If excess fat accumulation is to be considered a disease, and not just a trigger for many others, it is an open health debate . There is no doubt that it promotes a bad evolution of numerous pathologies, and covid-19 is among them: several hospital centers are putting the focus on obesity as a possible risk factor that must be added to other more known ones, like age. Its effects have attracted attention especially in cases of morbid obesity and in patients younger than 65 years.
The European Association for the Study of Obesity recalls that this population is particularly vulnerable to the effects of the pandemic because it has a higher rate of serious complications . “In a very recent and still provisional publicationdata from more than 4,000 patients treated by NYU Langone Health Medical Center, New York University, point to obesity, along with age, as the two most determining factors in the probability of requiring hospital admission for covid- 19. In this study, the prevalence of obesity in the group of hospitalized patients was 39.8%, while in the group of non-hospitalized patients it was 14.5%, “observes Camilo Silva Froján, specialist in Endocrinology and Nutrition at the Clinic University of Navarra.
To these figures must be added those of the Lille University Hospital Center, in France, where they have detected a high prevalence of obesity among patients admitted to the ICU, which reaches 47.6%. “It is associated with a greater probability of requiring invasive mechanical ventilation, regardless of age or the presence of high blood pressure or diabetes,” says Silva, member of the Center for Biomedical Research in the Pathophysiology of Obesity and Nutrition. The United States Centers for Disease Control and Prevention also mentions severe obesity — characterized by a body mass index greater than 40, which is equivalent to that of a person 1.60 meters tall with a weight of 103 kilos— as a risk factor for the appearance of complications in cases of covid-19, and the presence of cardiovascular disease or diabetes stands out as risk factors additional.
The data accumulated so far does not surprise specialists such as Francisco Tinahones, president of the Spanish Society for the Study of Obesity and head of the Endocrinology and Nutrition service at the Virgen de la Victoria University Hospital in Malaga. “We have a lot of experience with the common flu . Obese subjects are known to be at increased risk for mortality and respiratory complications. Covid’s first data matches what we already had for the common flu.“the endocrinologist indicates. Silva adds that” in the 2009-2010 influenza A pandemic, as in other respiratory infections, a worse evolution of the disease was found in patients with obesity. In some studies, the prevalence of severe obesity of up to 56% was confirmed in the group of patients who required mechanical ventilation. ”
Much more than weight and fat
Although the relationship between obesity and covid-19 is still unclear, the high percentage of obese people susceptible to worsening due to infection is explained by the comorbidities associated with it, such as diabetes and hypertension, which complicate the evolution of the infection. “In cases of morbid obesity, excess abdominal fat compresses the diaphragm, reducing lung capacity, reason why most respiratory diseases evolve worse. Another factor that makes them more vulnerable is chronic inflammation and the increased risk of venous thrombosis, a cause of mortality derived from spending a lot of time in bed, “says Tinahones. At the cellular level, it is also explained that obesity alters the inflammatory and immune response . “The adipose tissue, excessive in the patient with obesity, expresses the ACE2 protein, used by SARS-CoV-2 to infect the cell, ” adds Silva.
Accumulated clinical experience and studies, according to this endocrinologist, should promote close monitoring of the evolution of the disease, especially in patients in whom it is severe. “Given the increase in the prevalence of morbid obesity in Spain —0.88% of the Spanish population— in recent decades, healthcare centers must be prepared to care for these patients,” Silva warns.
In light of the figures linking obesity with worsening disease progression, the question that arises is whether people with obesity should be officially considered as a risk population. An editorial in the medical journal ObesityIt slides this scenario by recommending, in the pandemic situation, greater attention to patients who are obese. “We are on the way to being recognized. Above all, the person with morbid obesity must be considered as the subject of greatest risk, as they evolve worse due to coronavirus infection. We know that the elderly population and those with associated diseases is the most fragile, but you have to go to a second level. The first escalation has focused on age as the main risk factor, but when we begin to analyze deaths in people under 65, it is being seen that obesity plays a very important role “, Tinahones points out.
When assessing the risk factor, various expert voices ask to take into account the nuances. “In cases of obese patients, the evolution may be worse by making ventilation difficult, but it is difficult to single out obesity, understood as weight or fat, because it is always linked to other things. What should be considered as a factor of risk is the entire constellation that obesity entails , “suggests endocrinologist Clotilde Vázquez, head of the Department of Endocrinology and Nutrition at the Jiménez Díaz Foundation.
Confinement as an opportunity to improve
Among the usual precautions to face the pandemic, specialists encourage people with obesity to make confinement an opportunity to incorporate healthy habits and help perceive it as a health problem. “We have been hammering for years that obesity is not an aesthetic problem, but a health problem, and that the person must recognize it and remedy it. We cannot turn our backs on it as a health problem. It is still believed that having a few extra pounds is benign, and we should encourage people to lead a healthy life, especially through physical exercise that increases their lung capacity. An obese person who exercises has fewer risks than he does not, “observes Tinahones, who recommends strength exercises isometric, which provide as many benefits as aerobics to improve respiratory, cardiac, metabolic and immune conditions.
Specialists like Vázquez insist that confinement is the time to make an extraordinarily light diet. “I call it the doubly green Mediterranean diet. We recommend that two dishes of greens and vegetables a day so that it is very satisfying while reducing calories and fat. The advantage of confinement is not having external temptations, as long as anxiety is controlled. In our non-face-to-face follow-ups we see that there are many patients who have lost weight by improving their diet , with less processed products. But the most important thing is to remind them that they are not guilty. Obesity is not someone’s fault, but a problem they may have a person due to multiple factors, “emphasizes Vázquez.
In addition to recommending moderate weight losses —from 5% of initial weight and through balanced diets— Silva recalls that fast ones are completely discouraged, which are achieved with excessively restrictive diets or heterodox methods. “Following inadequate guidelines could facilitate infection or worsen its evolution. If contagion exists, close monitoring of the evolution of covid-19 symptoms and associated comorbidities (diabetes, hypertension …) should be sought, maintaining the habitual pharmacological treatment or adjusting it to the needs that arise “.