Obesity, racism and Covid: a deadly combination

Obesity, racism and covid-19: a deadly combination

During the early days of the Covid-19 pandemic, the people who were most likely to be hospitalized or die from the virus had a few things in common.

Age was the biggest risk factor couple falling seriously ill with covid-19. Race and ethnicity also seemed to have a connection, like the Covid-19 deaths were highest for Blacks, Hispanics and Native Americans.

Having two or more medical conditions (called comorbidity) increases the risk of serious illness and death from covid-19. But some of the comorbidities we hear about, such as asthma, heart disease, lung disease and diabetes, have not put Covid-19 patients at the highest risk of hospitalization and death.

It was obesity.

“Obesity is a disease characterized by a chronic inflammatory process that has had a major impact on several factors during the pandemic,” he said. Fatima Cody Stanford, MD, MPH, MPA, associate professor of medicine at Massachusetts General Hospital and obesity medical scientist. “Covid-19 is an inflammatory process sharp and these two things (covid-19 and obesity) are not a good combination.

Studies show that the social determinants of health — the conditions in the environments in which people are born, live, learn, work, play, worship and age — have made the virus worse for people living with obesity. Covid-19 was too worse for black people. In his TEDx talk In 2021, Cody Stanford said that people of color were battling three pandemics, obesity, racism and covid-19.

Read: Social determinants of health, health inequalities and health equity >>

How does obesity affect covid-19?

The characteristics of obesity provide insight into why covid-19 has been so deadly.

“A very simple reason was that obese patients couldn’t expand their lungs very much,” said Holly F. Lofton, MD, director of NYU Langone Health’s weight management medical program and a member of the women’s health board at NYU. Healthy Women. “If you add a respiratory disease like covid-19 to a condition that already prevents you from expanding your lungs, mucus will start to build up and it will be very difficult to expel.”

Dr. Lofton said people with obesity usually have larger waist circumferences, defined as more than 35 inches for women and more than 40 for men. That mass of the central part presses on the diaphragm, causing the chest cavity around the lungs it is smaller. For covid-19 patients, the smaller chest cavity means less room to breathe when air is needed most.

Fat causes inflammation. fat cells secrete cytokines they are inflammatory hormones that can worsen immune function. Obese people have high levels of one of these cytokines (interleucine-6 ​​or IL-6) and high IL-6 levels are associated with poor outcomes for covid-19 patients.

Inflammation from obesity is also a risk factor for blood clots. Dr. Lofton said she warns otherwise healthy obese people about the risks of blood clots before weight-loss surgery. Blood clots can occur in response to infection or lack of movement. There’s more chance than blood coagulation as a reaction to inflammation caused by covid-19 And when the clots travel from arteries and veins to organs, they can cause heart attack, stroke, organ damage or death.

When obesity, social determinants of health and covid-19 coincide

Obesity is a disease. A study by the Centers for Disease Control and Prevention (CDC) that monitor obesity rates found that black or African-American women had the highest rates of obesity of any other racial group at 57%. For Hispanic women, 44% live with obesity. Non-Hispanic white women have an obesity rate of 40%, while Asian women had the lowest rates of obesity at 17%. another study showed that 48% of all Native Americans were obese.

As with other diseases, social determinants of health influence obesity, with many of the following factors contributing to its development.

  • racism and discrimination: Historical and current racial inequalities in health care, housing, education, criminal justice, and finance have been shown to contribute to obesity.

    The Black Women’s Health Study (The Black Women’s Health Study) was the first to really show how exposure to racism predisposes people to an increased risk of obesity,” said Cody Stanford. “When you experience racism as a person of color here in the United States or anywhere, you are Stressed Stress causes fatty tissue (adipose tissue) to store.

    There was certainly no shortage of chronic stress in 2020 from people who have lost friends and family to Covid-19 and from public exposure of acts of racial violence, such as the murders of George Floyd, Breonna Taylor and Ahmaud Arbery.

  • access to health care: Lack of insurance, transportation, childcare, or inability to take days off can make it difficult to see health care professionals (HCPs). Cultural differences, language barriers, and biases from healthcare professionals can also affect the quality of healthcare people receive.

    Read: The cost of racial bias in obstetric and gynecological care >>

    Dr. Lofton mentioned that medical distrust of black people, caused by historical examples such as the tuskegee syphilis study and the forced sterilization of Black, Latina and Native American womencoupled with personal experiences of poor care, it can make people from marginalized groups less likely to seek care.

    While access to health care is often related to education, income, and wealth differences, people of color from more advantaged socioeconomic backgrounds also report unequal treatment they believe it is associated with their race or ethnicity.

    At the start of the pandemic in 2020, stories of people of color who have not been admitted to hospitals in urban areas and many have died of covid-19 in their homes. Dr. Lofton mentioned the pharmacological inequality which is when bias or lack of insurance causes marginalized groups to receive older or less effective drugs when better treatments are available. For example, when covid-19 drugs became available on the market, people of color were less likely to receive them.

  • Food deserts, food insecurity and areas without healthy food: Areas that lack supermarkets or restaurants, as well as healthier and less expensive food options are called food deserts. They can be found in many urban and rural areas where people of color live. Even when food is available, lower income can also cause food insecurity, which is when people cannot buy enough food.

    There are often many fast food restaurants with fancier, less nutritious options available in these areas. Many times they are even on the same block. These are called areas without healthy food.

    “They’re convenient and cheap and easy,” Cody Stanford said. “And when you’re stressed, what does your body want? You want things that are comforting, and fast food can be that.”

  • Activity: People of color are more likely to work as essential employees interacting with the general public or performing indoor work activities without the ability to work from home. They may have less financial flexibility to quit those jobs or stay home when they get sick, putting them at a higher risk of contracting COVID-19.
  • weight bias: Several studies have found that health professionals have negative biases against overweight or obese patientswhich could affect the quality of care they receive.

    “There are times when doctors have to make a decision: ‘Who do I put the ventilator on? There’s only one ventilator, but two patients need it,’” Dr. Lofton said, noting that weight bias could be a contributing factor in those cases.

improve results

If you are obese, you can do the most to protect yourself from COVID-19 by staying up to date with your COVID-19 vaccinations and taking preventative measures when you go out in public, such as wearing a mask and washing your hands often or using hand sanitizer. . You can also improve your results by getting tested right away if you have symptoms and contacting your healthcare provider as soon as possible if you suspect you have COVID-19 so you can get prompt treatment.

You may not control many of the factors that contribute to getting COVID-19. But studies suggest that obesity treatments can improve your overall health and reduce your risk of poor outcomes from covid-19. A study determined that patients undergoing surgery to reduce their weight had a 60% lower risk of developing serious complications related to covid-19.

In addition to preventative measures, Dr. Lofton stressed the importance of health professionals continuing to study because it will help eliminate weight-related biases in health care.

“Clinicians need to be aware that there is an unconscious bias related to weight and that we should try to eliminate it when treating patients with obesity,” said Dr. Lofton.

Cody Stanford said his goal is to improve overall health which will help reduce the chronic inflammation that causes obesity and makes other diseases, such as covid-19, more dangerous, recognizing how the intersection of race and race affects the class in the overall results.

“My goal is to make people happier and healthier,” she said. “It’s not about hitting a number on a scale, but we look at cholesterol values, fasting blood sugar, insulin values, liver function, all together. I emphasize the missing element of health and the attempt to prevent all diseases caused by obesity”.

This resource was prepared with assistance from Pfizer.

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