Covid-19 and Obesity: the deadly combination

Being overweight increases hugely the severity of the infection’s impact on you. You can’t do much about Covid, but you can start TODAY to address your issues with weight

Studies have confirmed that the Covid-19 pandemic is further increasing the obesity pandemic. And, of course, in turn, obesity increases the patient’s risk of severe Covid disease, a range of health complications and mortality. The development of nutritional programs to help weight reduction or even improve insulin sensitivity would be of great public health interest and benefit, not just for so-called “fat people.”

With emerging Covid-19 variants, we need to find other means (alongside vaccination) to control the pandemic, and research suggests that even a modest reduction in obesity may have a profound effect on the pandemic.

In this article, we will discuss changes in diet and lifestyle during Covid-19, changes that worsen the obesity pandemic. We will also discuss the pathological changes in obesity that make the affected people vulnerable to severe Covid-19 and death.

Let me make it clear that obesity has no significant impact on the risk of infection, but, once infected, the obese person is at greater risk of tissue damage. Studies have shown an increased risk of death and the need for ITU care in class three obesity (those with a BMI of more than 40.) Another study showed that obesity increases risk of hospitalisation in seasonal influenza.

Therefore, making positive changes in diet and physical activity will not only reduce Covid-19 mortality in obese or fat people, but will also help them to reduce the severity of any viral infection.

How does obesity make Covid-19 more severe?

We know that patients at high risk of Covid-19, including the obesity group, are admitted to hospitals mainly with viral pneumonia, which often requires intensive care. We want to find out how obesity put patients at risk of severe Covid disease.

Medically, Covid-19 results in alveolar hypoperfusion, hypoxaemia and respiratory failure. Bottom line: they require artificial ventilation. This is confirmed in CT lung perfusion scans.

Lung function involves having adequate ventilation (breathing) and perfusion (lung circulation.) You breathe to transfer adequate air into the lung alveoli (small spaces), oxygen diffuses through the alveolar wall to oxygenate blood in the lung micro circulation (perfusion), and the heart pumps oxygenated blood to supply the rest of the body.

Covid-19 in obese patients destroys the lung tissue, however the main pathology is due to small clots blocking the lung micro circulation. Obesity patients progress to viral pneumonia and often acute respiratory distress syndrome (ARDS) resulting in hypoxaemia (low oxygen) and respiratory failure, thus frequently requiring artificial ventilation and ITU care.

Centres in Europe reported that most of the ventilated patients have a preserved ventilation with well aerated lungs, indicating that the hypoxia (low oxygen) is caused by blockages of the lung micro circulation.

The micro thrombosis (clots) in the lung circulation can be confirmed with a simple test known as D-dimer, commonly used to diagnose venous thrombosis and lung clots. Elevated D-dimer is a common finding in patients admitted with Covid-19 pneumonia.

How does obesity lead to severe Covid-19 lung disease?

The main pathological feature of obesity is insulin resistance. This means the body cells become less sensitive to the action of insulin, the hormone that opens the gate for sugar to enter your body’s cells. This puts more pressure on the pancreas to produce more insulin, to compensate for the defect. This results in a high insulin level and eventually type 2 diabetes, when the pancreas is too exhausted to produce more insulin.

Obesity causes an accumulation of fat in the body mid-section (belly fat) that produces inflammatory cytokines such as TNF alpha and IL-6. These exacerbate the inflammatory response to Covid in the lung, resulting in more severe disease. This explains the high mortality associated with obesity and metabolic disease.

The metabolic hormones also contribute to the severity of Covid-19 infection in obesity. There is higher level of Leptin (the satiety hormone) in obesity while levels of adiponectin (insulin sensitivity hormone) drop to a low level. Research indicates that adiponectin has an anti-inflammatory effect and hence lower levels exaggerate Covid-19 inflammatory response and the predisposition to severe lung disease.

Adiponectin is reported to be significantly low in Covid-19 high-risk groups. Black ethnic minorities tend to have a lower level of adiponectin than white people. This explains the higher risk of severe Covid disease in this group.

Visceral (belly) fat is a major source of complement components. A modest increase in these can cause micro thrombosis (clots) in the lung capillaries and enhance inflammation.

Animal research showed that lack of complement C3 in mice protects against severe lung disease. Covid-19 contains an N-protein that activates the complement pathway, resulting in small clots in the lung micro circulation.

Obese people are known to have a high risk of arterial and venous thrombosis. This is due to their low ability to dissolve clots that form. Research has found the adipose (fat) tissue produces a plasminogen activation inhibitor (PAI-1) to stop dissolving any clot. This explains the high risk of thrombosis in obesity.

Obesity encourages an abnormal deposition of fat in various body tissues, including the lungs. This causes what is known as lipotoxic (fat-induced) cellular damage, contributing to the severity of Covid-19 pneumonia. Similarly, the state of overnutrition encourages deposition of fat in the lung cells, which then exacerbates inflammation and lung damage.

The second type of lung cells (pneumocytes AT2) produce a surfactant, a very thin coat important for gas exchange and to support the lung function. These lung cells are destroyed early in Covid-19 infection, because they have ACE2 receptors, and the virus uses them to enter the lung cells to infect and damage them.

Deposition of fat in lung cells (pneumocytes AT2) is common in obesity. Studies have confirmed that even a modest improvement in insulin sensitivity reduces ectopic fat in the lung cells. High fibre and a nutrient-rich diet, good physical activity or the use of insulin sensitising drugs, such as Metformin, may help to reduce the high risk in obese individuals.

What can YOU do NOW?

68% of the population in the UK are either overweight or obese, with 28% being obese (28% in men, 29% in women.) In the US, it’s worse, with 70% being obese or overweight, 40% of them obese. Globally, 2 billion people are overweight or obese, and I personally think the figure is probably underestimated.

Now, having a normal body weight and a normal or so-called healthy BMI does not give you the all-clear. A condition known as TOFI (Thin from the Outside, Fat from the Inside), with too much belly fat but normal body weight, can still give you all the negative effects of obesity and can increase your risk of metabolic disease.

To check yourself for this possibility, you need to measure your Waist and Hips, to determine your WHR (Waist Hip Ratio): alarm bells should ring if it’s above 0.90 in men and 0.85 in women.

As a general rule, stored fat particularly around the middle (belly fat) increases body inflammation, risk of disease and mortality.

So, obesity is exerting a high mortality rate through metabolic abnormalities, including insulin resistance, which should get better with a healthy diet and more physical activity. Unfortunately, lockdown arrangements limit physical activity and stress worsens the diet problem.

I have said it before and I’ll say it again: healthy diet, regular physical activity, restful sleep, lower level of stress and great relationships with unconditional love will give you a strong immune system to protect your body against any invaders, including Covid-19.

Being overweight or obese puts you at risk of a range of chronic conditions, including type 2 diabetes, cardiovascular disease, cancer, non-alcoholic hepatitis and sleep apnoea. Obesity is also associated with reduced life expectancy, and a lower quality of the life that’s left.

In the context of Covid-19, evidence suggests that excess weight is associated with an increased risk of hospitalisation, intensive care and death. The risks seem to worsen progressively as your BMI increases above the healthy weight range.

Lifestyles changes during the pandemic

Disruption of supplies and panic buying has limited access to fresh real food, encouraging people to rely on unhealthy junk food with a long shelf life.

Restricted and banned access to sports clubs (gyms, swimming pools, golf, tennis) and local, national and international competitions has naturally taken its toll on many people’s exercise routines.

With no gyms, people are reluctant to exercise in public, because of potential infection and embarrassment.

There have been no weight management services, and no bariatric surgery during the lockdown.

Altogether, Covid-19 has had a huge negative impact on weight-related behaviour among adults with higher BMI. Junk food, no exercise and no weight management all add up to a perfect storm of negative conditions.

An online survey of over 2,000 participants with a higher BMI revealed that 56% reported snacking more frequently and finding it harder to focus on weight management (motivation and food control) compared with before lockdown.

Adults experiencing mental health issues have increased by 50% during Covid-19, and those who reported a decline in mental health reported greater overeating and lower physical activity in the lockdown.

Prime Minister Boris Johnson had the full Covid-19 experience in intensive care last April. He acknowledged he was ‘too fat,’ and since then, he has lost a significant amount of weight with the help of a personal trainer.

Again, a study of Polish women study during lockdown showed that 34% gained weight, and 44% of those with obesity before the pandemic further increased their body weight, with an average weight gain of 2.8 kg. 65% of participants increased their total food intake.

Negative lifestyle changes included an increase in screen time and a decrease in physical activity – key factors associated with weight gain. A higher risk of weight gain was found in those who were obese before the pandemic.

Children were found to be having an extra meal a day

Compared with the previous year, children were found to have eaten an additional meal per day, slept an extra half hour, spent nearly five hours per day in front of a phone, computer or television, and dramatically increased their consumption of red meat, sugary drinks and junk food.

Another factor is “emotional eating,” which occurs when people associate feeling with hunger. You feel you need to eat more junk food to reach a certain level of “happiness.” Or you reach for a treat as a distraction whenever you’re stressed out.

The high blood sugar levels caused by junk food can impact our mood, memory and our decision-making process. A study has shown that teenagers’ ability to process emotion is affected when their blood glucose spikes.

Binge eating can also lead to feelings of guilt, which further feeds into our unhelpful, critical inner voice, which can result in unhealthy coping behaviour.

Dealing with emotional eating comes down to stress management. This can range from making lifestyle changes to increasing self-awareness and self-care. Exercise and sleep are both crucial here.

Health and diet expert Yumna Zaidi recommends spending less time on activities that don’t enhance your life: “Limit your time on social media and watching the news. Instead focus on activities that help you recharge, invest in a network of friends who energise you.”

Your weight-loss solution: eat less, exercise more?

The strategy of ‘eat less, exercise more’ does not work for many reasons. Simply put, you cannot depend on your willpower, and anyway, faced with less food, your body is intelligent enough to slow down your metabolism, to conserve energy. A better approach is to find and address the underlying cause(s) of your weight problem. Applying a scientific approach, very much under control, can be used to develop your personalised weight management plan. I have found that this works with every single patient who attends The Vitality Clinic.

Most of these patients had been struggling with weight problems for years, sometimes decades, without success. Proper clinical assessment, supported with high technology tests, helps to identify the real cause(s) behind their weight gain and the best approach to sort out the problem, for good.

For example, a high level of inflammation is a common cause of weight gain. This is because inflammation leads to insulin resistance and metabolic syndrome, and weight gain is the biggest part of the problem. Inflammation could be related to allergens such as gluten, dairy or soy, but more commonly they are due to refined and highly processed inflammatory foods.

Again, toxins in food are common causes of obesity. These include pesticides and herbicides; heavy metal toxicity is common in people with slow detoxification, often related to genetic variants such as COMT, which slow detoxification of oestrogen and heavy metals. Toxins are stored in fat and your body will make more fat to store toxins, if you don’t have an efficient detox system.

Hormonal imbalances are common: an underactive thyroid often presents with weight gain as the only symptom, even before the thyroid test reports abnormality. Oestrogen excess can lead to the deposition of fat on the hips and thighs. This often happens due to having the wrong gut bug that interferes with oestrogen detoxification.

Stress is a common cause of weight gain. This could be an external stress but more commonly is an internal stress due to body imbalances, the commonest being blood sugar dysregulation. This keeps your cortisol and insulin high, and you can’t lose a single ounce without sorting out this issue.

Sleep disturbance, lack of physical activity and your eating patterns can all contribute to your weight gain and may stop you from achieving your ideal body weight.

Obesity and Covid-19 are indeed a perfect storm of two pandemics coinciding. I worry for the future of our population, but I am here to help, my friends. If you have any questions or concerns about your weight, belly fat, BMI, WHR, diet, exercise, sleep, stress – or any other of the lifestyle issues mentioned above – please do get in touch. I will try and help – and your valuable experience will feed into my knowledge, which will in turn help others.

You alone cannot do much about Covid-19, but you can take steps to address your weight. Please do not be embarrassed to step forward. Thank you!

References

Would Covid-19 pandemic worsen obesity epidemic?

https://www.nature.com/articles/s41574-020-0387-z

Obesity during Covid-19 pandemic

https://www.nature.com/articles/s41574-020-0387-z

Obesity, eating behaviour and physical activity during Covid-19 lockdowns

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540284/

When two pandemics meet: why is obesity associated with increased Covid-19 mortality?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323660/

Obesity, eating behaviour and physical activity during Covid-19 lockdown: A study of UK adults

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540284/