At the outset of the Covid pandemic, those most at risk were individuals from certain demographic groups – predominantly black or Latino males aged 50 years or over and those living alone or with limited financial means were among them.

Age was found to be the greatest risk factor for becoming seriously ill with Covid, with Black, Hispanic and Native American people having higher Covid mortality rates than other races and ethnicities.

Multiple health conditions (known as comorbidities) raised the risk of severe illness and death from Covid, with asthma, heart disease, lung disease and diabetes being among those most frequently associated with increased hospitalization risk and early mortality in Covid patients.

“Obesity is a chronic inflammatory process, which interacted with other factors during the pandemic,” explained Fatima Cody Stanford, M.D., M.P.H., M.P.A. an obesity medicine physician scientist from Massachusetts General Hospital. Covid is an acute inflammatory response; therefore these two don’t go well together.”

Studies indicate that social determinants of health — the conditions under which people are born, raised, educated, work, play, worship and age — exacerbated the Covid virus for people living with obesity. Furthermore, people of color were particularly affected; according to Cody Stanford’s 2021 TEDx talk at Stanford’s TEDx presentation Cody Stanford pointed out how people of color were dealing with three pandemics at once — obesity racism and Covid-19.

Read: Social Determinants of Health, Health Disparities and Equity

How does obesity contribute to Covid? Understanding how obesity functions provides insight into why Covid proved so lethal.

“One factor could be that patients with obesity cannot expand their lungs as much,” explained Holly F. Lofton, M.D., director of NYU Langone Health’s medical weight management program and member of HealthyWomen’s Women’s Health Advisory Council. When combined with respiratory illness such as Covid, mucus can quickly build up, becoming hard to expel.

Lofton noted people with obesity typically have a larger waist circumference – defined as more than 35 inches in females or 40 inches for males – causing weight to press on the diaphragm, shrinking the chest cavity surrounding their lungs and leaving less breathing room when breath is needed most. He further observed how patients living with Covid are particularly at risk due to this reduced lung space available to them when breathing becomes necessary.

Fat is itself an inflammation causer. Fat cells release cytokines – hormones known to worsen immune function – when exposed to high amounts of body fat. People who are obese typically exhibit higher levels of Interleukin-6 or IL-6 which has been linked with poor outcomes in Covid patients.

Lipid inflammation from obesity is another risk factor for blood clot formation. Lofton said she warns people living with obesity who are otherwise healthy of this risk before considering weight loss surgery, particularly those at higher risk due to inflammation from Covid, that could increase their likelihood of blood clot formation due to infection or lack of movement, with potential outcomes such as heart attack, stroke, organ damage or even death depending on where those clots travel and collect.

Obesity, Social Determinants of Health and Covid Collide
Obesity is a complex health issue. A study by the Centers for Disease Control and Prevention (CDC) tracking obesity rates showed that Black/African American women had the highest rates of obesity compared to any other racial group (57%), Hispanic women 44% had obesity while non-Hispanic white women had 40%, Non-Hispanic white women 40% while Asian women had 17% rates of obesity; another study even revealed 48% among Native American groups (488% overall).

As with other diseases, obesity is strongly influenced by social determinants of health; many factors play a part in its development.

Racism and Discrimination: Racially-biased inequities across healthcare, housing, education, criminal justice, economics and politics have long been implicated as contributing to obesity.

“The Black Women’s Health Study was the first study to demonstrate how exposure to racism may lead to increased risks of obesity,” according to Cody Stanford. When you experience racism as a Black person in any form, stress causes storage of adipose [fat tissue].”

2020 saw no shortage of chronic stressors, from families losing loved ones to Covid to publicizing acts of racial violence such as George Floyd’s murder by Breonna Taylor and Ahaud Arbery’s killings.
Healthcare Access: Accessing healthcare can be difficult if people lack insurance, transportation or child care options or the ability to take time off work to see an HCP. Cultural differences, language barriers and provider bias could further impede quality care services received.

Read: Racial Bias in OB-GYN Care

Lofton noted that medical mistrust among people of color stemming from historical examples such as Tuskegee syphilis study and forced sterilization of Black, Latinx and Native American women along with personal experiences of poor care can make it less likely for marginalized groups to seek treatment.

Healthcare access can often be linked to education, income and wealth gaps; however, people of color from more privileged socioeconomic backgrounds also report receiving unequal treatment that they believe to be related to their race or ethnicity.

At the start of the pandemic in 2020, stories emerged detailing people of color being turned away from hospitals in urban areas and dying due to Covid at home. Lofton mentioned “pharmaco-inequity”, in which provider bias or lack of insurance leads marginalized groups to receive older or less effective medications when more effective alternatives exist – for instance when Covid drugs first hit the market they were more likely to go to white people than vice versa.

Food deserts, food insecurity and food swamps: Areas without grocery stores or eateries offering healthy and less costly food options are known as food deserts; this can often be found in urban and rural communities where people of color reside. Even when there are food options available to people at lower income levels, insecurity often results from not having enough funds available to purchase sufficient supplies of groceries at any one time.

These areas often boast numerous fast food establishments offering more processed and less nutritious options, often within one block – often called food swamps.

“Fast food can be convenient, cheap, and easy,” Cody Stanford noted. “And when we feel stressed out, our bodies seek comforting things; fast food can provide just that.”

Occupations: More people of color were employed as essential workers who dealt with the public or performed close quarter tasks without the option to work from home, leaving less economic flexibility when sick to stay at home, putting them at increased risk of getting Covid coverage.

Weight Bias: Multiple studies have uncovered HCPs’ negative attitudes toward those with overweight or obesity, potentially impacting the quality of care they receive.

Lofton noted that physicians sometimes must make difficult decisions regarding which patient will receive the ventilator as there may only be one available and two who need it, adding that weight bias could play a pivotal role in such instances.
Improve outcomes As an obese individual, you can take measures to protect yourself from Covid-19 by keeping up-to-date on vaccinations and taking preventative measures in public such as wearing a face mask and washing hands frequently or using hand sanitizer. Furthermore, to improve outcomes faster you should test for symptoms as soon as they arise and contact your healthcare provider (HCP) promptly in order to receive prompt and timely treatment from them.

Studies show that obesity treatment may help improve overall health and decrease the risk of Covid complications. One such study showed that patients who underwent weight loss surgery had a 60% lower risk of serious Covid complications.

Lofton noted the significance of preventive measures as well as continuing education for HCPs to assist in eliminating weight bias within healthcare.

“Physicians need to become aware that there may be unconscious weight bias among healthcare providers and that we should work hard to put that aside when treating obese patients,” according to Lofton.

Cody Stanford said her primary focus is improving overall health to reduce chronic inflammation that contributes to obesity and makes other diseases such as Covid more dangerous, while taking into account how race and class intersect in overall outcomes.

“My goal is to help people reach a happier, healthier state of being,” she stated. “That doesn’t mean giving people numbers on a scale; rather it means looking at cholesterol values, fasting blood sugar, insulin values, liver function and so forth as part of our assessment. I focus on health over weight issues as part of preventing all the diseases caused by obesity.”


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