Evidence obesity is a risk factor for serious illness with coronavirus is mounting – even if you’re young



World Obesity

Andrea Pattinson, University of Sydney and Amanda Salis, University of Western Australia

Recent studies have found alongside older age and chronic health conditions, obesity is a risk factor for becoming seriously ill with COVID-19, the disease caused by the coronavirus SARS-CoV-2.

It’s true a number of the health conditions which we know increase the risk of severe illness from COVID-19 are also associated with obesity. These include type 2 diabetes, high blood pressure, heart disease and respiratory disease.

But new research suggests obesity independently is a strong predictor of severe illness, particularly in those aged under 60 years.

This is concerning given two-thirds (67%) of the Australian adult population have a body mass index (BMI) in the overweight or obese range.




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BMI is a person’s weight in kilograms divided by the square of their height in metres (kg/m²). While it’s an imperfect measure for an individual person, BMI is very useful in comparing health and weight across a population and between groups.

For adults, overweight is a BMI of 25 or above, but less than 30kg/m². For a woman of average height (162 cm), this would be equivalent to a weight of 66kg or above, and for a man of average height (176 cm), a weight of 78kg or above.

Obesity is defined as a BMI of 30kg/m² or above. This equates to a weight of 79kg and above for a woman and 93kg and above for a man, both of average height.

The evidence

One study from China looking at data from 112 patients reported overweight and obesity were almost five times more prevalent in patients with COVID-19 who died (88%) compared to those who survived (19%).

Preliminary data from another Chinese study involving 383 patients, although not yet peer reviewed, suggests overweight or obesity more than doubled the risk of developing severe pneumonia as a result of COVID-19, particularly in men.

We’re still working out why exactly obesity might increase the risk of coronavirus complications.
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Researchers in France found almost half of 124 patients admitted to an intensive care unit (ICU) with COVID-19 had a BMI in the obese range. This was nearly double the rate of a comparison group of ICU patients with severe acute respiratory disease unrelated to COVID-19.

Further, the need for mechanical ventilation increased with increasing BMI.

A UK surveillance study of patients admitted to intensive care with COVID-19 reported almost three-quarters (75%) of the 6,720 patients had a BMI in the overweight or obese range, which is greater than the population prevalence of overweight and obesity in adults in the UK (around 67%).




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Why are older people more at risk of coronavirus?


Although some of these studies factored in chronic conditions when reporting their results, it’s difficult to separate all of the conditions associated with obesity that may contribute to some degree to the poorer outcomes.

So it’s likely that some – but not all – of the increased risk of severe COVID-19 associated with obesity could be due to people having other chronic conditions.

Young people

It seems obesity may have more of an impact on the severity of COVID-19 in young people, according to two studies from New York.

One study of 3,615 people who tested positive for COVID-19 found those aged under 60 years with a BMI of between 30 and 34 were almost twice as likely to be admitted to ICU compared to patients with a BMI of less than 30. This likelihood increased to 3.6 times in those patients with a BMI of 35 or greater.

In patients over 60 years, the researchers didn’t find a significant link between obesity and severe illness (as indicated by admission to ICU).

Another study, which recorded weight for 178 patients, found obesity was the most common underlying condition for patients aged under 64 years admitted to hospital for COVID-19.

Why the greater risk?

Taken together, the above data suggest there is an association between obesity and more severe COVID-19 illness, particularly in those with a BMI of 35 or greater.

The US Centers for Disease Control and Prevention (CDC) now lists “severe obesity” as a risk factor for serious COVID-19 illness.

We don’t know exactly what role obesity plays in the severity of COVID-19 symptoms. But the mechanisms are likely to be multifaceted, particularly since obesity itself is the result of a complex interaction between genetic, hormonal, behavioural, social and environmental factors.

We know obesity can have a significant impact on lung function. Excess weight around the abdomen can compress the chest, making it more difficult for the diaphragm to move and the lungs to expand and take in air. This can contribute to lower levels of oxygen in the blood, which may exacerbate the symptoms of COVID-19.

We also know obesity results in a chronic state of inflammation which can impair the body’s immune response. This could potentially make it more difficult for the body to fight coronavirus.




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The challenges in caring for patients with severe obesity may also affect their outcomes from COVID-19.

For example, it’s more difficult to intubate or perform imaging such as X-rays and CT scans in patients with obesity.

Further, positioning ventilated patients on their stomachs can increase the amount of oxygen entering the lungs. But this is often not possible for patients with severe obesity.

Should I be worried?

The short answer is no. If your body weight is above the healthy range, these results should not be cause for panic or impetus to engage in crash diets to reduce COVID-19 risk.

While the data does suggest obesity is a risk factor for more severe illness, it’s early days in the life of COVID-19 and we need more research before we can definitively say what’s going on.

The most significant thing you can do to lower your risk is to follow the government’s guidelines.

It’s not a time to panic about your weight, but it could be a good time to concentrate on healthier choices.
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These restrictions can be challenging and might lead to reduced physical activity and eating for comfort or to ease boredom, potentially resulting in weight gain.

If you find yourself with extra time during the pandemic, you may find it helpful to view it as an opportunity to make healthy choices and cultivate new habits to reduce your risk of illness in general and to enhance health and well-being going forward.




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How to stay fit and active at home during the coronavirus self-isolation


The Conversation


Andrea Pattinson, PhD Candidate, University of Sydney and Amanda Salis, NHMRC Senior Research Fellow in the School of Human Sciences, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Changing the terminology to ‘people with obesity’ won’t reduce stigma against fat people


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Fat activists argue fat is the most appropriate word to describe their bodies.
Yulia Grigoryeva/Shutterstock

Cat Pausé, Massey University

The British Psychological Society is calling for changes for how we talk about fatness, suggesting we should no longer use the phrase “obese people”, but instead, “people with obesity” or “people living with obesity”.

These changes are being proposed to recognise that fatness is not about personal choice and that fat shaming and fat stigma are harmful.

But this suggested language change is based on the idea obesity is a disease to be cured and fat people are not a natural part of the world. This serves to reinforce stigma, rather than prevent it.




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How does stigma and shame affect fat people?

Fat stigma can harm people’s physical health, mental health, and relationships.

Independent of body mass index (BMI), fat stigma increases blood pressure, inflammation, and levels of cortisol in the body, due to the activation of the fight or flight response.

Fat stigma reduces self-esteem and increases depression.
It isolates fat people, making them less likely to engage with the world. It also impacts on fat people’s relationships with family, colleagues, and friends.

Fat stigma erodes self-esteem and isolates people.
Motortion Films/Shutterstock

People around the world, and of all ages, hold negative attitudes about fatness and fat people. In a study in the United States, for example, more than one-third of the participants reported:

one of the worst things that could happen to a person would be for [them] to become obese.

How terminology reinforces stigma

While many people are uncomfortable with the term fat, fat activists prefer the term. They see it as both as an act of rebellion – to adopt a word that has been wielded against them – but also because they argue it’s the most appropriate word to describe their bodies.

To be overweight implies there is a natural weight to be; that within human diversity, we should all be the same proportion of height and weight.

Obesity is a medical term that has pathologised the fat body. The British Psychological Society’s acknowledgement that rather than saying “obese people”, we should call them “people with obesity” reinforces that obesity is a disease; a chronic illness people suffer from.




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What does fat discrimination look like?


The British Psychological Society’s desire to shift to person-first language is understandable. Person-first, or people-first, language is an attempt to not define people primarily by their disease, or disability, or other deviating factor.

Person-first language recognises people as individuals with rights to dignity and care, and puts the person, rather than their “condition”, first.

But others have argued person-first language attempts to erase, deny, or ignore the aspect of the person that isn’t “normal”, and reinforces that there is something shameful or dehumanising about their disability or disease.

They promote identity-first language, which allows people to take pride in who they are, rather than separating a person from that aspect of themself.

The problem with person-first language, they argue, is that those identities are stigmatised. But without the stigma, there would be no concern with calling someone a disabled person, for instance, rather than a person with disabilities.

So what should we do?

Ask people what they want to be called.
Rawpixel.com/Shutterstock

The best approach, especially for health-care professionals, is to ask people what they prefer their designation to be.

And for the rest of us, to acknowledge that what an individual wants to be called or how they want to talk about their experiences is up to them, not us. If a fat person wants to call themselves fat, it is not up to non-fat people to correct them.

Shifting the language we use to talk about fatness and fat people can reduce fat stigma. But continuing to frame fatness as a disease is not a helpful contribution.




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Study finds obesity stigma erodes will to exercise, socialise


The Conversation


Cat Pausé, Senior Lecturer in Human Development, Massey University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Obesity has become the new normal but it’s still a health risk



Exercise is good for you, no matter what your weight.
Pressmaster/Shutterstock

Tim Olds, University of South Australia

Nike’s London store recently introduced a plus-sized mannequin to display its active clothing range which goes up to a size 32.

The mannequin triggered a cascade of responses ranging from outrage to celebration. One side argues that the mannequin normalises obesity and leads obese people to feel that they are healthy when in fact they are not.

The other side argues the representations are inclusive, combat fat stigma and encourage fat women to exercise.

Both arguments have some merit.

The representations of bodies we see around us — including shop mannequins – affect the way we calibrate our sense of what is normal and acceptable. And obesity is indeed associated with a greater risk of heart disease, stroke, type 2 diabetes and early death.

It is possible to be metabolically healthy and fat. But even metabolically healthy obese people may still have a shorter life expectancy than their lean peers.

On the other hand, exercise is almost universally beneficial, and people of all shapes and sizes should be encouraged to participate.




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Overweight and obesity have become the new normal

Based on body mass index (BMI), about two-thirds of Australian adults and one-quarter of kids are overweight or obese. While this proportion has flattened out for children in the last 20 years, it continues to rise for adults.

There is strong evidence parents consistently misjudge the weight status of their children because they see more and more fat kids.

The same is true for adults: a recent study from the United Kingdom found 55% of overweight men and 31% of overweight women considered their weight to be in the healthy range.




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I would guess the Nike mannequin is close to 100 kg, with a BMI maybe in the low 30s, well into the obese category.

But given the average female shop mannequin has a BMI of about 17, there are probably at least ten times as many Australian women like the plus-size mannequins than like the usual minus-size variety.

Obesity is not a lifestyle choice like smoking

Obesity is necessarily the result of behaviours — eating too much, exercising too little — albeit heavily constrained by genetic predispositions, and social and economic pressures.

But unlike, say, smoking, being fat is also part of what a person is: most people who are fat have usually been fat for a long time. It’s not something a person has complete control over.

Divergent paths into fat and lean start very young, and once you’re on the obesity train it’s hard to get off.

While it is possible to “give up obesity”, for many it can be a very hard road, involving a lifelong struggle with hunger and recidivism.




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Empowering vs shaming

Anti-obesity campaigns that are built on disgust, fear or shame – such as Measure Up – have been criticised as being stigmatising, ethically problematic and ineffective.

Australia’s 2009 Measure Up campaign is built on fear and shame.

There has, to my knowledge, been no high-quality research comparing the actual effectiveness of shaming versus empowering anti-obesity, or pro-physical activity, campaigns.

However a number of studies show, unsurprisingly, that obese and inactive people prefer empowering campaigns, find them more motivating and less stigmatising.

Health risks of obesity

It has been argued one can be “fit and healthy at any size”: that an obese person can be as fit and healthy as a lean person.

Depending on definitions, about 25-50% of obese people have “metabolically healthy obesity” – normal levels of inflammation, blood sugar, insulin, blood fats, and blood pressure. Other than being obese, these people appear healthy.

But obese people — fit or unfit, active or not — remain on average at greater risk of heart disease, diabetes and early death than lean people with similar behaviours.

Similarly, the claim that people can be both fit and fat, and that fit, fat people are at less risk than unfit, lean people depends on how we define fitness and fatness.

One study, for example, might compare overweight people in the top 20% of fitness with lean people in the bottom 20%. Because there are modest differences in fatness and big differences in fitness, fat people are much more likely to have a similar risk to lean people.

But if another study compares obese people in the top 50% of fitness to lean people in the bottom 50%, the fatter people will be much less healthy.

What is certain is that whoever you are, exercise will almost certainly improve your health.




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Fat and fit? There’s no such thing for most people


The Nike mannequin controversy is a morality tale of how we navigate between the devil of normalising obesity and the deep blue sea of excluding obese people from the world of exercise.

Obesity has been called both a disability and a disease, and just another way of being in the world. The reality is that for most people, it’s something in between.The Conversation

Tim Olds, Professor of Health Sciences, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Christian Forced to Sell Kidney to Pay Debt to Boss in Pakistan


Employer charges non-Muslims at least 400 percent interest.

LAHORE, Pakistan, May 14 (CDN) — A low-wage Pakistani Christian said his Muslim employer last week forced him to sell his kidney in an effort to pay off a loan his boss made at exorbitant interest rates charged only to non-Muslims.

John Gill, a molding machine operator at Shah Plastic Manufacturers in the Youhanabad area of Lahore, said he took a loan of 150,000 rupees (US$1,766) – at 400 percent interest – from employer Ghulam Mustafa in 2007 in order to send his 17-year-old daughter to college. 

“I kept paying the installments every month from my salary, but after three years I got tired of paying the huge interest on the loan,” Gill told Compass.

The employer denied that he had received payment installments from his Christian worker, although Gill said he had receipts for monthly payments.

Mustafa confirmed that he took over Gill’s home last week after giving the Christian two weeks to pay off the outstanding interest on the loan. Then, on May 6, Mustafa came to Gill’s home with “about five armed men” and transported him to Ganga Ram hospital, where they forced him to sell his kidney against his will, the Christian said.

“They sold my kidney and said that they will come next month for the rest of the money,” Gill said.

The value of the kidney was estimated at around 200,000 rupees (US$2,380), leaving Gill with outstanding debt of about 250,000 rupees (US$2,976), he said. Recovering at home, Gill said he did not know he would repay the rest of the debt.

Mustafa told Compass that Gill owed him 400 percent interest on the loan.

“I only offer 50 percent interest to Muslim employees,” he said, adding that he refused to take less than 400 percent interest from any non-Muslim.

‘Kidney Bazaar’

There was no immediate confirmation from Ganga Ram hospital. Rights groups, however, have complained that hundreds of rich foreigners come to Pakistan every year to buy kidneys from live, impoverished donors.

Kidney failure is increasingly common in rich countries, often because of obesity or hypertension, but a growing shortage of transplant organs has fueled a black market that exploits needy donors such as Gill and risks undermining voluntary donation schemes, according to Pakistan’s Kidney Foundation.

Pakistani legislation aimed at curbing trafficking in human kidneys has not ended a business that has turned the country into the world’s “kidney bazaar,” critics say.

Gill said he is trying to contact local Christian advocacy groups to help him recover and overcome his financial and spiritual difficulties. Christians are a minority in heavily Islamic Pakistan, where rights groups have lamented discrimination against Christian workers.

Report from Compass Direct News