Source – https://www.healio.com/
Obesity and race are additive, multiplicative mediators or confounders influencing COVID-19 outcomes among American adults, and the disparities have substantial implications for medical and public health responses, according to a speaker.
“Due to the complexity of the relationship between COVID-19, obesity and race/ethnicity, studies show conflicting results with regard to the reasons behind the greater morbidity and mortality noted in communities of color in the U.S.,” Fatima Cody Stanford, MD, MPH, MPA, FAAP, FACP, FAHA, FTOS, an obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School, told Healio. “Almost 8 months into this pandemic, we have learned that there is no clear answer as to why these disparities exist. However, it does appear that better health at baseline lends itself to the best outcomes with COVID-19. We need more studies to ascertain this relationship.”
Disproportionate outcomes
There is still much to be learned about the pathophysiology of COVID-19, but it has become clear that Black Americans are disproportionately affected by the novel coronavirus and are far more likely to experience its more severe outcomes, including ICU admission, mechanical ventilation and death, Stanford said during an online presentation at ObesityWeek Interactive.
“When we look at the pandemic’s racial disparity … COVID-19 deaths per 100,000 people, we can see that Black Americans share a large burden,” Stanford said during the presentation. “I can tell you, talking to my parents who lost ten of their friends to this pandemic, my best friend who lost her father, and my mentee who is an internal medicine physician and has lost both parents, that this is indeed real.”
In a study published in June in The New England Journal of Medicine, researchers showed that among 3,481 patients with COVID-19, Black adults were nearly twice as likely to be hospitalized as their white counterparts, with an OR of 1.96 after adjustments for multiple variables (95% CI, 1.62-2.37). Obesity, as well as residence in a low-income area, were also associated with increased odds for hospital admission in the study, Stanford said.
In another analysis published in Clinical Infectious Diseases in August, researchers demonstrated that Hispanic men and women with COVID-19 were significantly more likely to be admitted to the ICU and require mechanical ventilation compared with Black and white adults, Stanford said.
A ‘complex relationship’
The inflammatory state that typically accompanies obesity is associated with several disease processes, including impaired adipogenesis, oxidative stress and insulin resistance, Stanford said. Those processes can lead to metabolic syndrome, type 2 diabetes and cardiovascular disease. Stress — including post-traumatic stress disorder and depression — acts through the brain to further affect eating and exercise behaviors, Stanford said.
“It is important for us to recognize that these are intertwined,” Stanford said.
Adding to the burden, a person’s economic status, underlying health conditions and actual pathophysiological differences in inflammation may lead to the health disparities observed among underrepresented adults, Stanford said.
The additive effects create perfect storm for worse COVID-19 outcomes, she said.
“We need to be cognizant of the fact the people who are disproportionately impacted are those that have less power to deal with these issues,” Stanford said. “Better chronic disease management, particularly surrounding obesity, which has borne itself out to be one of the major risk factors for COVID-19, is necessary for the treatment of obesity across the age spectrum, particularly in those communities that look like mine.”
Stanford said the COVID-19 story “has not yet been completely written.”
“There is still a lot for us to learn as we conduct research that will hopefully go beyond this jump to publish,” Stanford said. “We can make an impact. We know that issues related to structural racism and related to the history of this country have made it that certain groups are disproportionately impacted by chronic and acute diseases like COVID-19.”