COVID-19 Comorbidity

Researchers in Lille, France studied patients admitted to intensive care for COVID-19 and concluded that Obesity is a risk factor for severity. It has been recommended that quarantine of obese subjects be extended longer than nonobese patients.[1]

Black Americans are being disproportionately affected by COVID-19.[2]  The increased incidence of obesity among the Black population who are concentrated in our inner cities is most likely responsible.

Diabetes mellitus modulates host immune response and host-virus interaction to increase morbidity. [3] As it is the visceral or “belly fat” within the abdomen which secretes resistin, a cellular hormone which antagonizes the body’s own insulin to cause type 2 diabetes, reducing the size of that noxious cytokine factory which functions as a life-shortening gland with Endoscopic Visceral Lipectomy is potentially a direct approach to the problem if carried out sufficiently ahead of time.

A societal effort must be made to reduce the vulnerability of these obese and diabetic sectors of the population to COVID-19 and future pandemics. Obesity, metabolic syndrome and type 2 diabetes need not just to be maintained under control, but efforts should be made to prevent, eliminate and cure them. 

Governments need to make existing modalities and treatments available to everyone, especially those in inner cities, or these hosts will remain as soft targets and as breeding pools for the next pandemic. They will comprise the majority of admissions and fatalities. Fortify the herd or nature will cull it at our expense.

[1]  High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, Labreuche J, Mathieu D, Pattou F, Jourdain M; Lille Intensive Care COVID-19 and Obesity study group. Obesity (Silver Spring). 2020 Apr 9. doi: 10.1002/oby.22831. [Epub ahead of print]

[2] https://theblackwallsttimes.com/2020/04/05/covid-19-more-deadly-to-black-americans/

[3] COVID-19 Pandemic, Corona Viruses, and Diabetes Mellitus. Muniyappa R, Gubbi S. Am J Physiol Endocrinol Metab. 2020 Mar 31. doi: 10.1152/ajpendo.00124.2020. [Epub ahead of print] PMID: 32228322

Cleveland Clinic Study Finds Weight Loss Surgery Decreases Risk of Heart Attack and Stroke

Dr. Steven Nissen and colleagues compared the impact of various types of bariatric surgery on almost 2,300 people to the usual medical care on more than 11,000 obese patients with similar symptoms treated between 1998 and 2017 at the Cleveland Clinic.

Those having bariatric surgery lost more weight and had fewer heart attacks, fewer strokes, a lower incidence of kidney and heart failure, a lower incidence of atrial fibrillation, lower blood sugar levels, and experienced a 41% lower over all morbidity during the study.  Additionally, those who had surgery used fewer medications for diabetes and other conditions.

The researchers concluded that many of the deleterious effects of obesity are potentially reversible.

Obesity Surgery Benefits May Be Greater For Teens Than Adults

obese kids
 

Most obese teens remain obese as adults, and adults who were obese as teens are unhealthier than those who become obese later in life. 

A new study presented at the Combating Childhood Obesity Conference in Houston (Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. Inge TH, Courcoulas AP, Jenkins TM, et al. N Engl J Med 2016; 374:113-123) suggests that teens may benefit more from early surgery than adults.  

The researchers compared results from two studies of gastric bypass surgery in 161 teens and 396 adults who had been obese since they were teens. Three years after their operations, both groups had lost between 26% to 29% of their weigh and Diabetes went into remission in 86% of teens and 53% of adults diagnosed with the disease before surgery. High blood pressure was also normalized in 68% of teens and 41% of adults.

Although a 2% mortality accompanied surgery in both groups, two of the teens died from drug overdoses, suggesting substance abuse and self harm may accompany teen obesity.

The researchers documented the durability of clinically meaningful weight loss and metabolic improvements and weight-related quality of life among adolescents who underwent gastric bypass surgery or sleeve gastrectomy. The benefits of these current bariatric surgical alternatives must be viewed in the context of the risks of nutritional deficiencies and the possibility that future surgical procedures will be needed in some patients.

It is this author’s hope that Endoscopic Visceral Lipectomy, which does not expose the patient to the nutritional and surgical risks inherent in bypass surgery or sleeve gastrectomy, may prove equally effective and a safer minimally invasive intervention for this younger population (Uncoiling the Tightening Obesity Spiral. Cucin RL Clin Res Diab Endocrinol:1(2):1-5 (2018)).