Fat Shaming

Obese People Who Lost Bodyweight Got Less Severe Covid

Aside from older age and male gender, obesity is one of the most important risk factors for severe Covid. Compared to those with a healthy BMI, the obese (those with a BMI greater than 30) are about twice as likely to end up in the ICU, and are about 20% more likely to die.

Which raises the question: is obesity a modifiable risk factor? Can obese people reduce their risk of severe Covid by losing a large amount of bodyweight? While the answer might seem obvious, it isn’t necessarily ‘yes’.

Rather than obesity per se, it might be some factor strongly correlated with obesity that predisposes you to severe Covid. Or perhaps obesity leads to permanent changes in the body, so that even once you lose the extra bodyweight, you’re still at higher risk than someone who was never obese to begin with.

It’s certainly possible. Yet a new study suggests that obesity is a modifiable risk factor. Ali Aminian and colleagues examined a cohort of obese people who’d had gastric bypass surgery at particular hospital in Cleveland between 2004 and 2017.

Members of this cohort were matched to similar individuals who’d never had gastric bypass surgery. Matching was based on age, sex, race, BMI at the time of surgery and an index of comorbidities.

The researchers therefore compared two groups: obese people who’d lost weight thanks to gastric bypass surgery; and obese people who’d never had gastric bypass surgery. Note: most members of the surgery group were still obese by the time of the pandemic. Their average BMI was 38, compared to 46 in the control group.

The groups were compared with respect to their Covid outcomes during the first year of the pandemic. What did the researchers find? Their main results are shown in the figure below.

The two groups had almost identical infection rates, as shown in the top-left chart. However, the incidence of severe Covid was much higher in the control group, as shown in the other three charts. This provides relatively strong evidence that losing weight does reduce the risk of severe Covid. 

So far, governments have made very little effort to encourage weight loss during the pandemic. (One exception is a recent campaign by the tech-savvy government of El Salvador.) In fact, the net effect of Britain’s lockdowns has been to increase the rate of obesity.

But if Aminian and colleagues’ findings hold up, more emphasis on weight loss is clearly warranted – especially since obesity is risk factor for various medical conditions, not just Covid.

Of course, the main obstacle to promoting weight loss in the current year is not lack of evidence, but concerns around ‘fat-shaming’. To reduce stigma around obesity, you’re supposed to affirm that people can be ‘healthy at any size’. Unfortunately for the activists, this simply isn’t true.

Reducing obesity isn’t a silver bullet in the fight against Covid. But it would certainly help.

Stop Worrying About Fat Shaming. We Need to Talk About Obesity

A GP has emailed Lockdown Sceptics with a short piece about obesity, which she calls the elephant in the room. Given its links to susceptibility to COVID-19, we have to start talking about it.

Forgive me if this offends you. For the past 16 months we have an elephant in the (COVID-19) room that we seem to refuse to talk about. As a clinician working in a very large London GP practice, I’ve been wondering if and when patients might spot the elephant and take some action. It hasn’t happened yet.

So what is the elephant you ask? It’s the undeniable fact that a healthy weight and lifestyle which includes regular exercise will (almost definitely) reduce your risk of dying with an infection such as Covid by an enormous amount. To name it and shame it, the elephant’s name is specifically obesity. Yes there are genetics, yes there is age, yes there are the random unlucky ones. But for the vast majority who become seriously ill with COVID-19, obesity is a significant contributory factor. The vast majority of patients who end up in ITU with Covid have a BMI of >25 and it often does’t end well for them.

Now you might think that’s not relevant to you as you have checked out the infection fatality risk in your age group (and hopefully the Covid ship has sailed anyway…) and you know it’s ridiculously low. However, is that really a good excuse? So you might get Covid and not die (I certainly hope you don’t), but what about the increased risks of developing diabetes, cancer, heart disease, strokes, infertility, difficult labours, long Covid (the list goes on and on)?

So, I’ve spent 16 months talking to my patients about this. (Contrary to public perception we have been doing something!) Have they listened? Well, yes, I would say most of them hear me out. However, what has struck me is that a few of them (a generally well educated, affluent bunch) were genuinely surprised by what they heard. They had no idea there was such a strong correlation between obesity and increased risk of dying or being very unwell with Covid. But sadly in the majority of cases I fear I’ve wasted my breath.

So, who’s to blame? SAGE wouldn’t deny it, Boris has mentioned it, the BBC have whispered about it… But the mystery remains as to WHY WE AREN’T SHOUTING ABOUT THIS FROM THE ROOFTOPS?!? Is it because the media and the rest of the band wagon are afraid of fat shaming? Or would a massive increase in health promotion distract from all the fear mongering and vaccine obsession? Boris has the perfect platform to mention this every time he does one of his irritating lectures to the nation.

I’m not writing this piece to rant. I’m writing it because maybe this is the forum to speak out and start to create a change that will not only reduce people’s risk of dying from diseases like Covid, but, more importantly, will reduce the risk of them getting innumerable diseases. Maybe what is needed is to separate statement of fact (obesity carries significant health risk) from subjective judgement (it’s your fault you’re obese). If we remove the subjective element, then perhaps we’d be able to talk about it in a more objective and calm way? It would allow us to state plainly the health risks, and (more importantly) facilitate weight loss for those who want to attempt it. It is very sensitive subject and until we stop worrying about causing offence we won’t be able to have a proper grown up discussion.

Update: Gary Johnson, the Managing Director of Inpharmation, has emailed us to correct the impression, given by the author of this piece, that obesity is a more important risk factor than age when it comes to susceptibility to COVID-19.

I know from reading your site regularly that you will be well aware that the risk of increasing age spans several order of magnitude. Whereas the risks from obesity are a fraction of an order of magnitude.

The best data I know of for the demographics and outcomes for patients on critical care is the INARC report on COVID-19 in critical care.

While it is true that around four fifths of the COVID critical care population have a BMI of over 25, this misleads. Firstly, the cut off for obesity is 30 and not 25. Secondly, as we age, we put on weight and the average age for critical care COVID patients is around 60. So we need to compare the critical care COVID population with the sex and age matched general population. You can see this on page 65 of the INARC report. The COVID critical care population is a just a little more overweight/obese than the general population. In earlier INARC reports, the proportions have actually been quite similar.

And, while it is true that it often does not end well for overweight COVID patients on ITU, it is no more true for them than for other COVID patients who end up on ITU. On page 65 of the report you will see that, surprisingly, a lower percentage of obese patients in critical care die (34.6%) than of non-obese patients. The worst outcome is for those patients with a BMI of <25, with 42.2% of those in critical care dying.

Please don’t get me wrong, I am not advocating obesity – just fact checking.

Keep up the great work.