Electrocution Risk

Why Obesity Matters for COVID-19 Outcomes

It’s an understandable reaction. In various ways, a few people tell us that we should not discuss the risk of bad outcomes in people with obesity and a coronavirus infection. “It 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,” wrote one person. But we disagree strongly. Obesity matters for COVID-19 outcomes and clinicians should pay attention in order to deliver the best possible care.

Objective Risk Assessment

It seems that political agendas creep into everything these days. Without any evidence, body liberation advocate Lindo Bacon (formerly Linda) is whipping up fears that doctors are “literally causing” a higher death rate for people with obesity by excluding individuals with a high BMI from ventilator treatment.

We don’t need more conspiracy theories right now.

The objective truth is that obesity matters. It is a risk factor for pulmonary disease. This is the result of of physiology – not choice or anti-fat bias. Fat advocacy can’t whisk this problem away. It’s a medical problem.

It’s also objectively true that obesity has a role in inflammatory responses and hypoventilation syndrome. Furthermore, it’s clear that patients with obesity fared worse in the H1N1 flu pandemic. These are facts, not ideas ripe for philosophical debate. These and other facts explain why the CDC advises that people with severe obesity are at risk for bad outcomes with COVID-19.

The Impact of Neglecting Patients at Risk

Going into this pandemic, the assumption was that it would be a problem mainly for older people – especially people over 80. Thus, many young people took a cavalier attitude. Throngs of “spring breakers” in Florida and Mexico were emblematic. Feeling invulnerable, they returned home with the virus.

But that’s just part of the problem. Ignoring risk factors in young, otherwise healthy patients who develop the infection can have dire consequences. Kara VanGuilder, 25 and in generally excellent health, tells the Boston Globe about her experience with COVID-19:

That’s the closest encounter I’ve had with death in my whole life. I really was convinced that weekend that I was going to die.

Even more compelling is the story of New Jersey’s first patient with COVID-19, James Cai. He is a physician assistant who knew what was happening to him as COVID-19 took over his body and threatened to kill him. And yet, he could not get his doctors to take his case seriously because he was young and generally healthy. They repeatedly told him that he would be fine because of his age. It would feel like a bad case of the flu. It took the intervention of experts from all over the world to turn them around. He very nearly died.

This is why it’s important to pay attention to every risk factor we know about. Not to deny, but to deliver the care that’s needed. To recognize those of us who are at risk and give us the care we need.

Ideology and medical care is not a good mixture. Especially in the midst of a pandemic.

Click here for more on the experience of James Cai and here for more on the threat of truth decay to sound decision making. For more on the risk of obesity and COVID-19, click here, here, here, and here.

Electrocution Risk, photograph © Indrid Cold / flickr

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April 6, 2020

4 Responses to “Why Obesity Matters for COVID-19 Outcomes”

  1. April 06, 2020 at 9:30 am, Angela Meadows said:

    Ted, I feel you have willfully misrepresented the comment I made on one of your posts a few days ago by quoting part of the comment totally out of context.

    I do not dispute that obesity is associated with a range of risk factors that increase the risk of more severe outcomes with COVID-19, nor that doctors should take into account all relevant clinical information. The point I was making was that statements like ‘X% admitted to ICU’ or ‘X% have died as a result of the coronavirus’ simply reflects prevalence to date of high-weight status in the population in question. It suggests high BMI per se, rather than other risk factors, is an indicator of poor prognosis.

    • April 06, 2020 at 2:21 pm, Ted said:

      Thanks for clarifying your thinking, Angela.

      I ask that you not presume to know what lies in my heart by telling me what I’ve “willfully” done.

      The words you earlier posted reflect thinking that I have heard from other people as well as you. I did my best to understand your words. I’m glad to know that your quarrel is all about BMI as a risk factor and not about obesity per se. So I really do appreciate your making that explicit with this comment.

      As you know, I agree that BMI not a perfect substitute for a clinical diagnosis of obesity.

  2. April 10, 2020 at 9:35 am, Natasha said:

    Don’t ignore the obesity paradox. People with high BMI with chronic conditions, acute conditions and older age live longer than people with those same conditions and lower BMI. A high BMI is a sometimes consequence of disease, not a cause. In chronic inflammation, metabolism slows down, ATP is pushed out of the cells and fat is synthesized. Metabolic slowdown gives the body more time and a greater chance to survive. Fat bodies are smart bodies.

    • April 10, 2020 at 11:51 am, Ted said:

      Thanks, Natasha, for sharing your feelings about this. However, you might do well to read about the flaws that are pervasive in papers about the obesity paradox. Katherine Flegal and John Ioannidis write here that it is “a misleading term that should be abandoned.” Also, Hailey Banack and Andrew Stokes do a good job here of explaining that most papers about the obesity paradox are inherently flawed and do more to cause confusion than provide real insights. Thus, Ana Peters argues here that reputable scientific journals should no longer accept such flawed papers for publication. I agree.