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Obesity: The risk lurking in the shadows during the COVID-19 pandemic

Adolfo G. Cuevas and Michael V. Stanton

As the United States grapples with the ever-growing number of COVID-19 cases, it is becoming more obvious that inequality — including poor access to health care for low-income individuals and high rates of poverty and economic hardship — is currently contributing to the emergency.

However, this pattern is especially clear when seen through the lens of the ongoing public health crisis around obesity, which is accentuating the COVID-19 pandemic.

Excess weight and obesity are immense public health issues in this country. About 70 percent of adults in America are overweight or have obesity. Moreover, the trend in obesity is not evenly distributed across the U.S. Poverty, race, and obesity are closely related. Obesity disproportionately affects racial/ethnic minorities and low-income groups — and these disparities are more pronounced in many states in the South.

Obesity is known to contribute to major causes of death in the U.S., including cardiovascular disease, stroke, Type 2 diabetes and some types of cancer. It is also known as a risk factor for communicable diseases.

Obesity causes a chronic state of inflammation that, in turn, can weaken the immune system’s ability to fight off viral, bacterial and pathogenic agents. Due to restricted lung capacity, people with excess weight have an increased risk of viral transmission and poorer recovery from ailments.

Among adults with viral infections — including coronavirus, metapneumovirus, parainfluenza, and rhinovirus — those with severe obesity are more likely to be hospitalized compared to adults with normal weight.

Reports from the National Health Service in the United Kingdom suggest that almost two-thirds of coronavirus patients who fall seriously ill have obesity, and more than half of the patients in intensive care in U.K. hospitals due to the virus have overweight — a technical term for specific excess weight for body mass — and obesity.

In the U.S., researchers are finding that COVID-19 patients with obesity and obesity-related conditions such as diabetes, cardiovascular disease and chronic lung disease were at higher risk of experiencing severe infection than those without them. Patients with those underlying conditions were more likely to be admitted to the hospital and to an ICU compared to patients without any reported underlying conditions.

There is also a growing number of reports suggesting that severe obesity is a potential risk factor for COVID-19 patients who experience severe disease progression. Low-income people and people of color, most affected by obesity and its harmful effect on health, are also at greater risk of infection from the virus causing COVID-19. There are currently no specific medicines or vaccines to fight against the novel coronavirus.

Physical distancing is currently the most effective measure for slowing the spread, especially to protect groups most susceptible to serious complications of COVID-19. But, low-wage workers — many of whom are racial/ethnic minorities — do not have the option to work from home.

Many of them work at grocery stores and pharmacies and depend on public transit systems, areas where transmission can be high. They also live in areas with poor access to health care, which translates to poorer access to coronavirus testing and greater likelihood of receiving care only when the symptoms are severe.

These social and health issues have contributed to the growing COVID-19 severity that has ravaged low-income communities and communities of color thus far.

Here in Boston, while black residents make up just 25% of the population, they may account for 41% of all COVID-19 cases in the city, according to National Public Radio. Even when they do receive care, racial/ethnic minorities and low-income groups are more likely to experience discrimination. A preliminary study from a biotech data firm reviewed recent billing information in several states and found that black patients with cough and fever were less likely, compared to white patients, to receive coronavirus tests.

Decontextualizing the pandemic has the potential of exposing marginalized groups to further discrimination and stigmatization. Historical and contemporary events that have shaped the social conditions of marginalized groups are the root cause of the disparities exacerbated by COVID-19. For instance, redlining policies in the 1930s have had enduring effects, placing many black families today in racially segregated neighborhoods, like those in Boston, that lack fundamental goods and resources. Without considering the structural influences that have placed people in vulnerable positions, we are prone to blame the victims and lose sight of ways to implement effective change.

Public health officials and policymakers need to implement strategies that can specifically reduce the risk of disease transmission in low-wage workers and racial/ethnic minority communities, for this pandemic and for public health emergencies in the future. They can start to do this by implementing programs focused on vulnerable, low-income people at high risk for obesity and on people with obesity at even higher risk for disease and early mortality. How we respond to this public health crisis will determine our future.

Adolfo G. Cuevas, Ph.D. is Assistant Professor of Community Health and Director of the Psychosocial Determinants of Health Group at Tufts University.

Michael V. Stanton, Ph.D., is Assistant Professor of Psychology at California State University, East Bay.

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