Amid new hopes and plans for the new decade- 2020, none of us had anticipated the sudden arrival of game changer- Covid-19. To date, Covid-19 has killed 28,205 people (15.3% death rate) in the UK and over 66,000 people in the USA (5.8% death rate). These figures seem gigantic compared to only 250 deaths in South Korea (2.3% death rate). What do these striking numbers mean? Is there any correlation or confounding factor related to increased mortality in the UK or the USA?
It might be too early to draw conclusions between Covid-19 and death rates, but certainly, there is something common between these two wealthiest countries of the world. From a historical perspective, the rich and developed countries have witnessed massive migration from rural to urban areas, busy lifestyles, and an increase in energy intake in the form of calorific food popularly known as ‘western diet’. As a result of increased calorie intake and no time for physical activity, obesity inevitably ensues in the wake of development. The Organization for Economic Cooperation and Development (OECD) regards only 4% of Korea’s population as obese, compared to 39.8% in the USA. or 28.7% in the UK. These numbers partly explain why South Korea has a low Covid-19 death rate.
Obesity- The Real Player In Masquerade: There is a strong evidence indicating that excess fat negatively impacts immune function and host defense, impairs gas exchange (breathing), increases oxygen requirements in the lungs, and the risk of pneumonia. The reports from 2009 swine flu or influenza A (H1N1) evidently laden with the detrimental role of obesity. Those reports range from accrediting obesity as a forecaster for the worse outcomes of infection to holding it responsible for the increase in the number of intensive care unit (ICU) admissions. On the contrary, non-obese individuals reportedly remained on ventilators for a shorter duration and spent lesser time in ICU. Recent research showed that obese adults shed influenza A virus 42% longer than non-obese adults suggesting the impact of obesity in disease transmission as well.
Fast Forward From 2009 to 2020– Is Obesity Still An Active Player? The overwhelming number of Covid-19 casualties in the E.R. left no time for attending physicians to assess the patient outcomes. And the potential comorbid factor-obesity has been ignored. But as observed in the past, strong clinical evidences again point to obesity as a risk factor for Covid-19. Data from the New York City area revealed that 41.7% of Covid-19 patients are overweight or obese. A study from France reported data from 124 COVID-19 patients showing that the need for invasive mechanical ventilation was associated with obesity. Another study from the UK showed that almost 72% of critical patients are either overweight or obese. The Italian National Institute of Health reported that 99% of Covid-19 deaths are attributable to pre-existing non-communicable diseases, such as obesity. Therefore, it is reasonable to speculate that obese COVID-19 patients are predisposed to the risk of a more severe condition such as obese hypoventilation syndrome.
It Is More Than Just ‘Being Fat’: During my initial days in the US, witnessing severely obese people with a myriad of comorbid conditions (diabetes mellitus, hypertension, cardiovascular and kidney diseases) was quite surprising. I often found myself rushed for advice on how to stay lean while working for irregular hours as a scientist. “It’s a challenge, either face it or succumb to it” is what I heard from friends frequently. And they were right as statistics also speaks for itself. The prevalence of metabolic health is ‘alarmingly low’ in the US with only 12.2% of metabolically healthy adults. It is likely that the statistics in other western countries are not dissimilar. It wouldn’t be overrated to entitle obesity as a ‘package’ that comes at a price. The comorbid associations with obesity impair immune function and increase the susceptibility to infections.
The Bottom Line- Better Now Than Never: Although several questions about the relationship between Covid-19 and obesity remain unanswered, but, we must not ignore such correlations. These correlations are predictors for unforeseeable health-related disasters and adverse reactions to viral pandemics. That being said, people with obesity shouldn’t feel stigmatized or avoid seeking medical care; it’s important to be aware of the threat COVID-19 poses.
Research is constantly evolving but what we know now is a good starting point to take necessary steps to not only protect our health but to reduce health care burden as well. The two major culprits behind the rising obesity epidemic are ultra-processed food commonly known as ‘junk food’ consumption and a sedentary life-style. We often hear ‘quit alcohol or quit smoking, but how about ‘quitting junk food’ and ‘adopting exercise’? The post-Covid-19 pandemic health message should now be ‘Eat Right And Run A Mile’.