COVID-19 and Obesity—A Link Too Dangerous To Ignore

Obesity and overweight

More than one-third of U.S. adults have obesity, which is defined as having a BMI > 30. According to the World Health Organization, obesity has nearly tripled worldwide since 1975. In 2016, > 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese. A staggering 38 million children under the age of 5 were overweight or obese in 2019. Most of the world’s population live in countries were overweight and obesity kills more people than underweight. Do I have your attention yet? If not, did you know that 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese. Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016. All the aforementioned facts are per the WHO . Obesity is preventable. We need to wake up and do better, not just for ourselves but the next generations to come. The COVID-19 pandemic has forever changed our lives and we must revisit our lifestyle choices in honor of health and disease prevention.

This article will highlight the association of obesity and Covid-19. First and foremost, for adults, the WHO defines overweight as BMI > or equal to 25; and obesity is a BMI > 30. BMI provides a rough measurement tool to correspond fatness in different individuals. It is not the best indicator of health as it is a population-level measure which is the same for both sexes and all ages and adults. BMI does not tell us bio-metrics, energy levels, sleep, relationship with food and other areas that predict health. However, it does provide a common way to classify

• Imbalance of calories from physical inactivity or surplus of calories consumed chronically over time
• Family history and genetics
• Medications: Some anti-seizure medications, antidepressants, steroids and beta blockers can lead to undesirable weight gain
• Environment: Surrounding yourself with friends and family who may be overweight making poor food and beverage choices can lead to greater risk of obesity
• Too little sleep which can increase appetite and desire to consume low nutrient foods

Why is obesity a risk factor for Covid-19?

Obesity is considered a large risk factor for risk of severe COVID-19 because of the respiratory dysfunction. Those with obesity have a greater likely hood of experiencing restricted airways, decreased lung volumes, and weaker respiratory muscles which are an essential defense against COVID-19. Such factors make an individual more susceptible to pneumonia, and experience additional cardiac stress. Furthermore, obesity is also linked with diabetes, heart disease, and kidney disease, which overall increase the risk of developing pneumonia. Other ailments like hypertension, hyperlipidemia, and pre-diabetes enhance the susceptibility to infection.

The current science:

• Data from 383 patients showed that having obesity was associated with a 142% higher risk of developing severe pneumonia associated with COVID-19.
• A larger study of over 4,000 patients with COVID-19 in New York City found that severe obesity was a major risk factor for hospitalization, second only to age.
• Analysis of critically ill COVID-19 patients in Seattle found that 85% of patients with obesity required mechanical ventilation, compared to 64% of patients without the condition. Moreover, 62% of the patients with obesity died of COVID-19, compared with 36% of those without obesity.
• Limitation: Study only assessed 24 patients, all of whom were critically ill, making it difficult to draw attention to the conclusions from the data.
  • Another analysis of 124 patients in Lille, France, found that patients with obesity were more likely to require invasive mechanical ventilation.

Collectively this evidence suggest that obesity may be a significant risk factor for COVID-19. Dr. Norbert Stefan, of the German Center for Diabetes Research stated that “obesity may put people infected with Covid-19 at more severe risk and possibly risk of death.” Many of the recent articles published in the last 2 months regarding comorbidities and the association with COVID-19 did not produce data surrounding body composition or metabolic health. The gap in data warrants further research to investigate how body composition, waist circumference, and blood glucose levels play a role in contraction and recovery from the virus, specifically metabolic syndrome.
Metabolic syndrome is a serious health condition that affects roughly 23 percent of adults and increases their risk of cardiovascular disease, type 2 diabetes, stroke and diseases related to fatty buildups in arterial walls according to the American Heart Association. The overall underlying cause of metabolic syndrome includes being overweight, obese, inactivity along with other genetic factors associated with aging.

However, given the limited studies there is not sufficient evidence to definitively say that those with obesity at higher risk for more severe COVID-19. The limited literature does suggest a connection and we can note that obesity is indeed a risk factor for worse outcomes in regard to health. Research does support the notion that those who are obese tend to experience more severe forms of infections according to a publication in the International Journal of Obesity .

However, given the limited studies there is not sufficient evidence to definitively say that those with obesity at higher risk for more severe COVID-19. The limited literature does suggest a connection and we can note that obesity is indeed a risk factor for worse outcomes in regard to health. Research does support the notion that those who are obese tend to experience more severe forms of infections according to a publication in the International Journal of Obesity .

Strategies to Overcome Obesity: Tips for a Healthier Tomorrow

Now that we are aware of the connection obesity has with disease and infection let’s talk about practical strategies and tips to improve body composition and overall health! First and foremost, obesity prevention begins at a young age. It’s important to help young growing adolescents maintain a healthy weight without a focus on the scale.

• Eat healthy foods as a family and create a healthy experience with eating at the table with no distractions like tablets, computes, phones and other games.
• Encourage eating slowly and eating only when hungry. Eating out of boredom can lead to excess calorie consumption. If you find yourself eating out of boredom be sure to have healthy snacks like fresh cut fruits and veggies available to snack on.
• Limit unhealthy foods that lack nutrients in the household. If it ends up in your cart at the store, it will end up in your mouth and eventually your tummy. Stock the fridge and pantry with healthy foods, and limit low nutrient foods as a “treat” that is not consumed daily.
• Establish a healthy sleep routine and focus on managing stress. Those that tend to sleep more heave a healthier weight and crave less unhealthy foods that are often low in nutrition. Higher stress is also associated with weight gain due to poor coping mechanisms.
• Incorporate regular physical activity which includes at least 60 minutes per day. A byproduct of being more active is less time in front of the screen.

Obesity prevention for adults

It is no secret obesity prevention tips are the same for losing or maintaining a healthy weight. Consuming a healthy diet, sufficient sleep and participating in regular physical activity can help prevent obesity.

• Consume plenty of healthy fats. A study published in the Nutrition Journal illustrated that intake of healthy fats, such as polyunsaturated fats, can attenuate cholesterol levels and decrease obesity risk.
• Eat regular meals on a schedule. Eat a proper breakfast, lunch and dinner that has appropriate portion sizes. Make half your plate fruits and vegetables. Adults should consume five to nine servings of fruits and veggies each day.
• Fruits and veggies are low in calories, high in nutrients, water and full of dietary fiber that supports satiety. Research shows dietary fiber plays a key role in maintaining a healthy weight. A 2019 trial published in Journal of Nutrition found that dietary fiber intake promotes weight loss and dietary adherence in adults with overweight or obesity consuming a calorie-restricted diet.

• High calorie, high sugar foods often contain limited nutrients and tend to promote over-eating. Processed foods that should be limited to avoided include cereals, white bread, potato chips, cookies, ice cream, granola bars, crackers and other snack foods. Be mindful of marketing claims for certain snack foods that may list “low-fat” or ‘low-carb” but still contain a significant amount of sugar and limited nutrients. Should you choose granola bars or grains ensure they are whole-grain.
• Participating in regular activity that includes both strength training and aerobic activity. Regular physical activity of 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity is encouraged per week according to the CDC . Find a movement that you enjoy doing and set a goal to complete it each week with the family. Establish smart goals and hire a coach that can assist you in completing appropriate exercise safely to prevent injury. If you’re new to exercise, begin by walking, stretching and strive to improve your time spent exercising each week.
• Focus on meal prep and have a plan. It is much easier to shop for healthy foods when you have a list that meets your budget. If you walk into a store with a list you are less likely to be tempted by unhealthy foods. Avoid walking down the aisles looking for items that are not on your list. A good grocery list should contain plenty of fruits, vegetables, fish, healthy whole-grains, lean proteins, healthy fats and spices. Be sure to make a regular list and post it on the fridge for items as you run out.
• Eat more protein and veggies as snacks. Higher protein intake is associated with better weight management, glycemic index and bone health according to several studies. A review published in the Journal of Food Science specifically illustrates the metabolic advantages of higher protein diet and benefits of dairy. Higher protein intake is associated with greater satiety and healthier better composition. Some great high-protein options include eggs, Greek yogurt, beef, chicken, fish, lentils, wild game and other dairy products. A study published in the European Journal of Obesity examining the effect of a high-protein diet versus a standard protein diet on weight loss and biomarkers of metabolic syndrome found significantly greater weight loss with higher protein diet.

Many are looking for ways to stay calm during one of the most unprecedented health crises our country has ever seen. Shift your focus to these 3 areas to improve your health during the pandemic.

Establish a routine:

Which includes regular wake, bedtime, movement, mealtimes, schoolwork, work projects and “leisure time” built in to create stability. Eat breakfast every day! Those that consume the majority of their calories early on are less likely to be overweight and obese. Be sure to incorporate a high-quality protein, fiber and fluids. By getting into the habit of completing tasks on a regular basis along with mealtimes you set yourself up for a new normal.

Nutrition 101

Be mindful of fluids, what you are eating at meals and snacking on. High-stress situations can lead to an impact on our ability to make healthy choices. By stress eating high-calorie and low nutrient foods you are more likely to put on undesirable weight. By creating a schedule of mealtimes and having a calendar of meals you are less likely to eat out of boredom.

• Have fruits and veggies cut and prepared in the fridge should you be hungry and snack on nutrient dense foods versus processed food.Grocery shopping is critical, be sure to have a list prepared ahead of time and stock up on plenty of frozen along with fresh fruits and veggies.
• Eat the rainbow and incorporate as many whole foods as possible. By eating colorful fruits and vegetables you can support a healthy immune system. Vitamins and minerals support a healthy immune system which are found in pigment rich foods (color!).
• Be sure to also incorporate unsalted, nuts, seeds, lean proteins and healthy fats can truly help optimize your immune function land even support good sleep. What we eat has a direct impact on our sleep which can also help keep unwanted pounds at bay!

Supporting positive mental health with movement and meditation!

Getting plenty of regular movement, aerobic activities like walking, biking, hiking, swimming along with resistance training with household items or weights at home. Exercise boosts physical, mental and emotional health which can help reduce stress overall. By reducing stress, you are also fighting off the risk of disease and illness. 30-40 minutes a day of yoga, meditation, walking, running or biking is a great way to stay healthy! Many apps, videos and programs are available on demand online.

Additionally, a personal trainer or fitness coach can also assist you in setting goals for routine physical activity. I work with several individuals on creating a periodized program for appropriate progression of physical activity. The goal is to move more and to feel good about the exercise you are doing. The journey to 100 miles begins with taking that first step. I am here to help you and support you, join me and take that first step to a healthier tomorrow!

In good health,

Wendi Irlbeck, MS, RDN