Boris Johnson is urging people in the United Kingdom (UK) to lose weight to save the National Health Service (NHS) by lowering the risk for COVID-19 by weighing less. The broad message is an oversimplification of the complexity of obesity and its contribution to COVID related mortality.
As we watch policy play out in the UK, a new paper in the Journal of General Internal Medicine by Sarah Tartoff and colleagues at Kaiser Permanente Southern California provides a real-world look at profiles of people with obesity who have passed from COVID-19. While BMI is an imperfect measure, other papers point to visceral fat being a better predictor of mortality due to the associated pro-inflammatory milieu that accompanies that type of body composition. It is nonetheless helpful to understand how BMI can help us have a clearer view of the risk posed to people with obesity regarding COVID-19 will be essential in developing treatment protocols as it is easier to measure.
The current paper examines BMI and other risk factors in 6,916 patients with COVID-19 with specific intent to look at the death rate within 21 days of hospitalization. Mortality rates reported 3.7% for males and 2.4% for female, even though the majority of patients were females, the mortality rate was higher for males. The average age of the sample was 49 years old. The most prevalent comorbidities were hypertension (24%), diabetes (20%, and asthma (18%).
Findings indicate a sobering relationship between BMI and mortality. The risk of dying from COVID-19 was higher in younger adults and males who had higher BMIs. A 2-4 fold mortality risk was seen in those with a BMI > 40. A 12-17 fold risk was observed in patients younger than 60. Early mortality data in COVID-19 pointed to higher risk in older adults, but newer data, like this paper, shows a more expansive risk profile. Obesity was a more strongly associated with mortality as compared to patients with comorbidities like heart disease, asthma, and diabetes. In this data set, race and ethnicity was not associated with mortality.
The more data that emerges on the health impacts of COVID-19, the more we realize that certain groups bear a disproportionate risk of dying from this virus. The value of knowledge is beyond BMI; the immune system impacts of obesity can point us to earlier treatment protocols to reduce the likelihood of death. Earlier risk profiles were incomplete, but those tracking the data know we are amid a novel pandemic, so the knowledge is only months old. Knowing how has specific immune system profiles and associated inflammatory responses show up within people with high BMIs will be an essential consideration in treating and preventing the more extreme sequelae of this virus.
Thanks for reading – Trina
(Opinions are my own)
Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization Sara Y. Tartof, Lei Qian, Vennis Hong, Rong Wei, Ron F. Nadjafi, Heidi Fischer, Zhuoxin Li, Sally F. Shaw, Susan L. Caparosa, Claudia L. Nau, Tanmai Saxena, Gunter K. Rieg, Bradley K. Ackerson, Adam L. Sharp, Jacek Skarbinski, Tej K. Naik, and Sameer B. MuraliAnnals of Internal Medicine 0 0:0 https://doi.org/10.7326/M20-3742