Severe COVID-19 in Young People: Caused by Obesity?

As the UK variant (B.1.1.7) became dominant in the U.S., something else started to change. More young people started showing up in the hospital. In fact, COVID wards are filling up with younger patients in Michigan. This may simply be a result of more infections in young people. Teens in Michigan are testing positive at the highest rate of any age group. But two new studies are telling us that in these younger patients, obesity explains much – or perhaps even most – of the severe COVID-19 popping up in young people.

A Prospective Study of 6.9 Million in England

BMI and Risk of Death Due to COVID-19This week Min Gao and colleagues published a cohort study of patients from a general practice database in England. They found the risk of severe COVID-19 with hospitalization and death going up in a straight line, starting at a BMI of 23. At a BMI of 40 – class 3 obesity – the risk of death roughly doubled.

Of course, the biggest risk for severe COVID-19 is age. But for younger persons, the authors of this study say obesity mostly explains the risk for bad COVID-19 outcomes:

“Notably, the effect of excess weight on the risk of severe COVID was greatest in young people aged 20 to 39 years of age, and decreased after age 60. Excess weight had very little effect on the risk of severe COVID in people aged over 80 years.”

Analysis of Patients in Mexico

The second study examined data from 71,103 patients in Mexico’s National COVID-19 Surveillance Study. They found that obesity by itself was a strong risk factor for mortality and critical illness. When combined with other conditions, risk was even higher. The authors note that the high prevalence of overweight and obesity in young Mexican adults could be responsible for the high toll COVID-19 is taking there.

Lack of Care

Professor Nick Finer tells us that these findings, with reference to the Gao study, are disturbing:

“It is a sobering comment on the lack of care provided to people living with obesity that the authors were unable to assess the potential benefits from weight loss due to the fact that ‘the number of participants reported to have been offered referrals to weight management programmes was low and weight change was poorly recorded.’ The findings highlight the need to recognise that obesity is not just a chronic disease, but also a risk for acute illness or even death, and there is therefore a need to improve access to evidence-based treatments for people living with obesity.”

But of course, we do have data to suggest that adequate treatment can cut the risk for hospitalization with COVID-19 by half. So it’s about time to start tearing down the systematic barriers to care for obesity. Our health is at stake.

Click here for the Gao study and here for the Mexican surveillance study. For further perspective, click here, here, here, and here. Finally, the study of bariatric surgery and COVID-19 hospitalization risk is here.

Youth, fresco by Jose Clemente Orozco / WikiArt

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April 30, 2021