April 16, 2020
Craig Primack, MD, FACP, FAAP, FOMA
The world is still bracing for the full impact of the novel coronavirus. The coming days and months hold many uncertainties, but a recent warning from the country’s top infectious disease expert said that the United States could ultimately see millions of cases of the coronavirus should give us all pause.1 And as hospitals, providers and public health officials work to identify who is most at risk for the coronavirus, it would be imprudent to ignore one of the country’s most vulnerable populations — people living with obesity.
The emergence and rapid spread of the coronavirus demand further research into its specific impact on different populations. That said, the rise of H1N1 in 2009 offers a glimpse into the risks that viral respiratory infections pose to people living with obesity. During that pandemic, patients with obesity experienced greater severity of illness with a higher risk of hospitalization and mortality.2 3
More than a decade later, America’s obesity rate has increased from 35 percent to 42 percent with no signs of slowing.4 5
How can patients with obesity reduce their risk? Adopt healthy habits.
Common sense calls for more frequent handwashing, less face touching and social distancing are a good starting point for generally limiting the risk of infection, and certainly good advice for everyone to follow during a global health crisis, regardless of body mass index. But given the unique health risks faced by patients with obesity, promoting broad lifestyle changes alongside these smaller habits among obesity medicine and weight loss surgery patients is critical to fortifying them against this looming pandemic.
The adoption of healthy lifestyle habits decreases mortality risk for people across the weight spectrum, but people living with obesity experience the greatest benefit.6 We may be years away from fully understanding the coronavirus, but in the meantime, we can lean on decades of clinical knowledge about reducing the risk of infectious viral conditions among vulnerable groups, like people with obesity.
Diet and exercise still matter — here’s why
Our understanding of effective obesity treatments has evolved beyond the conventional advice to “eat less and move more.” We know that obesity, like other states of malnutrition, carries an inflammatory element that is known to reduce immune function called adiposopathy.7 And we know that just 60 minutes of regular, moderate-to-vigorous exercise has a significant impact on the body’s natural defense system.8
For patients with obesity facing an increased risk of hospitalization due to viral respiratory infections, proper nutrition and physical activity can improve long-term health prospects.
Stress and the body’s self-defense system
Chronic stress is strongly linked with increasing levels of glucocorticoid, which plays a key role in the development of the inflammatory symptoms associated with obesity that impact overall immunity.9 Stress management strategies, which can include exercise, alongside cognitive behavioral techniques like talk therapy, can help patients with obesity strengthen their immune systems.
Obesity medicine resources for bariatric and metabolic surgeons
Bariatric surgery has emerged as an effective — and highly sought out — treatment for chronic obesity. And though the coronavirus pandemic is almost certainly impacting the way bariatric surgeons are currently practicing medicine, clinicians can continue to provide patients with life-saving care by empowering themselves with tools and resources to better meet the needs of this vulnerable population.
The Obesity Medicine Association (OMA) offers a trove of resources for clinicians and healthcare professionals to advance their knowledge of obesity medicine, including continuing medical education, American Board of Obesity Medicine (ABOM) exam preparation, Obesity Treatment Proficiency Badges™ and The Obesity Algorithm®, which offers comprehensive clinical guidance on the latest obesity management trends and evidence-based medical approaches to treatment.10 11 12
The coronavirus pandemic has exposed the vulnerability of certain populations, such as people living with obesity, to public health crises. Although it may be several years before the full impact of the coronavirus is completely understood, embracing healthier lifestyle habits is an easy, proactive way for anybody — regardless of BMI or body shape — to reduce their risk of infectious viral conditions. As we all look for ways to stem the spread of the coronavirus, it’s important to remember that everyone can play a part in flattening the curve by adopting common sense healthy habits and following official recommendations and guidelines from The Centers for Disease Control (CDC) as well as local public health departments.
For more obesity medicine resources related to COVID-19, visit: https://obesitymedicine.org/covid-resources/
1US Could See Millions of Coronavirus Cases and 100,000 or More Deaths, Fauci Says. CNN. https://www.cnn.com/2020/03/29/politics/coronavirus-deaths-cases-anthony-fauci-cnntv/index.html. Accessed 25 March 2020.
2Obesity and Respiratory Infections: Does Excess Adiposity Weight Down Host Defense?. Pulmonary Pharmacology & Therapeutics. https://www.sciencedirect.com/science/article/pii/S1094553912000703. Accessed 24 March 2020.
3Morbid Obesity as a Risk Factor for Hospitalization and Death Due to 2009 Pandemic Influenza A (H1N1) Disease. PLOS. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0009694. Accessed 24 March 2020.
4Prevalence of Obesity in the United States 2009-2010. Centers for Disease Control. https://www.cdc.gov/nchs/products/databriefs/db82.htm. Accessed 24 March 2020.
5Adult Obesity Facts. Centers for Disease Control. https://www.cdc.gov/nchs/products/databriefs/db82.htm. Accessed 24 March 2020.
6Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals. Journal of the American Board of Family Medicine. https://www.jabfm.org/content/25/1/9. Accessed 24 March 2020.
7Obesity, Inflammation and the Immune System. Proc Nutr Soc. https://www.ncbi.nlm.nih.gov/pubmed/22429824. Accessed 24 March 2020.
8The Compelling Link Between Physical Activity and the Body’s Defense System. Journal of Sport and Health Science. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6523821/. Accessed 24 March 2020.
9Oxidative Stress and Inflammation Interactions in Human Obesity. Journal of Physiology and Biochemistry. https://research.thea.ie/bitstream/handle/20.500.12065/2782/JPhysiolBiochemBondiaPonsI2012.pdf?sequence=1&isAllowed=y. Accessed 24 March 2020.
10Obesity Medicine Association. https://obesitymedicine.org/badges/. Accessed 24 March 2020.
11Obesity Medicine Association. https://obesitymedicine.org/. Accessed 24 March 2020.
12Obesity Medicine Association. https://obesitymedicine.org/obesity-algorithm/. Accessed 24 March 2020.
13Coronavirus (COVID-19). Centers for Disease Control. https://www.cdc.gov/coronavirus/2019-ncov/index.html. Accessed 1 April 2020.