COVID-19 and obesity
by David Dunaief
May 20, 2020 | 3302 views | 0 0 comments | 417 417 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Obesity has been associated with COVID-19, especially in the U.S. In a study involving 5,700 hospitalized COVID-19 patients in the New York City area, 41.7 percent were obese. Obesity is defined by a body mass index (BMI) greater than 30 kg/m2, but obesity can also be defined by excess body fat, which is more important.

One study’s authors suggested quarantining should be longer for obese patients because of the potential for prolonged viral shedding compared to those in the normal weight range. And though age is a risk factor for COVID-19, among those younger than 60 and obese, there is a two-times increased risk of being admitted to the hospital, according to a 3,615-patient study at NYU Langone Health.

Why are you at higher risk for severe COVID-19 with obesity?

According to the prevailing theory, obesity may interfere with mechanical aspects of breathing, thus increasing airway resistance and making gas exchange more difficult in the lung. It may also exert pressure on the lungs and involve weaker muscles necessary for respiration.

Why is excess fat more important than BMI?

First, some who have elevated BMI may not have a significant amount of fat; they may actually have more innate muscle.

More than 25 percent of my patient population is “solidly built,” which means they have greater muscle mass as well as too much excess fat. (I have a body analysis scale that detects muscle mass and fat through two different currents of ohms.) Visceral fat lines the organs, including the lungs.

Also, fat cells have adipokines, which communicate with other fat cells but also other systems such as the brain, immune system, muscles, and liver. Adipokines can be mediators of both inflammation and insulin resistance, according to an endocrinology study of over 4,000 patients with COVID-19.

The author suggests that inflammation among obese patients may be an exacerbating factor for hospitalizations and severe illness.

Inflammation reduction and weight-loss combined

In a randomized controlled trial with 75 participants comparing a plant-based diet to a control diet, there was a greater than 14 pounds weight reduction and roughly 10 pounds fat reduction over a 14-week period. Of the weight lost, about 70 percent was excess fat.

You also want a diet that has been shown to reduce inflammation.

We are currently submitting a small study for publication involving 16 patients from my clinical practice. It shows that those who ate a whole food plant-based LIFE (low inflammatory foods everyday) diet over a seven-day period had a significant decrease in inflammation measured by hsCRP (high sensitivity c-reactive protein).

This occurred in those who completely changed their diets to the LIFE diet, but also occurred in those who simply added a greens- and fruit-based smoothie daily to their existing diet.

In my practice, I have seen a number of patients lose a substantial amount of weight, but also excess body fat, over a short period. For instance, a 70-year-old male lost 19 pounds of weight and 12 pounds of excess body fat over a six-week period.

His inflammation, which was very high to start, dropped substantially to the border of optimal levels, using hsCRP as the inflammation measurement.

Exercise to reduce binge eating

While sheltering in place with fewer physical activities available, it is very tempting to binge eat or use food as a leisure activity. But there is a way around this.

In patients who were overweight and obese, those who exercised compared to those who were sedentary showed a significant reduction in binge eating over a 12-week period. The participants at baseline had a mean BMI of 30.6 kg/m2 and a mean age of 43 years.

Exercise can be as easy as doing exercises with your own body weight, such as calisthenics; taking online exercise classes (of which there are plenty); or using exercise equipment you have at home.
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