Study Says Obesity Raises Risk of Death from Covid-19 Among Men – The New York Times:

Older age and chronic health conditions like high blood pressure and heart disease are known to increase the risk of severe Covid-19. The Centers for Disease Control and Prevention also lists extreme obesity as a high risk.

But is excess weight in and of itself to blame? Or all of the health problems that accompany obesity, like metabolic disorders and breathing problems?
A new study points to obesity itself as a culprit. An analysis of thousands of patients treated at a Southern California health system identified extreme obesity as an independent risk factor for dying among Covid-19 patients — most strikingly, among younger and middle-aged adults 60 and younger, and particularly among men.

Among women with the illness, body mass index — a measure of body fat based on height and weight — does not appear to be independently associated with an increased risk of dying at any age, the authors said, possibly because women carry weight differently than do men, who tend to have more visceral and abdominal fat. The study was published in Annals of Internal Medicine on Wednesday.

If, like many of us, the “19” in COVID-19 also refers to the extra weight you’ve gained, there’s never been a better time to get things back under control—particularly if you’re a guy. As someone who’s lived most of his adult life in the “obese” category (and now sits in the upper reaches of “overweight”), I have some sense of the struggle. Getting weight under control and keeping it there is, at least for me, enormously difficult. 

I’ve had good success with the Keto—a low-carb diet—but I abandon it when the lockdown came. I’m a stress eater, and I don’t know anyone saying that present times aren’t stressful. Add in that all my exercise routines (gym, Pilates, soccer, swimming, tennis) were canceled in the lockdown, and I’ve only recently hopped back on the bandwagon. It has helped me to remember that there is much in life that I can’t control, but one thing I can is what I eat and how much of it.

This is made harder by American culture. To say that we live in a carbohydrate-rich society is to understate things by orders of magnitude. Why is 40% of America obese? We are insanely awash in carbs. Yes, exercise is great and healthy and good for you. But I can go run a mile, come home and eat a cookie, and I’ve wiped out the caloric deficit I just created from the run. You can’t outrun a bad diet, and American society presents us with so many bad food choices and quantities that having a bad diet is almost the default. 

In terms of COVID-19, it’s abundantly clear now that obesity is a (forgive the puns) huge risk factor for men. This cuts across racial lines, which is to say that race itself does not appear to be a risk factor for the infection. It is notable that more minorities tend to be obese, typically because of socio-economic factors like like income which is correlated with poor diet. But the virus is equally opportunistic. It doesn’t care about a victim’s race or ethnicity. 

There has been pushback against BMI (Body Mass Index) as a measurement tool for determining obesity and healthiness. I’m on board with some of that but not most of it. It’s possible for a very muscular man, for example, to have a BMI that would indicate he is obese when he obviously is not. BMI can fall apart as a diagnostic tool in some extremes and it needs to be combined with other information to provide an individual health assessment. 

That said, we know that obesity is dangerous. It’s implicated in diabetes, cardiovascular disease, sleep apnea, dementia, cancer, brain function, and other conditions, not to mention mortality itself. BMI is a simple metric based on weight and height, but since it was invented in 1972 studies have shown it to be a rather reliable predictor: If your BMI is too high or too low, you’re more likely to suffer premature death.

This has been validated across sex, racial, and ethnic groups, though what BMI means medically can differ between populations. Asians, for example, tend to have obesity complications at lower BMIs than other groups. The concerns that the BMI metrics are racist and that obesity is not a significant problem, recently brought forth by the once-proud Scientific American, are misguided. There is no significant difference in BMI-determined health risks between Americans of European descent and Americans of African descent. In other words, a white woman and a black woman of the same age with the same BMI face the same health risks. There may be individualized factors that separate the health risks of the two, but a general diagnostic tool BMI functions the same for both. 

Rather than attacking BMI, where the attention should be focused is on the disparities in access to high quality health care—a right that belongs to everyone.