Wed, May-06-20, 08:37
Coronavirus: obese people at greater risk of death and may stay infectious for longer
Obese patients are more likely to end up in hospital with the coronavirus — and are more likely to die — than those who are a healthy weight.
Government scientists on the scientific advisory group for emergencies (Sage) are investigating whether the link between obesity and the virus is stronger than previously thought. New figures from the UK’s Intensive Care National Audit and Research Centre found that the proportion of morbidly obese patients in intensive care units is twice the proportion in the general population.
The role of obesity was also in the spotlight last week after a doctor claimed that Boris Johnson had become so ill with the coronavirus because he is overweight.
Dr Aseem Malhotra, a cardiologist who wrote The Pioppi Diet, a controversial take on Mediterranean food involving high fat and low carbohydrates, argued that Johnson’s build — at 5ft 9in, he had admitted weighing almost 16½ stone in 2018 — led him to need hospital treatment for the virus.
What is the evidence?
Research is still at an early stage but a study published last week found that the risk of dying from the coronavirus was 37% higher in overweight patients.
Scientists at the Coronavirus Clinical Characterisation Consortium, which looked at almost 17,000 hospital patients, found that having a BMI (body mass index) of more than 30 — defined as “obese” under NHS guidelines — is a significant factor associated with dying from the disease.
Data from the NHS has shown that 38% of those admitted to intensive care with the coronavirus are obese, compared with the 28% of the UK population in that group. A similar pattern was observed in America, where even young obese patients with no other health problems were becoming gravely ill with Covid-19.
Why are the obese at greater risk?
Many seriously overweight patients suffer breathing problems and researchers believe that reduced lung function is probably a major factor in the higher death rates. Fredrik Karpe, professor of metabolic medicine at Oxford University, said that if you have a larger stomach, when you lie down the extra weight pushes your diaphragm upwards, reducing lung capacity.
This may explain why the lungs of obese patients with Covid-19 fail faster than the lungs of those who are a healthy weight.
A second potential factor is greater inflammation of the fatty tissue around internal organs. This could contribute to a “cytokine storm”, a life-threatening overreaction by the immune system seen in some Covid-19 patients.
The obese are also more likely to suffer from type 2 diabetes, high blood pressure and heart disease, to have a poor diet and not take enough exercise — all of which increase the dangers of the coronavirus.
Are fatter nations hit worse?
Ministers have privately said that the high death toll in the UK may be partly explained by the obesity rate. However, other factors include the slow adoption of the lockdown, the lack of mass testing and tracing, international tourists continuing to arrive without any checks and the high population density of London, which allowed the virus to spread quickly.
Are there any other risks from obesity?
Some scientists believe obese patients may be infectious for longer. There is also speculation that when a vaccine is developed, it may be less effective in those who are severely overweight.
This is an extrapolation from research into flu, which found that vaccination provided less protection for the obese. A 2017 study by the University of North Carolina at Chapel Hill found that 10% of extremely overweight participants developed flu despite being vaccinated, compared with 5% of participants who were a healthy weight.
Researchers suggested that the differences might indicate that T cells, part of the body’s immune response, could be impaired in the obese.
What should I do if I am overweight?
It is a good time to try to shed some inches, especially around the waist.
Most people, particularly men, tend to lose weight from the abdominal area first when they go on a diet.
Professor Neil Ferguson, the Imperial College epidemiologist, Karpe and Malhotra agree that a better diet will help you fight the virus.
Malhotra believes the prime minister could lead the nation: “Boris could set an example to us all by slimming down now he’s recovering.”
How to work out your BMI
Divide your weight in kilograms by your height (in metres) squared. So if you are 180cm tall and weigh 80 kilograms, your body mass index (BMI) is 80/(1.80²) = 24.7. A healthy BMI is between 18.5 and 24.9; between 25 and 29.9 means you’re overweight; 30-39.9 is obese; 40+ is morbidly obese.
Obesity is blamed for Johnson’s coronavirus suffering
Boris Johnson was so badly affected by coronavirus because he is “significantly” overweight, a doctor said yesterday.
Aseem Malhotra, a cardiologist, said that risk of death from the disease increased ten-fold if the patient is obese.
He pointed out that “slimmer” members of the cabinet, such as Matt Hancock, recovered much more quickly and were not hospitalised.
The prime minister, 55, has long struggled with his weight and in 2018 he revealed he weighed almost 16 and a half stone, which at 5ft 9in puts him in the high-risk category. Dr Malhotra, speaking on Good Morning Britain on ITV, said the Centre for Disease Control and Prevention had discovered that there was an alarming link between death rates for Covid-19 and obesity.
He said: “I used to speak with one of [Mr Johnson’s] very senior advisers when he was London mayor a few years ago who expressed to me personally concerns about his weight.
“People with obesity also seem to spread the virus for a much longer period of time and also clearly get sicker. If you notice Chris Whitty, Matt Hancock and other members of the cabinet who got the virus, [they] did not get it as badly and they are essentially pretty slim.”
Dr Malhotra said that issues such as high blood pressure, type 2 diabetes and heart disease all lead to Covid-19 complications.
He added: “This is really the elephant in the room. The Centre for Disease Control a few weeks ago did an analysis and put out the message that there is likely a ten-fold increase in death rates in people who have conditions linked to obesity, which basically include high blood pressure, type 2 diabetes and heart disease.”
He explained that in Britain, more than half the population is classed as obese or overweight and that could be one reason the country had been hit so hard by the virus.
“When you look at the roots of all of this, even pre-Covid-19 it is well established now that poor diet is responsible for eleven million deaths per year,” he said.