Obesity, racism and Covid: a deadly combination
Obesity, racism and Covid: a deadly combination
In the early days of the Covid pandemic, the people most likely to be hospitalized or die from the virus had a few things in common.
Age was the biggest risk factor for falling seriously ill with Covid. Even race and ethnicity seemed to have a connection, like Covid deaths were highest among Blacks, Hispanics and Native Americans.
Having two or more health conditions (called comorbidity) — increased the risk of serious illness and death from Covid. But some of the comorbidities you hear a lot about, such as asthma, heart disease, lung disease and diabetes, weren’t the ones giving Covid patients the highest risk of hospitalization and death.
It was obesity.
“Obesity is a disease characterized by a chronic inflammatory process and that process has had a major collision with multiple factors during the pandemic,” he said. Fatima Cody Stanford, MD, MPH, MPA, an associate professor of medicine at Massachusetts General Hospital and a medical scientist of obesity medicine. “Covid is a acute inflammatory process and these two things (Covid and obesity) don’t play so well together.
Studies show that 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 was too worse for black people. In its 2021 TEDx talkCody Stanford said 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?
How obesity works provides insight into why Covid has turned out to be so deadly.
“One very simple reason was that patients with obesity can’t expand their lungs that much,” said Holly F. Lofton, MD, director of the weight management medical program at NYU Langone Health and a member of the Advisory Council for Weight Management. HealthyWomen’s Women’s Health. “If you add a respiratory illness like Covid to a condition where you can’t already expand your lungs, mucus starts building up and it’s really hard to get it out.”
Lofton noted that people with obesity usually have higher waist circumference, defined as more than 35 inches in a female or 40 inches in a male. That weight of the central part pushes on the diaphragm, making the chest cavity around the smaller lungs. For a Covid patient, that smaller chest cavity leaves less room to breathe when breathing is needed most.
Fat itself causes inflammation. Release of fat cells cytokines, which are inflammatory hormones that can worsen immune function. People with obesity have high levels of one of those cytokines (Interleukin-6 or IL-6), and high levels of IL-6 have been associated with poor outcomes in Covid patients.
Inflammation from obesity is also a risk factor for blood clots. Lofton said he warns people living with obesity who are otherwise healthy before undergoing weight-loss surgery about the risk of clots forming. Blood clots can occur in response to infection or lack of movement. Blood may be more likely clot as a reaction to inflammation from Covidand when clots travel to arteries and veins into organs, they can lead to heart attack, stroke, organ damage or death.
When obesity, social determinants of health and Covid collide
Obesity is a disease. A study by the Centers for Disease Control and Prevention (CDC) monitor obesity rates found that Black/African American women had the highest rates of obesity of any other racial group at 57%. Among Hispanic women, 44 percent were living with obesity. Non-Hispanic white women had an obesity rate of 40%, while Asian women had the lowest rates of obesity at 17%. A different studio showed that 48% of all Native Americans had obesity.
Like other diseases, obesity is influenced by social determinants of health, 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 the economy have been shown to contribute to obesity.
“The Black Women’s Health Study was the first to really show how exposure to racism in and of itself predisposes you to a higher risk of obesity,” Cody Stanford said. “When you experience racism as a person of color here in the United States or everywhere, you feel stress.Stress causes the accumulation of adipose (adipose tissue).
There was certainly no shortage of chronic stress in 2020, from people losing friends and family to Covid to public exposure of acts of racial violence, such as the murders of George Floyd, Breonna Taylor and Ahmaud Arbery.
- Access to healthcare: Lack of insurance, transportation, child care, or the ability to take time off work can make it more difficult to see a healthcare provider (HCP). Cultural differences, language barriers, and provider bias can also affect the quality of health care people receive.
Read: The Cost of Racial Bias in OB-GYN Care >>
Lofton noted that medical distrust from black people, stemming from historical examples such as the Tuskegee Syphilis Study AND forced sterilization of Black, Latina and Native American womencoupled with personal experiences of poor care, it may make people from marginalized groups less likely to seek treatment.
While access to health care is often linked to education, income, and wealth gaps, people of color from more privileged socioeconomic backgrounds also report unequal treatment they believe it is related to their race or ethnicity.
As the pandemic began in 2020, stories came out people of color turned away from hospitals in urban areas, with many dying of Covid at home. Lofton quoted drug-iniquity, which is when provider bias or lack of insurance leads marginalized groups to receive older or less effective drugs when better treatments are available. For example, when Covid drugs entered the market, people of color were less likely to receive them.
- Food deserts, food insecurity and food swamps: Areas that lack grocery stores and restaurants with 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 incomes can also lead to food insecurity, where people cannot afford to buy enough food.
However, many fast food restaurants with fancier, less nutritious options are often available in these areas. Many times they are even on the same block. These areas have been referred to as food swamps.
“They’re convenient, they’re cheap, and they’re easy,” Cody Stanford said. “And when you’re stressed, what does your body look for? You look for things that are comforting and fast food can be that.
- Occupations: More black people were likely to be employed as essential workers dealing with the public or performing close-quarter work duties without the ability to work from home. They may have had less financial flexibility to quit those jobs or stay home when sick, putting them at a higher risk of contracting Covid.
- Weight bias: Numerous studies have found that healthcare professionals have a negative bias against patients with overweight or obesitywhich could affect the quality of care they receive.
“There are times when a doctor has to make a decision: ‘Who am I going to give the ventilator to? There’s only one ventilator, but there are two patients who need it,” Lofton said, noting that weight bias could be a deciding factor in these cases.
If you’re obese, you can do your best to protect yourself from Covid-19 by staying up to date on Covid vaccines and taking preventative measures when out in public, such as wearing a face mask and washing your hands often or using hand sanitizer. You can also improve your outcome by testing immediately for symptoms and contacting your healthcare provider as soon as you suspect Covid get prompt treatment.
You may not be able to control many of the factors that contribute to getting sick with Covid. But studies suggest that treating obesity can improve your overall health and reduce your risk of poor outcomes from Covid. One study found that patients who had undergone weight-loss surgery had a 60% lower risk of developing serious complications from Covid.
In addition to preventative measures, Lofton emphasized the importance of continuing education for health care professionals to help eliminate weight bias in health care.
“Clinicians need to be aware that there is an unconscious weight bias and that we should try to set it aside when treating patients with obesity,” Lofton said.
Cody Stanford said his goal is to improve overall health to help reduce the chronic inflammation that leads to obesity and makes other diseases, such as Covid, more dangerous, while acknowledging the intersection of race and class in the overall outcomes.
“My goal is to get people into a happier, healthier state of being,” she said. “It’s not about giving them a number on a scale, it’s about looking at cholesterol values, fasting blood sugar, insulin values, liver function – let’s look at all of this together. I emphasize the health piece of the puzzle and help prevent all the diseases that obesity can cause.
This resource was created with support from PfizeR.
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