OBESITY & COVID-19: A DANGEROUS COMBINATION

While the country continues to navigate the uncertainty of operating during the COVID-19 pandemic, recent evidence points to a distressing yet sadly unsurprising fact. Obesity, and especially morbid obesity, is linked to higher mortality and severe symptoms due to COVID-19 when compared to healthy weight patients.

While there’s encouraging news about the widespread availability of the COVID-19 vaccines, we won’t be out of the woods for a while. We should also view the pandemic as a wake-up call to the dangers of obesity to our general health.

Listen to Dr. Matthew Pinto and Dr. Chandrasekaran discuss why obesity puts patients at high risk for COVID-19 severity and death, and what you can do to protect yourself (see full transcript below).

 

• In China, where the outbreak began, data from 383 patients showed that having obesity was associated with a 142% higher risk of developing severe pneumonia associated with COVID-19.
• A larger study of over 4,000 patients with COVID-19 in New York City found that severe obesity was a major risk factor for hospitalization, second only to age.
• In Seattle, a study of critically ill COVID-19 patients made similar findings. This analysis found that 85% of patients with obesity required mechanical ventilation, compared to 64% of patients without the condition. Moreover, 62% of the patients with obesity died of COVID-19, compared with 36% of those without obesity. However, it is important to note that this particular study included only 24 patients, all of whom were critically ill, making it difficult to draw far-reaching conclusions from the data.
• The final study included in the analysis involved 124 patients in Lille, France, and also found that patients with obesity were more likely to require invasive mechanical ventilation.

Together the data suggest that obesity is a major risk factor for COVID-19 infection severity and mortality. What it also supports is the tremendously critical work needed to help reduce your exposure through weight loss. This is not only important now amid the pandemic but for the future of your weight loss journey.

We know these are trying times and we are here to support you to the best of our abilities. If you please do not hesitate to contact us.

CMWL Weight Loss Talk – FULL TRANSCRIPT

Dr. Pinto
00:00:03 – 00:00:50

Covid 19. Impact on the world and particularly in the US, is something most of us never expected. The public health crisis has devastated our hospital system, our economy and taking way too many lives. We’ve also learned that outside of age, obesity is a leading risk factor in disease, severity and death due to Covid 19. In reality, obesity has been a slow-moving health epidemic for decades. It is possible that the advent of Covid, 19, is the tipping point for medical providers. To finally, look at weight loss as a more serious topic. Welcome to Center for Medical Weight Loss Talk with Doctor Pinto on Dr Matthew Pinto, medical director of CMWL and your host today.

Dr. Pinto
00:00:50 – 00:01:21

I’m happy to welcome one of our doctors who’s been with us for over a decade practicing obesity medicine in New Jersey. She’s gonna help us make the connection between obesity and Covid 19. Doctor Aparna Chandrasekaran has practice obesity medicine for nearly a decade. She’s been one of the leading voices in New Jersey to identify the medical treatment of obesity as a chronic disease by the AMA. Her patients and we affectionately know her as Dr Chandra. Welcome back, Dr Chandra.

Dr. Chandra
00:01:22 – 00:01:46

Thank you, Dr Pinto. Very happy to be doing the podcast with you again. 2020 was indeed quite unprecedented year for all of us. The pandemic really changed the patient’s perspective about the health putting, um, obesity on the in the spotlight, emphasizing the seriousness of the disease state as well as an urgent call to action.

Dr. Pinto
00:01:46 – 00:02:34

Yeah, no doubt 2020 was an eye opener for me as a physician, among probably the world I don’t in my lifetime, we’ve never seen anything like this. And of course, over the years there’s been similar epidemics and pandemics. But this has been something that I think has shaken the core off of the world, Really. I mean, you know, there’s been horrible diseases, Ebola and things like that, but there have been so localized and even like SARS was somewhat localized. But when you look at this, this affected literally every country in the world for the most part. So the last year has been interesting for a lot of industries. We recognize that for a medical obesity specialist, um how has it affected your practice this past year?

Dr. Chandra
00:02:35 – 00:03:28

Um, like many other practices ours were affected too. Um so we were closed in the month off April and May during the lock down. Uh, initially it was like fear and uncertainty and then we were anxious to get back to some kind of normalcy. So during the logged on time, we were doing only televisits. So we reopened in June and so now we’re more settled and we’re comfortable and we I find the patients are also comfortable and feeling safe to come back to the office to, get medical help. And after we reopened in June, um, I find I have observed a lot more new patients are coming, which is quite uplifting. As we all know the effect off quarantine 15, with patients gaining weight and also the current change in the lifestyle has put a surge in the obesity epidemic.

Dr. Pinto
00:03:29 – 00:03:53

Yeah, and you know, interestingly enough, I had similar situation. We closed in March. We didn’t reopen till the end of May and we found the same thing that we you know, during that that shut down. We were open for telehealth visits, which actually, you know, sometimes bad things happen and good things come out of it right. So we started a whole new aspect of our practice where we do virtual weight loss consultations

Dr. Pinto
00:03:53 – 00:04:33

from new patients to existing patients. And what I found is that even though I think it’s better when a patient comes in and they’re able to get on the body composition analyzer and really get more data on, and talk face to face. What I found was a lot of my longer term patients who maybe we would get lost to follow up once in a while because life will get busy. Now we’re able to stay in more contact with us with these virtual visits, and we’ve actually kept them as an option for our patients. I even started a few new patients who are from different states I have a patient from Buffalo now who I speak to every month, so I think that’s great. Now, let me ask you this. Did you have a lot of patients tested positive?

Dr. Chandra
00:04:33 – 00:05:05

Uh, in my practice there was about 20 patient tested positive. So among them only two very critically ill requiring mechanical ventilation. So, interestingly, both of them were and male in their thirties and early forties and both had B m I greater than 45. So I have observed that among my patients tested positive. Those with lawyer B. M I had milder symptoms or they’re asymptomatic than those with B. M. I greater than 30 or 35.

Dr. Pinto
00:05:06 – 00:05:31

That’s very interesting. So there’s been reports that obesity is one of the biggest risk factors independent of age for the severity of Covid 19 symptoms and the risk of death on back fairly quickly based out of most of the patients in New York, which, of course, was the epicenter in our country. The CDC, actually, you know, has statistics about this,

Dr. Pinto
00:05:31 – 00:06:12

and what’s interesting to me is that you know, um, is that it all almost over, uh, over what’s the word I’m looking for? It’s almost more prevalent that obese patients are having severe issues than elderly patients, Right? Obviously, a lot out of our very elderly patients are very frail patients. They died fairly quickly, but our you know, I’d say 60 70-year-old relatively healthy patients that are not obese aren’t having as many problems as our younger of these patients. Um, what does this surprise you? What do you think about this? Why do you think that obesity is such a risk factor?

Dr. Chandra
00:06:13 – 00:07:12

Uh, not at all. It doesn’t that surprise me at all, so in fact, I wrote an article in medical economics in October 2020 highlighting the reason for increased susceptibility for severe infection, higher hospitalization on higher mortality rate in patients with obesity from Covid 19. So the number one reason is there altered immune response. Okay. With their impaired immunity on and, they also have, uh, they are in a state off chronic inflammatory status. The bodies are in the chronic inflammatory status triggering the cytokine storm, which we typically see in severe Covid 19 infection. So secondly, studies have shown that patients with BMI greater than 35 have or higher, are more susceptible to severe Covid 19 infection, ARDS, respiratory failure and also poor outcome from mechanical ventilation.

Dr. Chandra
00:07:12 – 00:08:02

So an abdominal obesity also makes it difficult to breathe in the prone position. That’s where the patients it’s most favored position to improve ventilation Covid19 and thirdly, the patients with obesity also have other disease state co mobility’s like diabetes, obstructive sleep apnea, hypertension, putting, putting them at higher risk. So hypertension by itself is an independent risk factor for severe infection. But most importantly, what I learned is the docking station, the docking protein for us to wires in the body or the H two receptor protein, which are seen which are evidently present in the fact issue or adipose tissue. Making the patients with obesity at risk for severe infection as well as prolonged viral shedding.

Dr. Pinto
00:08:03 – 00:08:26

Yes, so just so I know we have a lot of non medical people watching this, um, like just to summarize, basically that more obese you are more like your body is in a chronic state of inflammation because all that excess adipose tissue or fat tissue is basis inflammatory for lack of a better word chemicals in our body.

Dr. Chandra
00:08:26 – 00:08:27

Right

Dr. Pinto
00:08:27 – 00:09:16

One of the problems with with co vid is the virus triggers like an inflammation Superstorm right or our body overreacts to the virus. So If you already have increased inflammation, and then this triggers more inflammation. That’s why those patients that are obese deteriorate so much quicker because their bodies are already sort of set up for this for this inflammatory superstorm or site, a kind you called on Ben. You also mentioned that you know, one of the issues of literally just having a big belly, right? Having a lot of abdominal obesity, which we know is the most unhealthy, literally makes it harder to lay on your stomach right, which is the prone position. So they found that when patients have severe respiratory issues,

Dr. Pinto
00:09:16 – 00:10:07

they’re better off line on their belly than they are on their back. So these air some very interesting points that make complete sense to me as a medical provider and you But I think even to the general public, they can recognize why this puts them at risk. Um so when somebody goes from being morbidly obese to, let’s say, being obese, um, and let me define morbidly obese way. We define the level of obesity by how above your normal BMI. You are so BMI is your body mass index, which is you take your weight in kilograms, your height in meters, you divide them into each other and you get this body mass index number and we know normal body body mass index or BMI is between 20 and 25 and then 25 to 30. We considered overweight

Dr. Pinto
00:10:07 – 00:11:06

30 to 40 reconsider obese and then over 40 reconsider morbidly obese. So when someone goes from a morbidly obese, which is usually about 100 over ideal body weight down to obese or when someone goes from being obese. So maybe being 50 pounds overweight, too a little overweight, maybe 20 pounds overweight or if they get all the way back down to a healthy BMI. Um, what does the risk of Kogan severity or death due to Cove? It look like for these groups? I’ve read multiple articles. There are over 300 articles that have been published with this relationship between obesity, morbid obesity and morbidity and mortality from Cove in 19. So morbidity means illness. Mortality, of course, means unfortunately, death. A research article in the Annals of Internal Medicine from November of 2020 showed a J shaped association between BMI and mortality from Covid 19.

Dr. Pinto
00:11:07 – 00:11:22

And what that means is the lowest mortality happened in patients with a normal BMI and the highest mortality happened in patients that were morbidly obese. So you know, what do you think about that? What’s your insight on all this?

Dr. Chandra
00:11:23 – 00:11:42

Yeah, as you had mentioned. So that article was very interesting. The one from the Annals of Internal Medicine Eso as the person moves from a morbidly obese obese category to overweight a normal weight. So the risk for the severe infection, as well as the mortality decreases dramatically.

Dr. Chandra
00:11:42 – 00:12:27

So they found that the lowest mortality in a patient with normal BMI that means normal weight on de so that way, they concluded. And we also found in our experience and our practices that obesity by itself is an independent risk factor. So especially in anger patients and male population So we always thought that over 19 was affecting more of elderly population as you mentioned before. But when it comes to obesity patients who are much anger without much medical issues also or at increased risk for severe infection on also it puts them at a higher risk for death from Covid19 infection. Unfortunately.

Dr. Pinto
00:12:28 – 00:13:00

You know, that’s interesting. I have a lot of nurses as patients and, you know, when you said morbidly obese younger males, you know, being in a high risk. Um, you know, one of the things I’ve always I like to make small talk with my patients. Ask them how their life is, what they’re doing and a lot of ICU nurses and ER nurses that I’ve talked to. At least two gave me almost the same story and the story. Was you know, when I asked him how scolded is there a lot of patients in the hospital? A lot of people dying. How busy is the ICU. This was early on

Dr. Pinto
00:13:01 – 00:13:43

and they would say, you know, most of the people who are sick are people. We expect they’re coming from nursing homes there, you know, bedridden in their frail or elderly. But, you know, I’ve been surprised by by a patient, and I said, Well, what what surprised you about your patient? And this was two different nurses, two different days, two different hospitals, but really the same story. And they both said, Well, we had this young you really overweight male, come in. Both happened to be a minority. I believe they were both African American, but they came in. They looked okay, but they said they didn’t feel well. And before we knew it, they were. They were on a ventilator and fortunately, they both survived, but we’re both extremely ill. And these men were in their twenties.

Dr. Pinto
00:13:43 – 00:13:47

Um, and what surprised these nurses was how fast they decompensate it. How fast

Dr. Pinto
00:13:48 – 00:14:17

they went. Downhill is the other term on. But they were the sickest patients. Sicker than even the elderly patients. Andi. And that’s scary to me. Andi, I know. I had a lot of patients come into my office. Who said to me, I know I need to lose weight. You know, I’ve been wanting to lose weight, but I’m really scared about Covid, you know? And if I lose weight, they’ll ask me, Well, my risk could go down. And what you’re telling me with this study is yes, it will go down.

Dr. Chandra
00:14:17 – 00:15:07

Yes. Yeah. It will definitely go down in the studies as well as in our experience. As I told you, patients with the lower BMI in my own practice had milder symptoms. They did this positive, but they they had milder symptoms like flu like symptoms stayed home. They were not hospitalized and their illness was short lived on. They did not require any medical treatment. For Covid 19, so they were just fine with symptomatic treatment like they treated like a regular cold or flu on it went away. So definitely weight has had a huge impact on this, um pandemic. And we have to address those issues so that I mean, we still have a year or so that we’re going to live with this virus.

Dr. Chandra
00:15:07 – 00:15:17

So we really have to get the risk. Factors don’t as quickly as possible so that we can mitigate. Okay, the complication and the side effects with the Covid 19.

Dr. Pinto
00:15:18 – 00:16:01

So, like you said, we’re living with this virus, and it’s almost believe it or not, it’s almost been a year. Well, it’s been over a year that the virus has been obviously in other parts of the world. But we’re getting close to that, you know, march where we shut down basically the United States. Um, So my question is where we go from here, right? Vaccines are rolling out. I was fortunate enough to have my vaccinations already. I’ve had both on do you know, to put people’s minds at ease? I didn’t get sick. I felt fine. I had a little arm soreness with my first injection. My second injection, which was three weeks later because I had the fighter vaccine. Um, I felt maybe like a dull headache. But, you know, I get headaches here and there, just from

Dr. Pinto
00:16:01 – 00:16:54

yeah, other reasons. So I don’t even know if it was from the vaccine, but at any rate, um, were, you know, were slowly returning to some sort of normal. Who knows when that will be exactly on what normal really will end up being. But how do we use this experience of Covid 19 to drive more action among both patients and providers to take sustainable weight loss more serious? We know it’s not just Covid that’s a risk if you’re obese, right? We know that we know that there’s over 50 other chronic illnesses. Um, that obviously, obesity has a direct role in making worse some of the most common ones right are high blood pressure and heart disease, Cancer, diabetes, which can lead to heart disease. Um, so what can we do now to create real sustainable change?

Dr. Pinto
00:16:54 – 00:16:59

At least from a medical standpoint, um, to help get it out to the public. What do you think?

Dr. Chandra
00:17:00 – 00:17:44

So they mention obesity has long been linked to many chronic illnesses. But Cuban 19 has bean a wakeup call for both providers as well as patient to take this disease more seriously on also to give it the same status or the importance is any other serious illnesses like coronary artery disease or cancer. So the first step towards making any a sustainable change is to start educating the primary care providers in screening early intervention on medical management off obesity. So I still feel that a lot off reluctance in using the anti obesity medication and lot off misconception about it that needs to be addressed first,

Dr. Chandra
00:17:44 – 00:18:19

secondly, public education campaign will go a long way. So we have to get the word across. A lot of people who are suffering silently. They don’t even know that the medical treatment for ah, for a condition like obesity. So we have to educate the public on day to get them. I mean to instant some kind of optimism and hope. And un thirdly, I feel that we have to make the treatment readily available and affordable so that people who really need it can benefit from it.

Dr. Pinto
00:18:20 – 00:19:02

I agree. I think you’re spot on with your analysis. I think the number one first step for for this along with you know, this has not been something new, but something I think that’s even more important is educating primary care doctors to identify their patients who are overweight, obese or especially morbidly obese and address it with them. And if they’re not comfortable doing the weight loss, consultation and, you know, advice and, um, counseling and prescribing, or whatever it is that the patient’s gonna need, they need to get them to someone like you or someone like me or some type of medical professional that is comfortable with that, number one.

Dr. Pinto
00:19:03 – 00:19:48

I think frontline workers need to be comfortable talking to patients about the risk factor of being overweight or obese. No, unfortunately, in our country right now, um, there’s a well, let me say it like this. Fortunately, there is a movement to help the general public feel more comfortable with their weight if they’re overweight. You know, we see a lot of our, uh, exercise, uh, clothing companies. I just saw Athleta released a new catalog and they have plus size, you know, activewear for women. And they had, you know, some obese and morbidly obese patients on the cover, and I think that’s great that we’re, you know, we’re becoming more accepting of people of all different body types. But I think

Dr. Pinto
00:19:48 – 00:20:17

what the only issue I have with that is there is a medical risk with being overweight. And, um, if you can lose weight and become a healthier person, we need to not forget that, right? So I think a lot of times doctors are afraid to talk to their patients who are overweight or obese or morbidly obese, because they’re afraid that they’re gonna upset them or offend them. And I think that that’s sad, because I think that this is a major medical risk

Dr. Pinto
00:20:17 – 00:20:57

for their general health. But let alone now We have a disease that literally can kill them if they’re morbidly obese or obese, more so than if they weren’t. So I think that’s really important. I think also what you said about the medications. I still have patients that are doubtful whether medicine will help them. They’ve heard that it doesn’t work or it only lasts a little bit of time or it has not really bad risk factors or side effects. And we we both know none of those things were really true that these medications are very safe when used properly. They’re very effective when used properly. And like any medicine, they’re not perfect, right? So some work better than others for certain peoples. So I think that getting doctors

Dr. Pinto
00:20:57 – 00:21:37

to be more comfortable, if not prescribing at least recommending that patients go see someone who can prescribe it. And then lastly, I think that, you know, we need to get just a general education out to the general public that if you are overweight, if you’re having trouble losing weight, there are there are medical people that can help you. You know, the gym companies, planet fitness, they advertise all over the place, and Weight Watchers is all over the place and those air helpful. But I think that as a medical community we need to somehow come together and educate our the general public about what’s available for them to help them.

Dr. Pinto
00:21:40 – 00:22:13

So listen, I want to thank you, Dr Chandra, for this really important and informative discussion in connection between obesity and Covid 19, and why it is so critical that the medical community adopt obesity medicine as, ah, true specialty. We appreciate you and your dedication in helping not only your patients, but you know, our whole community of doctors who help with weight loss or medical providers that help with weight loss on helping us get this to the, you know, to the forefront.

Dr. Chandra
00:22:13 – 00:22:18

Thank you, Dr Pinto. And thanks to Center for Medical Weight Loss for giving me this opportunity.

Dr. Pinto
00:22:19 – 00:23:06

And thank you to our listeners out there. We really hope you take what you learned today, the heart and take some steps to reduce your risks of Covid 19 and all the other medical conditions that come with being over overweight or obese or morbidly obese. The first step you can take is really simple, right. Reach out to your primary care, doctor. Reach out to a center for medical weight loss provider. Um, you can go on our website CMWL.com. There’s lots of information on their toe. Help you get started in this journey. We are a great solution. However, there are solutions. Um, with other medical professionals, we even have ah find a center on our website. You type in your zip code and will help find or locate a Doctor that’s close to you. Who could help you with your medical weight loss journey?

Dr. Pinto
00:23:07 – 00:23:22

Please follow us on Facebook. Twitter, Um, for all our news updates and share your thoughts with us and your stories about achieving a healthier weight through medical weight loss. Andi, until next time I say, stay well and stay safe.