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A Dangerous Duo: An Obesity Epidemic in a Global COVID-19 Pandemic

When the novel coronavirus made headlines around the world earlier this year, the United States was already facing its own health crisis: an obesity epidemic. According to the Centers for Disease Control and Prevention (CDC), nearly 40 percent of the U.S. population is considered obese—having a body mass index (BMI) of 30 or more. While the negative impacts of obesity, such as diabetes, hypertension and shortened life expectancy, are well known, researchers have observed a correlation between severe COVID-19 cases and obese patients.

To help us understand more about the correlation between COVID-19 and obesity, we spoke with Gintaras Antanavicius, MD, medical director of the Institute for Metabolic and Bariatric Surgery (IMBS) and section chief of Bariatric Surgery, Abington – Jefferson Health.

“We know obesity has negative health impacts. Some studies show that patients who remain obese after age 40 may decrease their life expectancy by about 10 years. So obesity itself was already a problem, and now when COVID-19 started, unfortunately, we discovered that obese patients are at even greater risk during the pandemic,” says Dr. Antanavicius. “The severity of illness is significantly increased for obese individuals who contract COVID-19. For example, the hospitalization rates for obese patients are three times higher than those with a BMI below 30. Additionally, about 41 percent of all hospitalized COVID-19 patients are obese.”

When it comes to BMI, a person’s weight falls into one of several categories, according to the CDC: underweight (BMI less than 18.5), normal (BMI between 18.5 and 25), overweight (BMI between 25 and 30), obese (BMI of 30 to 39.9) or morbidly obese (BMI above 40).

According to Dr. Antanavicius, the correlation between severe COVID-19 cases and obesity exists for several reasons:

1. Weakened immune system: As a result of extraneous fat build-up, obese patients have a weakened immune system and thus a poor response to infections. A weakened immune system may hinder the body from defending itself against COVID-19.

2. Chronic inflammation: Typically, obese patients have chronic inflammation, which is caused when an excess of fat tissue increases inflammatory hormones at the cellular level throughout the body. Contracting COVID-19 tends to induce an abnormal inflammatory response, so for obese patients, the body responds with even more unnatural toxic reactions since it's already in a heightened state of inflammation.

3. Increased prevalence of blood clotting: Obese patients are prone to blood clotting. Many patients with COVID-19 have shown signs of clotting within smaller blood vessels in the lungs, which can become even worse for those who are already prone to it.

4. Mechanical difficulties: Obese patients have decreased lung capacity due to excess weight on the chest. In the event that an obese individual contracts COVID-19, which mainly attacks the respiratory system, their lung functionality is compromised and their chances of survival decrease significantly.

5. Self-discrimination: Unfortunately, obese patients often neglect to seek care because they don’t want to be discriminated against for their weight. This delay in medical attention is a leading factor in negative outcomes for obese patients.

When it comes to reaching a healthy weight, the best option is for patients to seek guidance by speaking with their primary care physician, nutritionist or other health care professional.

“We are seeing a surge is cases. And for our obese patients, that means it’s time to seek help,” says Dr. Antanavicius. “Our first line of defense is always non-surgical weight management. This includes healthy eating and a regular exercise plan. But if that is not working effectively, bariatric surgery is a phenomenal option.”

The ideal bariatric surgery candidate is an individual who has a BMI of 40 or more or has a BMI of 35 in addition to health problems such as type 2 diabetes, high blood pressure and other chronic conditions.

From a surgical perspective, there are three types of operations: vertical sleeve gastrectomy (decreasing the size of the stomach), gastric bypass (dividing the stomach and connecting it directly to the intestine) and duodenal switch (decreasing the size of the stomach and bypassing a large portion of the intestine).

“With weight loss surgery, we achieve two main goals: helping the patient lose weight and improving their health. Patients resolve diabetes, high blood pressure, cholesterol issues and sleep apnea—all of which are related to bad COVID-19 outcomes,” adds Dr. Antanavicius.

Dr. Antanavicius stresses the importance of proactive and early weight management and believes that bariatric surgery is one of the most effective options to lose weight and live a longer and healthier life.

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