COVID-19 is hitting some patients with obesity particularly hard – Science News


Posted: April 29, 2020 at 9:47 am

As part of theCOVID-19 response team at OConnor Hospital in San Jose, Calif., NiveditaLakhera wasnt prepared to see her intensive care unit filled with so manyyoung patients. Many of those patients had no medical condition other thanobesity.

They are youngand coming to the ER and just dropping dead, she says.

Age,particularly those over 65, as well as having a compromised immune system are stillmajor risk factors for being hospitalized with, and dyingfrom, COVID-19. But some doctors say that some of their sickest patients arethose under 60 who are obese.

The Centers forDisease Control and Preventions list of high-risk individuals includes theseverely obese, defined as people with a body mass index, or BMI, over 40. Whilestudies on coronavirus often focus on demographic breakdowns such as age, sexand race (SN: 4/10/20), somenow are starting to track COVID-19 patient BMIs.

For instance,of 180 patients hospitalized from March 1 to March 30, the most prevalent underlying condition for adults ages 18 to 49 was obesity.Of 39 patients in that age range, 23, or 59 percent, were obese, researchersreport in the April 17 Morbidity andMortality Weekly Report.

BMI is theAchilles heel for American patients, says Jennifer Lighter, an epidemiologistat New York Universitys Langone School of Medicine. That could be a crucialfactor in the death toll, particularly for those under 60, she says. In Chinait was smoking and pollution, and Italy had a larger older population, and manygrandparents lived with extended families. Here, its BMI thats theissue.

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In the UnitedStates, 42 percent of adults have a BMI over 30, the threshold forobesity, and more than 9 percent are classified as severely obese with a BMIover 40, according to the CDC. People with obesity can have other high-risk healthconditions, such as hypertension or diabetes (SN: 3/20/20). But some doctors suggest a high BMI should be a riskfactor in itself.

Lighter and hercolleagues found that patients under 60 with a BMI over 35 were at least twice as likely to be admitted to the ICU for coronavirus than patients with healthyBMIs, the researchers report April 9 in ClinicalInfectious Diseases. Those same patients were three times more likely todie from the infection than those with a lower BMI, she says.

The team tracked 3,615 people who testedpositive for SARS-CoV-2, the virus that causes COVID-19, at a New York Cityhospital from March 4 to April 4. Of those, 1,370, or 38 percent, were obese. Inpatients over 60, weight did not appear to be a factor in hospital admission orthe need for intensive care, she says.

A hospital in Lille, France, also found that the higher the BMI, the more likely a patient needed to be ventilated. Of 124 patients admitted to intensive care for COVID-19, almost half were obese or severely obese, researchers report April 9 in Obesity. Of the 85 patients who were intubated, nearly 90 percent had a BMI over 35, the data show.

The need for invasive mechanical ventilation was associated withsevere obesity and [was] independent of age, sex, diabetes and hypertension,the study says.

SanjumSethi, a cardiologist at Columbia University Medical Center, says his hospital isseeing a surprising number of younger patients with obesity, but no otherconditions such as diabetes or high blood pressure. On April 12, he tweeted that, for obese patients, theprognosis is extremely grim. They are NOT dying from comorbidities. They aredying from COVID-19.

People witha high BMI already tend to have problems breathing; they carry more weight ontheir chest, which compresses the lungs. Because COVID-19 is mainly a respiratorydisease, that may put heavier patients at a disadvantage, doctors say.

Obesepeople already have lower oxygen levels, they are predisposed to pulmonarydysfunction, and they have decreased chest function because of the weight ontheir chest. And many have sleep apnea. So theyre at pulmonary riskalready,says SamuelKlein, a gastroenterologist andthe director of the Center for Human Nutrition at Washington University School ofMedicine in St. Louis.

Public health officials saypeople with obesity shouldnt feel stigmatized or avoid seeking medical care;its important to be aware of threat COVID-19 poses. People with high BMIs might want to practice extra caution,wear a mask outside and have groceries delivered instead of going out intopublic, Sethi says.

I worry thisis going to have even more impact where obesity is more endemic, like in theSouth, he says.

The data shouldbe a wake-up call for people with obesity, agrees Donna Ryan, president of the London-basedWorld Obesity Federation. If they do develop fever or shortness of breath,they should not hesitate, call their doctor and get tested.

Doctors might take specific measures when treating obese patients for COVID-19, says Rekha Kumar, an obesity specialist at Weill Cornell Medical College in New York City. That might include giving them oxygen early or keeping them in the hospital longer.

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COVID-19 is hitting some patients with obesity particularly hard - Science News

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