The Indiana University School of Medicine National Center of Excellence in Women’s Health is working to help people at an increased risk of COVID-19 complications related to obesity or being overweight. The center recently hosted a webinar called “Surviving COVID-19: Help for people with enhanced risk due to extra weight.”
“Over 30 percent of Hoosiers have obesity or extra weight,” said Theresa Rohr-Kirchgraber, MD, FACP, FAMWA, executive director of the IU National Center of Excellence. “This webinar helps us understand the reason why obesity and overweight is a risk factor for illness with COVID-19 and how we can lower that risk now.”
The interactive webinar featured brief presentations and a question and answer session with Ashley Cuellar Gilmore, MD, assistant professor of medicine at IU School of Medicine, and Toyia James-Stevenson, MD, associate professor of medicine at IU School of Medicine.
“Obesity is a disease that is related to extra fat tissues,” Cuellar Gilmore said. “Overweight is defined as a body mass index (BMI) of 25-30 and then when we get into classifications of obesity, we look at three different classifications. Class I is a BMI of 30-35, class II 35-40, and class III is a BMI above 40.”
Cuellar Gilmore says obesity is classified by these different BMI ranges because researchers have found an association between higher BMIs and other diseases like heart disease and diabetes. Those conditions, as well as obesity, have been found to cause more complications when combined with COVID-19.
“Obesity has been associated with severe disease in different viral illnesses. This was seen in other coronaviruses such as SARS and MERS several years ago,” Cuellar Gilmore said.
The most common symptoms of COVID-19 include fever, cough and shortness of breath, but many also experience gastrointestinal (GI) symptoms, including diarrhea, nausea, abdominal pain and loss of appetite. “We understand that there are different systems within the body that have been affected significantly by this virus,” James-Stevenson said. “There are inflammatory responses that it causes related to the viremia and different factors that are released in the body when it is attacked by the virus. It can also alter our gut flora or intestinal flora. These flora are found to be important in how we metabolize foods, how our immune system works, and when altered these flora can affect presentation of GI conditions like diarrhea.”
Cuellar Gilmore said because this virus is still new, research in people with obesity who contract the virus is limited. Still, physicians are getting new data every day to study and discover how to best treat patients with the combination of COVID-19 and obesity.
“In one study out of New York University, we found that in patients who were sick enough to require hospitalization, obesity was one of the strongest risk factors,” Cuellar Gilmore said. “And that was true in both acute care settings as well as ward beds, so people who were just being admitted for less severe disease as well as people who were getting care in the intensive care unit.”
The NYU study also found that obesity was a risk factor in people younger than 60 years old.
“One of the most important things that I've heard repeated over and over is that, ‘well, I'm young. I don't need to worry about this,’ but even young people with obesity are having more severe disease and requiring more hospitalization and critical care compared to young people who have normal weight,” Gilmore said.
It’s not possible to change obesity as a risk factor in the next few weeks, but there are some steps that people with extra weight can take now to improve outcomes.
“Taking care of any kind of overweight or obesity that you or someone you love currently has is going to be very important for the future as well,” Cuellar Gilmore said. “When I see patients who have extra weight or obesity, oftentimes they come in looking for medications or interventions that can help them with weight loss and healthy lifestyle. And that's important, but I would say that medications, procedures, intervention pillars like that are much less important than all of these other foundation pillars.”
Cuellar Gilmore recommends focusing on the other four pillars good nutrition, physical activity, behaviors and overall health. Some of her nutrition suggestions include eliminating sugary beverages, high-sugar foods, processed foods and instead eating more healthy fats, lean meats and produce. When it comes to exercise, she suggests aiming for 150 minutes of moderate activity a week.
“I realize that it is difficult to exercise in this current environment, but walking, YouTube videos for home exercises, any of that counts,” Cuellar Gilmore said. “I think at this point, just going outside for a little bit and walking, if you're able to, and then doing things around your house is perfectly acceptable.”
It’s also important to get enough sleep and pay attention to mental health.
“Sleep is one thing that I think gets put on the back-burner. Often if you have obstructive sleep apnea, you need to be wearing your CPAP. Uncontrolled obstructive sleep apnea contributes to higher obesity rates and that of course cycles back around to worsening obstructive sleep apnea,” Cuellar Gilmore said. “Making sure any mental health problems are addressed appropriately is important as well, as all of this can contribute to overweight and obesity.”
While these are often also suggestions for making a long-term impact on issues with extra weight, Gilmore said making these changes now can still help fight potential complications with the virus.
“I think that people don't give credence to how impactful small changes are even in the short-term,” Cuellar Gilmore said. “Improving physical activity and nutrition right now does make a difference. And it will make a difference with some consistency in the long-term related to weight. And certainly, if we're going to be looking at a surge of COVID-19 again in the fall or in the winter months, then this is the time to start preparing and taking care of your health.”
Both James-Stevenson and Cuellar Gilmore recommend following the guidelines recommended by public health officials for preventing the spread of the virus and contacting your physician if you are concerned. Indiana University Health has a screening website if you are concerned about your risk.
