The group of people that are 3 times more likely to succumb to COVID-19

In a weekly roundup of COVID-19 coverage, Ladders included the CDC’s updated list of characteristic symptoms and compounding risk factors linked to the devastating disease. Obesity was among the latter.

Patients infected with the novel coronavirus who are also overweight often develop low-grade systemic inflammation in addition to evidencing a weakened immune response compared to patients of healthy weights.

According to a new study published in the journal Annals of Internal Medicine, men endure the most severe effects of this association.

“Obesity, race/ethnicity, and other correlated characteristics have emerged as high-profile risk factors for adverse coronavirus disease 2019 (COVID-19)–associated outcomes, yet studies have not adequately disentangled their effects,” the authors wrote in the new paper. “Obesity plays a profound role in risk for death from COVID-19, particularly in male patients and younger populations. Our capitated system with more equalized health care access may explain the absence of effect of racial/ethnic and socioeconomic disparities on death. Our data highlight the leading role of severe obesity over correlated risk factors, providing a target for early intervention.”

The researchers began their analysis by examining 6,916 patients diagnosed with COVID-19, previously featured in the Kaiser Permanente Southern California Health System, recorded between February and May.

The median age of the study pool was 49 with an average BMI of 30 (between 18.5 and 24.9 is considered clinically normal).

After all relevant data was collected, it was determined that obese COVID-19 patients (BMI of 40 or above) are about three times more likely to die as a result of the disease compared to otherwise healthy individuals.

Moreover, those with a BMI of 45 or over are roughly four times more likely to succumb to COVID-19.

Although BMI shared a relationship with COVID-19 survival rates for all of the cohorts examined, middle-aged men were found to fair the worse by a significant margin.

“Among 6916 patients with COVID-19, there was a J-shaped association between BMI and risk for death, even after adjustment for obesity-related comorbidities. Compared with patients with a BMI of 18.5 to 24 kg/m², those with BMIs of 40 to 44 kg/m and greater than 45 kg/ had relative risks of 2.68 and 4.18, respectively,” the authors explained. “This risk was most striking among those aged 60 years or younger and men. Increased risk for death associated with Black or Latino race/ethnicity or other sociodemographic characteristics was not detected.”

The mechanisms seem to vary, but leptin and inflammation clearly play a huge role.

The more fat we have in our body, the higher the amount of leptin in our cells. This surplus makes it harder for us to fight off infections by disturbing auto-immune functions and limiting lung capacity. There are many underlying conditions associated with this outcome:

• Cancer
• Chronic kidney disease
• COPD (chronic obstructive pulmonary disease)
• Immunocompromised state (weakened immune system) from solid organ transplant
• Obesity (body mass index [BMI] of 30 or higher)
• Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
• Sickle cell disease
• Type 2 diabetes mellitus

Men are not only more likely to be diagnosed with the conditions above compared to women, but they also lack certain hormones important to viral clearance.

As a result, adult men between the ages of 45 and 60 are three times more likely to die from COVID-19 than women.

“We found a striking association between BMI and risk for death among patients with a diagnosis of COVID-19 in an integrated health care system; this association was independent of obesity-related comorbidities and other potential confounders,” the authors conclude. “Our data also suggest that risk may not be uniform across different populations, with high BMI more strongly associated with COVID-19 mortality in younger adults and male patients, but not in female patients and older adults.”