Tsk Tsk: Obesity and COVID-19 Mortality

“Fat deposited in skeletal muscle may be sought after by top-end steakhouses but…” These words bubbled up from an editorial this week in Annals of Internal Medicine. It was about obesity and COVID-19. At best, this is an unfortunate metaphor. A less generous take is that the author – a professor of Medicine at Johns Hopkins – is not really taking the humanity of people with obesity seriously. In fact, the editorial is a commentary on a new study of mortality risk for people with obesity and COVID-19. It found that, for younger men, the risk of dying is up to 17 times higher if that person has a BMI above 45.

So why is the author writing about beef marbled with fat?

A Clever Play on Words

The title of this commentary offers a clever play on words: “A big problem?” But the conclusion is not so clever. It’s a shrug. “What is to be done?” asks the author. His answer is not much. Just avoid the virus. He offers no serious thought on obesity care. There’s a passing reference to weight loss – it’s hard.

The implication is clear. No point in doing anything about obesity. Just try not to get the virus. Yes, using a mask, keeping social distance, and other measures are smart.

A Time to Take Obesity Seriously

The study in Annals is indeed striking. With a BMI above 45, the risk of death with COVID-19 goes up more than four times – regardless of age. For younger men, the risk is 14 to 17 times higher. These risks “eclipse” the risks posed by other chronic conditions that often result from obesity, write the researchers. And they call for taking obesity more seriously.

The fact is that obesity is a problem of adipose tissue that has run amok. The body is not regulating it well and persistent inflammation results. It’s a problem that’s all about health, not size and weight. True, the accumulation of excess adipose tissue has an effect on weight. But the real problem is metabolic function.

Delivering Care

Obesity care is not simple, nor does it produce miraculous cures in most cases. However, it does yield better health. With good obesity care, diabetes and heart disease are better controlled. Other complications can be kept at bay. Better health status should mean better odds for survival of a serious illness like COVID-19.

Thus it seems unwise to neglect sound principles of obesity care when considering the implications of obesity and COVID-19 for mortality. This editorial, talking about beef marbled with fat instead of obesity treatment, is appalling.

Click here for the study in Annals and here for the editorial. For yet another new study of these risks, click here.

Indifference, photograph © Ben Cappellacci / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


August 14, 2020