Written by Dr Akshay Budhraja
With the COVID 19 pandemic infecting millions of people across the world, minimising mortality remains the top focus of the medical community as well as policymakers. While it is evidently understood that the elderly and people with co-morbidities such as heart disease, diabetes, kidney disease or hypertension are at higher risk of mortality from the novel coronavirus, new evidence has revealed a close link between obesity and a higher risk of complications. Studies have indicated that obese people face a greater risk of intubation and death from COVID 19. In this light, controlling obesity is not just a general health concern anymore but has become specifically important in controlling mortality from COVID 19.
The higher the weight, the greater the risk
As early as March, a small study in China first indicated that overweight Chinese patients were more likely to die from COVID 19 as compared to their lighter counterparts. Now, a new study published in the Annals of Internal Medicine has concluded that patients with obesity had an increased risk for intubation or death with the risk highest for class 3 obesity. In fact, for obese people the risk was higher than overweight people. The researchers analysed data from 2,466 patients hospitalised with severe acute respiratory syndrome coronavirus 2 infection. Interestingly, the association with obesity was observed in adults younger than 65 years but not in older adults.
Obesity, already a global epidemic
Increased consumption of unhealthy processed and nutrient-dense foods and reduced physical activity has over the past 50 years unleashed an obesity pandemic across the world. According to WHO, more than 1.9 billion adults aged 18 years and older were overweight in 2016. Of these over 650 million were obese. In fact, the worldwide prevalence of obesity nearly tripled between 1975 and 2016.
Considered a health burden of the developed world earlier, obesity is increasing rapidly in developing countries such as India in recent years. An estimate suggests that in India more than 135 million individuals were affected by obesity, which is a risk factor for a series of chronic diseases including diabetes, hypertension, cardiovascular disease, to name a few.
Obesity interferes with immune response
Not only does obesity makes patients with co-morbidities more vulnerable to COVID-related complications, adipose fat directly interferes with the body’s immune response as well. Researchers in immunometabolism suspect that even vaccines such as those for influenza, hepatitis B etc are less effective in people with obesity. This makes it harder for even a vaccine (whenever it is made available) to protect obese people from coronavirus.
Active transport such as cycling need of the hour
While coronavirus further necessitates controlling the obesity epidemic, physical activity has taken a backseat during these unsettling times as people stay indoors and avoid gyms and outdoor exercise routines. To counter this slump in physical activity and curb obesity during the COVID era, UK has initiated a major campaign to give thrust to active transport. UK Prime Minister Boris Johnson, himself a COVID 19 survivor, admitted that he was “way overweight” when admitted to ICU with the disease. He has launched €2 billion initiative to build thousands of miles of protected bike lanes across towns and cities, offer cycle training for everyone and make bikes available on prescription.
With a large population of overweight people, India too must work towards similar initiatives that encourage cycling and walking in everyday lives. An extensive campaign is needed to educate overweight people about the high risk they face from the disease and the need to reduce weight to decrease their vulnerability to the virus. Urban infrastructure must be redesigned quickly to make it more amenable to cyclists. Having a large number of people who have BMI above 25+ with coronavirus will also pose a heavy burden on our already overloaded healthcare systems. Not only do people with obesity face severe complications, but disease management is also difficult in them since it is tougher to intubate obese people and is also difficult to obtain diagnostic imaging for them.
What can be done?
*Ensure 50 minutes of safe physical exercise daily but avoid public gyms and group workout sessions.
*Try to incorporate cycling and walking in your daily activities such as traveling to work, traveling to buy groceries, etc
*Cycling and walking are the safest outdoor exercises. They also help build lung capacity. Cycling also benefits in keeping co-morbidities such as hypertension, diabetes and cardiovascular disease under control.
*Limit consumption of processed foods and foods laced with refined sugar.
*Consume more fruits, vegetables and fibrous foods.
The author is a consultant, respiratory and sleep medicine, Aakash Healthcare and Super Speciality Hospital