Break In Emergency

The Acute Problem of Neglecting a Chronic Disease

We are in the midst of an intense learning experience. We’re learning how to live in physical isolation. At the same time, we’re also gathering as much knowledge as we can about a new virus that can be both sneaky and nasty. But most of all, we’re getting a hard lesson about the cost of neglecting a chronic disease. Yet another study is telling us that obesity is an important risk factor for severe symptoms when someone gets COVID-19.

In a pre-publication study, Christopher Petrilli and colleagues found that age and obesity are the most important markers of risk for COVID-19 symptoms severe enough to warrant a hospital admission.

Age, Gender, and Chronic Conditions

This study comes from a cohort of 4,103 confirmed COVID-19 patients. The researchers conducted a multivariate regression analysis to find the most important risk factors for bad outcomes. What they found was that age and chronic conditions are the most important factors. And among the chronic diseases, obesity stood out:

The chronic condition with the strongest association with critical illness was obesity, with a substantially higher odds ratio than any cardiovascular or pulmonary disease. Obesity is well-recognized to be a pro-inflammatory condition.

They also found that markers of inflammation were predictive of more critical illness.

Interestingly enough, male gender dropped out as an important predictor of bad outcomes in this study. Others have focused on being male as a risk factor. Though the sicker patients in this study were more likely to be male, gender did not do much to predict worse outcomes when the researchers accounted for underlying health conditions.

It’s worth noting that these findings are preliminary. Peer review is not complete and thus we take them with a grain of salt.

Denial and Discrimination

Nonetheless, it is getting harder to deny that obesity contributes to the risk for severe symptoms with COVID-19. Nonetheless, some continue to try. HAES activists insist that “the percentage of high-BMI folks with critical COVID cases is basically the same as – if not lower than – the percentage in the general population.”

They also express worries about poor acute care for people with COVID-19 and a high BMI because of prevalent anti-fat bigotry. Of course they are right about the bigotry and it’s all too prevalent in healthcare. However sensational these claims might be, though, we can’t find any objective evidence to support them. In fact, the Petrilli study and others suggest that patients with a high BMI are more, not less, likely to get intensive care when they present with symptoms of COVID-19.

As far as we can tell, what really matters is the denial and discrimination that occurs over a lifetime. The well-documented problem is that people with obesity get substandard care for most of their lives. Ineffective advice to lose weight is a lousy substitute for evidence-based care.

COVID-19 is illustrating in vivid terms how neglecting the care needed for a chronic disease – obesity – can lead to a serious acute problem. Our response, as we deal with the acute crisis, must ultimately be to seek and deliver better care for the chronic disease that makes us vulnerable.

Click here for the Petrilli study and here for further reporting on it..

Break In Emergency, photograph © darwin Bell / flickr

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April 14, 2020