NOTE: We must bear in mind that practically all the information that exists concerning this topic is information that has been collected around the world. It has not been strictly analyzed to be considered as a rule or to establish specific guidelines for action when to this respect.

At the moment, despite what many believe, say or read, it is a reality that the coronavirus continues its expansion around the world, causing infections that range from asymptomatic to severe diseases that require intubation and intensive care management, and unfortunately sometimes death.

There are indeed reports on studies of the disease’s response to management with azithromycin, hydroxychloroquine, remdesivir, tocilizumab, etc. However,we need to realize that the fact that so many medications are being tested is a sign that it is a desperate cry from the colleagues at the forefront of this battle in search of stopping or at least decreasing the number of deaths and serious illnesses.

Unfortunately, to date, there are no conclusive or overly encouraging results even for those who have sounded the most in recent days, such as remdesivir. So it only remains to take care of each other by showing civility and responsibility towards our loved ones and us.

In this article, we will explain why patients suffering from obesity are particularly vulnerable to severe illnesses due to coronavirus infection.

The current panorama of coronavirus and obesity

Considering the current situation of the pandemic, especially in this region of North America and specifically in:

• The United States where 42% of the population is obese, around 80 million people)
• Mexico where close to 38% of the population is obese, (approximately 48 million people)

Being the number one and two places, respectively, in terms of obesity in adults worldwide, then the relationship between obesity and coronavirus infection takes on great relevance to all of us. (Mexico is also the world's number 1 place in childhood obesity!)

What do we know about COVID 19 infection and obesity?

In all countries where serious and formal statistics are kept, a direct relationship has been seen between the severity of coronavirus infection and the degree of obesity in patients. According to the World Obesity Federation, obesity-related illnesses can worsen the effect of COVID-19 infection; in fact, the United States Center for Disease Control and Prevention (CDC) reported that patients also with heart disease and diabetes are at an increased risk of complications from COVID 19.

Patients suffering from obesity-related illnesses are expected to be more likely. However, it has also been seen that metabolically "healthy" obese patients (i.e., without hypertension, hypercholesterolemia, diabetes, etc.) are also at higher risk due to their greater number of adipose cells (fat) in the body which have the angiotensin-converting enzyme 2 (ACE 2) receptors, receptors to which the coronavirus comes to bind to begin its infection and replication process.

That is why it is thought that in addition to the severe condition caused by the virus by binding to these receptors on lung cells, it also does so on fat cells in the body. Remember that fat is found under the skin but also around most of our internal organs such as large, small intestine, liver, stomach, heart, etc.).

We will not go into details that even experts in the field do not know for sure, so we simply explain that this affinity of the virus for cells with these receptors is related to greater severity of the disease with or without comorbidities, just because they are obese.

It is also considered that patients with significant abdominal obesity (more common in men), having higher intra-abdominal pressure due to excess fat inside and outside the abdomen, have greater difficulty in ventilating their lungs adequately. In short, their capacity for expansion and movement of the chest, lungs, and diaphragm is decreased.

On the other hand, it is also well known that obesity as such is a disease that is considered a pro-inflammatory state (a very complex process that we could explain in a future article) with the release of substances similar to those released by COVID-19 infection, what is thought to enhance each other and hence worsen the results.

Simply put, after age, obesity is the second risk predictor for severe coronavirus disease.

Other important details to consider for patients suffering from severe obesity is that the use of mechanical ventilators to assist if they get to require it, makes them more likely to depend on the ventilator for a longer time due to their previous respiratory condition due to obesity.

Likewise, most patients require advanced imaging studies such as computed tomography, and many of these devices cannot carry out tests in patients with severe obesity.

Are all obese patients at the same risk if they become infected with coronavirus?

As we mentioned before, the most significant risk is endured by obese patients who suffer from other obesity-related diseases, and over 60 years of age, this risk increases considerably.

Some experts mention that those obese patients who are relatively metabolically healthy, are usually physically active and are young are at a lower risk of severe disease. However, other experts have been surprised at the severity with which the infection occurs in generally healthy young patients who are only obese.

Isolated reports of statistics about Coronavirus around the world

• In an analysis of more than 4,000 patients infected with COVID-19 in a New York hospital, Dr. Leor Horowitz mentions the following: “Obesity is the most important factor for patients in need for hospitalization, whether or not they have diabetes or high blood pressure; however these three go hand in hand frequently. Obesity has been found that it is even a more important defining factor for the need of hospitalization than a previous lung disease, kidney disease or cancer.” “Likewise, there is also a greater relationship between obesity and death in infected people by COVID 19, although to a lesser degree.”

• In another study conducted at the same NYU Langone innovation and health center, it was found that this predisposition to require hospitalization and critical care was observed more in patients younger than 60 years of age than in older patients. This was a surprise for doctors since it was expected that elderly patients would be more at risk as in Asian countries and Europe, but it was not.
  
  
• In one of the reports in China, in an analysis of 112 cases, 17 deaths occurred, of which 15 were obese patients.

• In a group of 41 hospitals in the Louisiana and Mississippi region, they mention that 60% of the patients who were hospitalized were obese, and those patients were twice as likely to require ventilatory support. Along this same line, a study that is about to be published in the Obesity journal, clearly confirms that there is a close relationship between obesity and patients who are admitted to intensive care units due to COVID-19 infection; the severity of the disease increased in relation to the body mass index.

• The explanation for why they require more frequent ventilatory support, in addition to what has already been mentioned, is that severe obesity increases the risk of suffering a respiratory problem known as acute respiratory distress syndrome (ARDS), which is one of the main complications in coronavirus infection.

What do experts recommend to obese patients in this coronavirus pandemic?

They mention that the best thing you can do for your health right now is to abide by the quarantine orders in a rigorous way, the well-known handwashing, and the new good measure of using facemasks in case you have to leave home. Avoid contact of hands not recently washed with the face, eyes, mouth.

Also, the distance between people of not less than six feet and avoid crowded places. They recommend that if you live with someone else at home and you are obese, it is ideal to isolate from them if they leave the house frequently since they could also infect you. It is a measure that may seem very drastic, but, considering what is mentioned here about the severity of the problem, it is worth the temporary sacrifice.

Exercise and healthy eating against Coronavirus

In these times, it would be worth considering starting a lifestyle that allows the obese person to change the course of their health. This pandemic is a good excuse to take a healthy or unhealthy path, and it is up to you to decide which one to follow. In the article Gaining weight during the coronavirus pandemic? How to avoid it. We share our point of view of how we can face this difficult situation and get some benefit from it.

In summary, what we recommend is to stay as active as possible, starting an exercise routine at home or in its surroundings and also try to avoid unhealthy food and integrate fruits, vegetables, seeds, grains, etc. into your diet if you don't do it regularly. We explain it to you in more detail in that article.

My best recommendation is that you should seek to achieve the goal of not only not gaining weight during the pandemic but losing some weight since it would put you in less unfavorable conditions if you suffer from coronavirus infection. However, the ideal would be precisely to avoid ending up infected.

I always tell my potential patients when they are hesitating to decide to have gastric sleeve surgery due to fear or for any other reason, that there is no better medicine than prevention. Just as in the case of obesity in which it is better to lose weight by any means necessary to avoid severe related diseases, the same thing happens with SARS-CoV-2 infection, there is no better solution to the disease than to prevent being infected.

Conclusions

So, after viewing this information we can conclude why the trend of severe diseases and deaths related to COVID-19 infection has been so different in North America from that observed in Asia and Europe, we explain why:

While in European countries, there was a tendency to affect elderly patients, in North America, it has been seen that patients suffering from severe disease are young people under the age of 60, and this is because the prevalence of obesity is very different between these countries. In the United States, as we mentioned at the beginning, more than 40% of the population suffers from obesity, the prevalence of obesity is only 6.2% in China, 20% in Italy, and 24% in Spain.

The general idea that obesity is nothing more than an imbalance in the number of calories entering and leaving the body is nowadays considered obsolete since many medical groups recognize obesity as a complex disease that depends on a large number of interrelated factors that, in turn, promote predisposition to other diseases.

Our intention is not to scare you if you suffer from obesity, but to inform you and help you create awareness. Not only the importance of following your local authority recommendations to prevent infection, but also that you take this situation as an excellent time to turn your life around and get rid of this severe and silent disease, as is obesity, once and for all.

If you are looking for help, you will indeed find it. If you want guidance from us, we will gladly answer your questions regarding the weight loss surgery of your interest.

In Obesity Free we perform weight loss surgery in México. Know if you are a gastric sleeve candidate. Contact us for more information.

REFERENCES:

https://www.endocrineweb.com/conditions/obesity/covid-19-obesity

https://www.nytimes.com/2020/04/16/health/coronavirus-obesity-higher-risk.html?fbclid=IwAR0ae94yiHy7qP4h9UEH6xDdPjT9cZCVXNFdCLnUuYZ3ZwsYz5ukrfLwZXM

High prevalence of obesity in severe acute respiratory syndrome coronavirus-2

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31024-2/fulltext

https://www.webmd.com/lung/news/20200429/obesity-new-risk-factors-for-young-covid-patients

https://www.worldobesity.org/news/statement-coronavirus-covid-19-obesity

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