Croissant d'Or, New Orleans

COVID-19, Obesity, Disparities, and Denial Meet in New Orleans

New Orleans is in a world of hurt right now. That’s because COVID-19, obesity, disparities, and denial have come together and contributed to a grotesque catastrophe. The city leads all other cities in the U.S. on deaths per capita from COVID-19. Obesity and the complications of untreated obesity are important factors.

As of yesterday, out of 185 people who have died in Louisiana, only three percent did not have an underlying chronic disease. Diabetes was the most common primary condition, affecting 40 percent of those who died. Next was obesity in 25 percent of the deaths. Kidney disease, heart disease, and lung disease followed in that order.

Seven Times Higher Than New York

The impact is big. For an idea of how big, consider this: the death rate is seven times higher for COVID-19 in New Orleans than in New York City. It’s ten times higher than in Seattle. One reason is disparities. COVID-19 is hitting poorer people harder. It’s more dangerous in people with chronic diseases and those diseases are more common in people of color, as well as people living in poverty.

Rebekah Gee was Louisiana’s Health Secretary before she became the head of LSU’s Health Care Services Division. She explains:

We’re just sicker. We already had tremendous healthcare disparities before this pandemic – one can only imagine they are being amplified now.

Donna Ryan, from Baton Rouge, is President of the World Obesity Federation and a past-President of the Obesity Society. She recently co-authored an editorial on obesity and COVID-19 in the Obesity journal and explains the issues:

The risk factors for a bad outcome with COVID-19 are age, any disease (including obesity) and male sex. Of course there are other things going on. Certainly viral exposure load must play a role, but we don’t really understand that very well. Mardi Gras was almost certainly a factor. It’s exactly the opposite of social distancing. One of the early hot spots was Lambeth House, a retirement community where many participated in Mardi Gras balls and parties. There were 53 cases there and 13 deaths. My church has many members there.

Disparities and Denial

This becomes a sticky mess very quickly because bias, stigma, disparities, and denial come into play. COVID-19 is hitting people with social and economic disparities hardest. All of the chronic diseases that predict worse outcomes with COVID-19 are more common in disadvantaged communities, including people of color. Discrimination is rampant against people with obesity, independent of race and ethnicity.

Denial comes into play because obesity is so highly stigmatized. Close to half of Americans have it, but people run from the O-word. “I’m not that bad off,” we hear many people say. Some people will even argue that obesity isn’t a valid medical condition. But denial doesn’t make risks go away.

Justly Allocating Resources

On top of that you have the challenge of allocating health resources as COVID-19 overwhelms our systems. Writing in the New York Daily News, Jacob Appel, an Assistant Professor of Medicine at Mt. Sinai, describes the ethical problem:

Early evidence suggests that patients with underlying health conditions are more susceptible to death from COVID-19. Many of these conditions – obesity, diabetes, COPD – afflict those with less economic power more than their affluent peers. So favoring the more healthy is in itself discriminatory, compounding underlying disparities resulting from inequality.

COVID-19 is magnifying the flaws in our systems for healthcare. In the UK, it’s revealing the true cost of underfunding the NHS. Here in America, it’s putting a spotlight on health disparities.

We can do better.

Click here for further perspective on COVID-19 in New Orleans and here for more on obesity and COVID-19 from the Stop Obesity Alliance.

Croissant d’Or, New Orleans, photograph © Ted Kyle / flickr

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April 3, 2020

7 Responses to “COVID-19, Obesity, Disparities, and Denial Meet in New Orleans”

  1. April 03, 2020 at 9:22 am, Donna Ryan said:

    Ted, as usual, you have put a face on the problem. Your empathetic and eloquent blog ought to be required reading for all the policy makers who refuse to pay for evidence-based and proven effective treatments for the disease, obesity. WE CAN DO BETTER!

  2. April 03, 2020 at 2:09 pm, Angela Meadows said:

    25% of people dying from Covid-19 had obesity? What is the prevalence of obesity in New Orleans?

    • April 03, 2020 at 3:44 pm, Ted said:

      A high proportion of the population in New Orleans has obesity, as your question suggests, Angela. But as you may or may not know, obesity is a diagnosis often not recorded because it’s rarely treated and it provides payers with an excuse to deny coverage for care.

  3. April 05, 2020 at 1:51 pm, Angela Meadows said:

    The point being though, that when you repeat statistics like 25% of people who died had obesity (NO) or 70% of ICU intake for covid in UK were overweight or obese, the implication is that higher weight is in itself a risk factor for severe symptoms needing extra treatment, when what we’re actually seeing is an almost exact replica of the distribution of high-weight status in that particular population, i.e., no increased risk due to BMI per se. As a friend and colleague of mine said, 70% of the people who blink in the UK are overweight or obese. Statements such of these, while technically accurate, are misleading and over-inflate the impact of high-weight status (excluding issues relating to comorbidities) and can contribute to anti-fat attitudes at a time when many marginalised groups of people are already being thrown under the bus in discussions around triage.

    • April 06, 2020 at 4:14 am, Ted said:

      Angela, I understand the point you’re trying to make. But I disagree completely. CDC has found that severe obesity is a risk factor for bad outcomes. Prior research has shown quite clearly that obesity increases the risk of pulmonary problems. Outcomes for patients with obesity who need a ventilator are not as good. In H1N1 influenza and SARS, outcomes were worse for patients with obesity.

      The point here is not, as you suggest, to throw people with obesity under the bus. Rather, it is to ensure that young people with the coronavirus and obesity receive the clinical attention they need because they are at risk of death and other bad outcomes. They should not be dismissed as young and healthy and thus not needing careful attention.

      Doctors are doing the very best they can with a flood of illness. To suggest that they should not pay attention to important risk factors is a serious error that will harm people living with obesity.

  4. April 10, 2020 at 9:18 am, Natasha said:

    Angela cites current evidence specific to covid19. Ted ignores current evidence and the evidence supporting the obesity paradox where fat people with chronic conditions, acute conditions and older age have better life expectancy than thin people with those same conditions. Ted chooses medical blindness over the totally of evidence. It is not the fat, it is chronic and acute conditions and old age. Fat is a sometimes consequence of disease, not a cause of disease.

    • April 10, 2020 at 11:56 am, Ted said:

      Natasha, the CDC advises that severe obesity is an important risk factor for severe illness with COVID-19. I agree with them. To argue that this is not so is to spread misinformation that will harm people. I cannot agree with that.