When an obese population encounters something like Covid-19 (sports ineligibility)

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Body mass index (BMI)

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Candida Rebello: "The problem for people with obesity is that their leptin levels are always high, and that can affect the response to a COVID-19 infection."

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Brenda Goodman: It has become clearer that people who are obese are one of the groups at highest risk from the disease, regardless of their age. The CDC recently refined its risk categories for COVID-19, stating that obesity was as big a risk for COVID as having a suppressed immune system or chronic lung or kidney disease. The agency also lowered the bar for where that risk starts -- from a BMI of 40 to a BMI of 30. Roughly 40% of Americans have a BMI over 30.

The CDC’s change in BMI risk comes after a British study of more than 17 million people found that people living with severe obesity were about twice as likely to die from COVID-19 as people who were not obese. That was true even after other things like their age and sex were taken into account. The study also found that risk rises with the degree of obesity. The bigger a person, the higher their risk of a COVID-19 death.

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Ross Pomeroy: Comedian Bill Maher holds a number of kooky, anti-science views [...But...] he shared a candid, evidence-based truth: obesity in America is a major driver of COVID-19 illness and death. "America fighting COVID is like a boxer who went into the ring, out-of-shape and is taking a beating for it... I think so many lives could have been saved at the very beginning of this crisis if the medical establishment had made a more concerted effort to tell Americans, 'while you're in lockdown, getting free money for not working, you need to do something, too... A national campaign to get in shape would have dramatically improved our chances against this disease..."

America's obesity rate currently stands at an astounding 42.4%, up from 30.5% just twenty years ago. Obese individuals have a body mass index of 30 or greater. To fall into this category, someone who stands 5'9" (the average height for a male) must weigh at least 203 pounds. Similarly-tall individuals tipping the scales at 237 pounds have a body mass index of 35. People in this category suffer vastly more from the effects of COVID-19. A study in France found that they are twice as likely to require mechanical ventilation after entering the intensive care unit compared to healthy-weight individuals. A systematic review discovered that obese COVID-19 patients were 2.3 times more likely to have severe disease. Public Health England recently shared the most glaring data. "For people with a BMI of 35 to 40, risk of death from COVID-19 increases by 40% and with a BMI over 40 by 90%, compared to those not living with obesity."

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worldobesity.org: Given the extremely high rates of obesity around the globe we expect that a high percentage of the population who will contract coronavirus will also have a BMI over 25. Furthermore, persons with obesity who become ill and require intensive care present challenges in patient management as it is more difficult to intubate patients with obesity, it can be more challenging to obtain diagnostic imaging (as there are weight limits on imaging machines), patients are more difficult to position and transport by nursing staff and, like pregnant patients in ICUs, they may not do well when prone.

Special beds and positioning/transport equipment are available in specialized surgery units, but may not be widely available elsewhere in hospitals and certainly not in all countries. In general health systems are already not well set up to manage patients with obesity (as reported by our MAPPS study published in Clinical Obesity) and the current crisis will expose their limitations even more.

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