadn’t already gone from being obese to a normal body weight a few years ago, I certainly would be very motivated to do it now.]

For the past 5 years I have spent about half my clinical time helping others do just that, while helping them considerably improve their lab markers for several different metabolic conditions. Since we are already eating most of our meals at home, now is an ideal time to make the dietary changes needed to lower our risks of requiring hospitalization should we get Covid-19.

More Info?

If you would like more information about how I can help you lose weight and then keep it off, please reach out to me. All my services are now provided via Distance Consultation but I already have more than a decade of experience providing virtual nutrition support, so this is nothing new for me and I am licensed as a Dietitian in every province in Canada except PEI. I can also provide nutrition education services to those in the US and elsewhere.

You can find more about the details of the different packages I offer by looking under the Services tab or in the Shop. If you have any service-related questions please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/JoyKiddie
Facebook: https://www.facebook.com/BetterByDesignNutrition/

References

  1. Christopher M. PetrilliSimon A. JonesJie YangHarish RajagopalanLuke F. O’DonnellYelena ChernyakKatie TobinRobert J. CerfolioFritz FrancoisLeora I. Horwitz, 
  2. Lighter J, Phillips M, Hochman S et al, Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission, accepted manuscript, Clinical Infectious Diseases. doi: 10.1093/cid/ciaa415,  https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa415/5818333
  3. Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders Vol 20, No. 20, pg 1-7, DOI: 10.1089/met.2018.0105

Obesity Poses Significant Risk to People less than 60 years with Covid-19

As covered in the preceding article, we now know from US data between March 1-30, 2020 that older adults and those with hypertension (high blood pressure), obesity, diabetes and CVD are at an increased risk of requiring hospitalization should they contract Covid-19, but a new study finds that so are young people with obesity.

A study released ahead of publication found that of the more than 3600 people who tested positive for Covid-19 in a large academic hospital in New York City, more than 20% had a BMI of 30-34 (Class I obesity) and more than 15% had a BMI > 35 (Class II obesity or higher). When stratified by age, researchers found significantly higher rates of hospital admission and the requirement for ICU care in patients <60 years of age with obesity.

Compared with patients with a BMI of < 30 (i.e. overweight but not obese), patients under 60 years of age with Class I obesity were;

  • 2.0 times more likely to be admitted to Acute Care
  • 1.8 times more likely to be admitted to intensive care

Compared with patients under the age of 60 years old with a BMI <30 (not obese), patients with a BMI of 35 and above (Class II obesity and higher) were;

  • 2.2 times more likely of being admitted to Acute Care
  • 3.6 times more likely to be admitted to intensive care

Among the 3600 patients who were subjects in this study, there was no significant difference in hospitalization rates and intensive care needs by BMI among people 60 years of age and older, which is consistent with findings reported in the preceding article which found that obesity was a significantly higher risk factor of hospitalization in those 18-49 years of age [1].

Note: As covered in the previous article, hypertension (i.e. high blood pressure) is a significant underlying condition to adults ⩾ 65 years of age hospitalized with Covid-19.

Patients with a BMI of ⩾30 in the current study represented 36% of all patients; which is fairly representative of the US population as a whole which is estimated to have an obesity rate of BMI ⩾30 of 40% [3,4]. Given that obesity rates of BMI ⩾30 in Canada [5] is ~ 33%, it is possible that need for hospitalization and acute or intensive care may be somewhat lower here (i.e. more reflective of the slightly lower obesity rates in Canada).

With a vaccine for COVID-19 a year or longer away, current efforts to reduce the risk of contracting the virus necessarily focus on physical and social distancing, personal hygiene including proper hand-washing techniques and avoiding touching one’s face, as well as wearing face coverings in public places. These are all very important, however those under the age of 60 years of can reduce the risk of getting serious complications or dying from complications from the virus by achieving, then maintaining a healthy body weight.

Weight Loss – easier said than done?

Most people know that achieving and maintaining a healthy body weight is important to lower the risk of getting type 2 diabetes, hypertension and cardiovascular disease. Since we are already eating most of our meals at home and with a covid-19 vaccine a year or more away, now is an ideal time to make the dietary changes needed to achieve a healthy body weight and lower our risks of requiring hospitalization should we get Covid-19. In fact, most people in the class I obesity (BMI > 30) category can make the dietary changes necessary to achieve a normal body weight within in a few months. 

I can help.

More Info?

If you would like more information about how I can help you lose weight and then keep it off, please reach out to me. All my services are now provided via Distance Consultation, but I already have more than a decade of experience providing virtual nutrition support, so this is nothing new for me.  I have both the experience and expertise to help.

You can find more about the details of the different packages I offer by looking under the Services tab or in the Shop. If you have any service-related questions please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/JoyKiddie
Facebook: https://www.facebook.com/BetterByDesignNutrition/

References

  1. Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. ePub: 8 April 2
  2. Lighter J, Phillips M, Hochman S et al, Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission, accepted manuscript, Clinical Infectious Diseases. doi: 10.1093/cid/ciaa415,  https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa415/5818333
  3. Ogden, C.L., et al., Prevalence of Obesity Among Adults, by Household Income and Education – United States, 2011-2014. MMWR Morb Mortal Wkly Rep, 2017. 66(50):p. 1369-1373
  4. State of Obesity, Adult Obesity in the United States, https://stateofobesity.org/adult-obesity/
  5. Statistics Canada, Health at a Glance, Adjusting the scales: Obesity in the Canadian population after correcting for respondent bias,  https://www150.statcan.gc.ca/n1/pub/82-624-x/2014001/article/11922-eng.htm

Copyright ©2020 BetterByDesign Nutrition Ltd.

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Why Underlying or Comorbid Conditions are Very Important in COVID-19

It is well-known that older adults are at greater risk of getting serious complications from COVID-19, but few people realize that the majority of people that require hospitalization in the US [1] (and presumably the data is similar in Canada) have very common underlying medical conditions (known as “comorbid” conditions), including high blood pressure (hypertension), obesity, diabetes and cardiovascular disease and chronic lung disease [1]. With a vaccine for COVID-19 coronovirus more than a year a way, current efforts to reduce the risk of contracting the virus focus on physical and social distancing measures, personal hygiene including proper hand-washing techniques and avoiding touching one’s face, as well as wearing face coverings in public places but there is more we can do to reduce the risk of getting serious complications or dying from complications from the virus — and that is addressing dietary and lifestyle changes that are documented to put comorbid conditions such as high blood pressure, type 2 diabetes and obesity into remission.

Early release of a research study on April 8, 2020 [1] reported that between March 1-30, 2020, hospitalization rate in 99 counties of 14 US states was 4.6 people per 100,000 population, and rates were highest amongst those who were ≥65 years of age and those with underlying medical conditions. Among almost 1500 laboratory-confirmed COVID-19–associated hospitalizations, almost 25% were between the ages of 5–17 years, almost 25% were aged 18–49 years, ~30% were aged 50–64 years and 43% were aged ≥65 years. Among those patients with data on underlying medical conditions, almost 90% had one or more comorbid conditions — with almost 50% of patients having hypertension (high blood pressure) or obesity and almost 30% having diabetes or cardiovascular disease. This is huge.

“These findings suggest that older adults have elevated rates of COVID-19–associated hospitalization and the majority of persons hospitalized with COVID-19 have underlying medical conditions.”[1]

Underlying comorbid conditions among US adults with COVID-19

Changing What’s in Our Control to Change

Many of us feel somewhat powerless during this COVID-19 outbreak and while the internet is full of recommendations for dietary supplements, many overlook the most obvious way to lower risk of serious complications by lowering any known comorbid conditions we may have. We can achieve and maintain a normal body weight and waist circumference, normalize blood pressure and blood sugar, and lipid markers such as improving HDL cholesterol and lowering triglycerides.

As covered in an earlier article, a study published in November 2018 reported that 88% of Americans are already metabolically unhealthy[2]; that is, only 12% have metabolic health defined as [2];

  1. Waist Circumference: < 102 cm (40 inches) for men and 88 cm (34.5 inches) in women
  2. Systolic Blood Pressure: < 120 mmHG
  3. Diastolic Blood Pressure: < 80 mmHG
  4. Glucose: < 5.5 mmol/L (100 mg/dL)
  5. HbA1c: < 5.7%
  6. Triglycerides: < 1.7 mmol/l (< 150 mg/dL)
  7. HDL cholesterol: ≥ 1.00 mmol/L (≥40 mg/dL) in men and ≥ 1.30 mmol/L (50 mg/dl) in women

When considering only waist circumference, blood glucose levels and blood pressure levels~50% of Americans were considered metabolically unhealthy [3].  Given the slightly lower rates of obesity in Canada as in the United States, there is likely a slightly lower percentage of Canadians who are metabolically unhealthy, but the similarity of our diets may make that difference insignificant.

While we obviously can’t reduce our age or the presence of chronic lung conditions such as asthma or COPD, we can lower our risk of having severe outcomes should we contract the virus;

  • If we are overweight, we can lose weight.
  • If we have high blood pressure we can make safe and effective dietary changes to lower that, and by adding other lifestyle changes, achieving normal blood pressure without the need for medication is possible.
  • If we have higher than normal blood sugar, we can normalize that through dietary and lifestyle changes. Type 2 diabetes need not be a “chronic progressive disease”! It can be put into remission.
  • If we have abnormal lipid panel (cholesterol), we can change the way we eat to lower triglyceride levels, as well as increase HDL (“good”) cholesterol levels.

Final Thoughts…

There is much about the current situation we can’t change. Physical (social) distancing measures will likely be in place for some time. The need for consistent hand hygiene and avoiding touching our face will likely be come second nature for most of us, as may be the wearing of face coverings in public for many.

But with all of us eating at home almost all of time, now is an ideal time to find out how to eat in such a way to improve our metabolic health and lower our risk of serious outcomes should we contract the virus.

More Info?

If you would like more information about how I can help you and your family eat better, or how I can help you lose weight, lower blood pressure or blood sugar or lower cardiovascular risk, please reach out to me. While all my services are now provided via Distance Consultation, I have more than a decade of experience providing virtual nutrition support.

You can find more about the details of the different packages I offer by looking under the Services tab, or in the Shop and if you have any service-related questions, please feel free to send me a note using the Contact Me form above, and I will reply as soon as I can.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/JoyKiddie
Facebook: https://www.facebook.com/BetterByDesignNutrition/

References

  1. Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. ePub: 8 April 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6915e3
  2. Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metabolic Syndrome and Related Disorders Vol 20, No. 20, pg 1-7, DOI: 10.1089/met.2018.0105

 

Copyright ©2020 BetterByDesign Nutrition Ltd.

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.