Obesity as a risk factor for coronavirus complications

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MedRxiv posted an expedited preprint publication (not yet peer reviewed) regarding the conditions associated with hospitalization and critical illness due to COVID-19 in New York City.

The authors presented sobering data from the 1,999 COVID-19 patients hospitalized in New York, which represented 48% of positive tests.

While 48% sounds like a remarkably high hospitalization rate, keep in mind that the authors sampled mostly from those presenting to an emergency room for testing. They therefore likely preselected those who were the sickest since their symptoms were severe enough to warrant an ER visit. This study did not include those who self-quarantined at home to ride out their illness.

Of those who were hospitalized, 41% had a critical illness and 18% died. The median age among those who developed a critical illness (intensive care, mechanical ventilation, hospice and/or death) was 67, and 68% were men. As with prior studies, people who were hospitalized were more likely to have a diagnosis of high blood pressure, diabetes and kidney disease.

By far the most predictive variable for hospitalization was age greater than 75; these patients were 66 times more likely to require admission. The second most predictive variable was also age; patients age 65-74 were 10 times more likely to require hospitalization.

Next, however was obesity. Those with a BMI above 40 were 6 times more likely to require hospitalization.

In my mind, that is what makes these findings different from the results published out of China. This is the first publication to my knowledge showing obesity as a major risk factor for hospitalization.

Given that obesity is frequently associated with hypertension, diabetes and heart failure, which were also risk factors, it makes sense that obesity is associated with more serious COVID-19 outcomes. It is not clear whether the authors tried to control for these co-morbidities when assessing the risk of obesity.

So, is obesity an independent risk factor for complications from COVID-19? I am not sure this paper answers that question. It reaffirms that advanced age is by far the greatest risk. But it suggests that obesity, with other metabolic conditions such as type 2 diabetes or high blood pressure, is also likely to contribute to a particularly high risk.

Unfortunately, we cannot do much about our age. But this paper highlights the importance of controlling metabolic diseases and maintaining a healthy weight.

It is never too late to commit to taking charge of your health and devising a plan to improve it. Whether that means focusing on sleep hygiene, addressing endocrine issues with your physician, or committing to improving nutrition and exercise, the stakes appear to be higher than ever to improve our health however we safely can.

Although weight loss is gradual and can be elusive, many patients see dramatic improvements in metabolic health after just a few weeks of low-carb eating.

According to this study out of New York, it appears as if every little bit may help. At Diet Doctor, we are here to provide content that can help you on your journey.

Thanks for reading,
Bret Scher, MD FACC




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