Obese patients at higher risk of COVID-19 complications

BY W. GIFFORD- JONES MD & DIANA GIFFORD- JONES

In the play, Julius Caesar, William Shakespeare wrote, “Let me have men about me that are fat. Yond Cassius has a lean and hungry look. Such men are dangerous.” Caesar saw no risk in well-fed men. But fast forward 500 years, and we now know that being overweight is a major health hazard. Several reports show this is especially true for those attacked by COVID-19.

A study of 17,000 hospital patients with COVID-19 in the UK showed that those overweight had a 33% greater risk of dying than those who were not obese.

Another study by the British National Health Service showed the risk of dying from COVID-19 doubled among obese people. Researchers noted that having additional risk factors related to obesity, such as diabetes or heart disease, makes the rate even higher.

In the U.S., several doctors have noted the same problem. Dr. Jennifer Lighter, Assistant Professor of Pediatrics at New York Langone Health, reports in the Clinical Infectious Diseases Journal, obese patients are two times more likely to need hospital treatment, and three times more likely to end up in intensive care.

So, although Shakespeare’s lean Cassius is more dangerous, he’d fare better in a viral pandemic. We’ve known for decades that a normal weight guards against Type 2 diabetes, hypertension, heart attack, and some cancers. But trying to pinpoint disadvantages of extra pounds when assessing COVID-19 is not so easy.

Professor Naveed Sattar, at the University of Glasgow, Scotland, says, “Because people are more overweight, they have a greater demand for more oxygen. So that means their system is actually undergoing greater pressure.”

Dr. Dyan Sellayah at the University of Reading adds, “Eventually the obese body becomes overwhelmed by the lack of oxygen getting to the major organs.”

Other researchers believe that fat cells may act as a reservoir, or safe zone, where the COVID-19 virus can hide. Or, that it’s simply a mechanical matter where excess fat makes it harder for the diaphragm to move decreasing oxygen supply.

Surgeons are accustomed to large masses of fat around abdominal organs, and we know this increases the risk of surgical complications. We also know that abdominal fat is more metabolically active. This is why it’s easier to gain this type of fat, but also easier to lose it in this location.

The Lancet has recently reported that more people from African, Asian and minority ethnic communities are dying of COVID-19.  Dr. Sellayah believes they have a specific type of fat tissue that is more prone to inflammation. At times this can trigger an over-reaction of the immune system, called a ‘cytokine storm’, and is potentially life threatening. But more research is needed; others argue the disparities may be explained by socioeconomic factors.

It’s not the first time obese people have faced increased risk from viral diseases. Arya Sharma, Professor of Medicine at the University of Alberta and Scientific Director of Obesity Canada, reports that obesity was a significant risk factor in the SARS and H1N1 epidemics.

Dr. Sharma feels that obese people with COVID-19 face another problem, discrimination. This means they are less likely to seek medical treatment and wait longer for care when they do seek help. The good news for those who are overweight is that a COVID-19 infection is not always a death sentence, as many patients recover.

Shakespeare was a literary genius.  But his health advice needs a rewrite. Today, our health will be the better for “a lean and hungry look”.