Why Do Obese Younger Americans Do Worse With COVID 19?

[McCamy Taylor]

I am going to propose an answer that might have practical applications. What do obese people have in common? They eat more. Also obesity is a major risk factor for gastro esophageal reflux—-food in your stomach tries to come back up the esophagus due to increased intra-abdominal pressure.

How might these two things put people who have a severe lower respiratory infection at risk? Aspiration. This is what happens when gastric contents—-including hydrochloride acid gets into your airway. This is a common killer in the elderly and those with certain neurological conditions. And we now know that COVID can have certain neurological manifestations in particular the loss of the sense of smell and in rare cases confusion, lethargy and other symptoms which in themselves are not fatal but which might make a person more prone to aspiration.

Plus, simply lying flat on your back in bed increases the risk that gastric contents will move out of the stomach into the throat. And where is the place most of us want to be when we are sick? In bed.

So, I am going to make a recommendation which has no potential for harm and which might, theoretically help. If you have COVID or think you might, have small meals, stay sitting up for an hour after eating and use a wedge pillow to elevate your head when you lie down. Also avoid foods which cause reflux. Do not eat anything solid for two hours before going to bed at night. Avoid alcohol at bedtime which can make reflux worse.

It is normal to want to eat “comfort food” when we are sick. And if the airway were not right next door to the esophagus that couldn’t be a problem. But since the two are side by side what you eat definitely can affect how you breathe.

[Hassler]

1. I heard an interview yesterday by an author/doctor who

Wrote a book on chromosomes and disease. He said that 80% of deaths world wide have been males. That it has to do with XX chromosome combination being naturally healthier than XY combination.

[Bernardo de La Paz]

3. 80% is not in the statistics. It is bogus. Extraordinary claims need extraordinary evidence. nt

[Hassler]

5. Dr. Sharon Moalem is the one making the claim.

[Bernardo de La Paz]

7. He seems to be captive of confirmation bias. I don't see 80% in the statistics

What I do see is maybe roughly a 65 / 35 split.

In studies that don't account for risk factors.

Are men more likely to smoke?

Are men, particularly older men, more likely to have worn out bodies?

Are men more likely to have worked in polluted factories and with risky chemicals? For example cadmium among auto mechanics.

[Hassler]

8. Or I misheard it as I was working around the house at the time.

But it's definitely the majority.

[WhiskeyGrinder]

2. Covid-19 Does Not Discriminate by Body Weight

The claim that those with higher BMIs are at special risk of dying from the coronavirus is grossly overstated.

https://www.wired.com/story/covid-19-does-not-discriminate-by-body-weight/

To date, the most plausible research pointing to higher BMI as a risk factor includes three preliminary reports that have been released since April 8: a Centers for Disease Control and Prevention report with descriptive statistics on people who’ve been hospitalized for Covid-19, showing that 48 percent of those with available BMI data are in the “obese” category (a slightly higher percentage than the 42 percent in the US as a whole); a small French study that found people with a BMI of 35 and above are at higher risk of being put on a ventilator; and a letter to the editor of the journal Clinical Infectious Diseases from researchers at NYU’s School of Medicine (including one of the authors of last week’s preprint), sharing a preliminary finding that people with a BMI of 30 or above appear to be at higher risk for hospitalization and intensive-care admission, if they’re less than 60 years old. (Among people who are 60 or older, weight status did not seem to be important.)

All of these reports are flawed in similar ways. Most important, none of them control for race, socioeconomic status, or quality of care—social determinants of health that we know explain the lion’s share of health disparities between groups of people. Structural racism and other forms of inequality in our society have long been linked to worse health outcomes, including higher rates of diabetes and hypertension (two likely Covid-19 risk factors) among people in oppressed groups. Now, those health disparities are on full display in the Covid-19 pandemic, which is disproportionately impacting black communities—not because of biology, but because of systemic inequalities like higher rates of exposure to the virus and less access to medical care.

As it happens, that recent preprint from NYU did take race into account, in its finding that having a very high BMI was a major risk factor for hospitalization. But the same analysis also found that BMI was only marginally important at predicting which hospitalized patients would go on to have “critical” illness. It also seemed to indicate that being African American was in some way significantly protective against Covid-19: Black patients admitted to the hospital were only half as likely as white patients to develop the most serious symptoms, according to the study. Needless to say, few if any outlets touted this dubious result.

Another glaring issue with the three published reports about BMI and Covid-19: They don’t control for known individual health risks that may be associated with worse outcomes for this virus, including asthma and other chronic respiratory conditions, cancer, and immunosuppressive medication use. The CDC report and NYU letter to the editor don’t control for diabetes or cardiovascular conditions, either, although these two likely risk factors for Covid-19 happen to be associated with higher BMI. The French study of 124 patients does control for diabetes and hypertension, as well as dyslipidemia, but not for other risk factors—even though in the study’s introduction, the authors themselves acknowledge that cardiovascular disease, chronic respiratory disease, and cancer are also likely to raise the risk of Covid-19.

[McCamy Taylor]

9. "A very high BMI was a major risk factor for hospitalization"

Aspiration will happen at home. At the hospital there will be all types of safeguards.

[crickets]

4. Good advice for anyone - K&R for post and discussion

[Maru Kitteh]

6. Obese patients of all ages always fare worse (statistically) with respiratory illness

Excess weight in of and by itself increases the effort of breathing. Any condition, including obesity, that taxes respiratory effort can mean the difference between living and dying with this *ucking bastard virus.