January 17, 2022

It is Time to Start Talking About Obesity

It is Time to Start Talking About Obesity

Although comparisons on how countries fared during the COVID pandemic is fraught with data problems, most metrics seem to indicate that the US has done rather poorly.  Almost all of Western Europe, Canada, and Japan, where the data is reliable, had per capita COVID fatality rates well below the US.

There have been numerous explanations floated for the US experience.  Of course, last year, Democrats blamed the Trump administration response but with more COVID deaths in 2022 than 2021, they have come to realize how little control the President, or any public official, has over an epidemic.  Other factors, like vaccine hesitancy, lack of contact tracing, and inadequate public health funding, have also been advanced.  But none of those hold up in a statistical correlation to other countries.

However, there is one obvious factor which no one seems to want to discuss – morbid obesity.

Early in the pandemic, I was talking to a doctor friend of mine who runs the critical care unit for one of Houston’s largest hospital systems.  He told me that most of the people dying in his wards from COVID were morbidly obese.  Anecdotally, I have heard the same report from many doctors since then.

Some research has been done on the effect of obesity in COVID cases but frankly, probably much less than the subject deserves.  This review is a good summary of some of the research.  Severe obesity exacerbates any respiratory issues, which of course, is the principal clinical issue with COVID.  Severe obesity is also associated with dysfunction in the immune system and there is also some evidence that severe obesity reduces the efficacy of vaccines generally.  

For a point of reference, morbid obesity is defined as someone with a body mass index (BMI) of 40 or more, which is roughly 100 pounds over a person’s “ideal” weight.  For a 5’9” person a BMI of 40 would equate to that person weighing 270 pounds.

When it comes to morbid obesity, the US is in a class of its own.  This analysis by the NCD-RisC1  found that the US ranked far higher than other large countries in the prevalence of morbid obesity.  The NCD-RisC estimated that about 10% of the US population was morbidly obese as of 2016 (the latest comparative data available).  Other than a few very small countries, no other country is even close.  Most of Western Europe (4-5%) and in southeast Asia, morbid obesity is essentially nonexistent.

Yet there has been astonishingly little discussion by public health officials about the danger of COVID to the roughly 30 million Americans who are morbidly obese.  There is a reference on the CDC’s website that timidly suggests that obese individuals are about three times more likely to be hospitalized by COVID but there is no reference to any research backing up the claim. This CDC study that found that in 78% of COVID fatalities and cases requiring ventilation, the person had been obese back in March, 2021 got very little media coverage.

Of course, exacerbation of a COVID infection is just one of the many health complications from obesity.  It is closely associated with the incidence of diabetes, heart disease and various auto-immune diseases.  Obesity is taking a heavy toll on those suffering with it and on all of us by inflating health care costs.  As many of you are probably aware, the US spends about twice what other developed countries spend on healthcare.  I do not think that it is a coincidence that the US share of the population that is morbidly obese is also about twice other developed countries.

Don’t misunderstand me.  I am not calling obese Americans out for ridicule or condemnation.  Morbid obesity is a serious medical condition that needs treatment.  But is past time for us to start talking candidly about our epidemic of obesity and the serious consequences it is having on our country.  COVID is just the most recent example.

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