COVID-19 reveals how obesity harms the body in real time

© Provided by Live Science
The excess adipose tissue, which stores fat and is shown here in a scanning electron microscope image, creates mechanical compression in obese patients.

The COVID-19 pandemic has once again put the obesity epidemic in the spotlight, revealing that obesity is no longer a disease that only harms in the long term, but a disease that can have extremely devastating effects. New studies and information confirm doctors’ suspicions that this virus is taking advantage of a disease that our current U.S. healthcare system is unable to control.

In the most recent news, the Centers for Disease Control and Prevention reports that 73% of nurses hospitalized with COVID-19 were obese. What’s more, a recent study found that obesity could interfere with the effectiveness of a COVID-19 vaccine.

Obesity correlates with a blunt immune response to COVID-19, and researchers are concerned that this could also affect the vaccine’s effectiveness. https://t.co/lRcNupif1POctober 25, 2020

I am an obesity specialist and clinical physician working on the front lines of obesity in primary care at the University of Virginia Health System. In the past, I have often found myself warning my patients that obesity can take years away from them. Today more than ever, this warning has become verifiable.

More damage than we thought

Initially, doctors believed that obesity only increases your risk of getting sicker from COVID-19, not your risk of getting infected in the first place. Now, more recent analysis shows that not only does obesity increase your risk of getting sicker and dying from COVID-19; obesity increases your risk of getting infected in the first place.

In March 2020, observational studies noted hypertension, diabetes, and coronary heart disease as the other most common conditions – or co-morbidities – in patients with more severe COVID-19 disease. But it was the editors of the journal Obesity who first sounded the alarm on April 1, 2020 that obesity would likely prove to be an independent risk factor for the more serious effects of COVID infection. -19.

Additionally, two studies involving nearly 10,000 patients have shown that patients with both COVID-19 and obesity have a higher risk of death on days 21 and 45 compared to patients with a body mass index. normal, or BMI.

And a study published in September 2020 reported higher obesity rates in patients with COVID-19 who are critically ill and require intubation.

It is increasingly evident from these and other studies that obese people face a clear and current danger.

Stigma and lack of understanding

Obesity is an interesting disease. This is an issue that many physicians talk about, often with frustration that their patients cannot prevent or reverse it with the overly simplified treatment plan that we were taught in our initial training; “Eat less and exercise more.”

It is also a disease that causes physical problems, such as sleep apnea and joint pain. It also affects the mind and spirit due to the prejudices of medical professionals and society against obese people. It can even hurt the size of your paycheck. Can you imagine the outcry if the headline read “Patients With Hypertension Earn Less”?

We doctors and researchers have understood for some time the long-term consequences of overweight and obesity. We currently recognize that obesity is associated with at least 236 medical diagnoses, including 13 types of cancer. Obesity can reduce a person’s lifespan for up to eight years.

Although knowing this, American doctors are not ready to prevent and reverse obesity. In a recently released survey, only 10% of medical school deans and program experts felt their students were “very prepared” when it comes to managing obesity. Half of medical schools responded that expanding obesity education was a low or no priority. On average, a total of 10 hours were spent on obesity education throughout their medical school training.

And doctors sometimes don’t know how or when to prescribe medications for obese patients. For example, eight FDA-approved weight loss drugs are on the market, but only 2% of eligible patients receive prescriptions for them from their doctor.

What happens in the body

So here we are, with a collision between the obesity epidemic and the COVID-19 pandemic. And one question I find patients ask me more and more: How does obesity create more serious disease and complication of COVID-19 infection?

There are many answers; Let’s start with the structure.

Excess adipose tissue, which stores fat, creates mechanical compression in obese patients. This limits their ability to fully absorb and release a breath of air.

Breathing takes more work in an obese patient. This creates restrictive lung disease and, in more severe cases, leads to hypoventilation syndrome, which can cause a person to have too little oxygen in their blood.

And then there is the function. Obesity results in excess fatty tissue, or what we colloquially call “fat.” Over the years, scientists have learned that fatty tissue is inherently harmful. We can say that adipose tissue acts as an endocrine organ in its own right. It releases several hormones and molecules that lead to a state of chronic inflammation in obese patients.

When the body is in a constant state of low-grade inflammation, it releases cytokines, proteins that fight inflammation. They keep the body on its toes, simmer and are ready to fight disease. It is all well and good when they are controlled by other systems and cells. However, when chronically released, imbalance can occur and cause injury to the body. Think of it like a small contained forest fire. It’s dangerous, but it doesn’t burn the whole forest.

COVID-19 causes the body to create another cytokine wildfire. When an obese person has COVID-19, two small cytokine fires come together, resulting in a raging fire of inflammation that damages the lungs even more than patients with normal BMI.

In addition, this chronic state of inflammation can lead to what is called endothelial dysfunction. In this condition, instead of opening, the blood vessels close and constrict, further decreasing oxygen to the tissues.

Additionally, an increase in fatty tissue may have more ACE-2, the enzyme that allows the coronavirus to invade cells and start damaging them. A recent study showed an association of increased ACE-2 in adipose tissue rather than in lung tissue. This finding further strengthens the hypothesis that obesity plays a major role in more serious COVID-19 infections. So in theory, if you have more fatty tissue, the virus can bind to and invade more cells, resulting in higher viral loads that stick around for longer, which can make the infection more severe and prolong healing.

ACE-2 may be helpful in countering inflammation, but if it otherwise binds to COVID-19, it cannot contribute to it.

[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]

The new SARS COVID-19 virus has forced the medical profession to face the reality that many American doctors know inherently. When it comes to preventing chronic diseases such as obesity, America’s health care system is not performing well. Many insurers reward physicians by meeting parameters for treating the effects of obesity rather than preventing it or treating the disease itself. Doctors are reimbursed, for example, to help patients with type 2 diabetes reach a certain level of A1C or a set blood pressure goal.

I believe it is time to educate physicians and provide them with resources to fight obesity. Doctors can no longer deny that obesity, one of the strongest predictors of COVID-19 and at least 236 other medical conditions, must become public enemy number one.

This article is republished from The conversation under a Creative Commons license. Read it original item.

Follow all of Expert Voices’ questions and discussions – and be part of the discussion – on Facebook and Twitter. The opinions expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.