Like many Americans I have been staying home doing my civic duty to contain COVID-19. As I was watching the news one night, it struck me to see that many of the patients hospitalized with COVID-19 were overweight.

Curious about this, I searched the literature and found a Centers for Disease Control report published April 8 which showed clinical characteristics of patients hospitalized with COVID-19. The most commonly reported medical conditions of patients hospitalized with COVID-19 were hypertension (49.7 percent), obesity (48.3 percent), lung disease (34.6 percent), diabetes mellitus (28.3 percent), and heart disease (27.8 percent). Among patients aged 18-64 years, obesity was the most prevalent underlying condition. People who contract COVID-19 and have these underlying conditions are more likely to be hospitalized because these conditions compromise the immune system. 

Recently, another troubling finding was reported. African Americans were disproportionately being diagnosed with COVID-19. Perhaps a 2020 study from the CDC might explain this finding. The prevalence of obesity among African Americans, Hispanics, and non-Hispanic whites was 50, 45 and 42 percent, respectively. 

The problem I have looking at clinical characteristics by race is that it misses the larger contextual factors. According to the National Center for Health Statistics, youth growing up in poverty have nearly double the obesity rates of their more affluent counterparts (19 percent versus 11 percent). African Americans and Hispanics have higher rates of obesity not because they are black or brown, but because they are overrepresented in the poverty bracket. Scientists who survey pandemics should collect and report social, economic, and environmental factors when characterizing patients with a new disease. 

When you look at all the underlying medical conditions of patients hospitalized with COVID-19, you will find that all roads lead back to obesity. Obesity is the major cause of hypertension, diabetes, and lung and heart disease, which are the most commonly reported underlying conditions in hospitalized COVID-19 patients. Obesity impairs respiratory mechanisms, metabolic function (diabetes, lipids), and increases comorbidities (high blood pressure, heart disease, and kidney disease).

So while we implement nonpharmaceutical interventions – like travel restrictions, banning public gatherings, social distancing, hand washing, and wearing face masks – to interrupt the chain of transmission; and while we wait for pharmaceuticals and biomedical technology to produce a vaccine or other treatment, there’s another initiative we can take to prepare for the next pandemic. Because there will be another one.

The initiative should work at the root of the problem. If it is obesity that is the condition most associated with COVID-19’s severe symptoms and complications, then obesity should also be addressed.

Approaches to childhood and adult obesity are different. To control obesity, one must understand that once a child develops obesity, this child is more likely to become obese as an adult and develop the chronic diseases described above. The solution is early-age interventions. School health programs, like the Bienestar Coordinated School Health Program, have been shown to decrease obesity, blood glucose, and improve the health behaviors of children.

For adults the best course to control obesity is in the doctor’s office. Medicare recently started reimbursing primary care physicians for providing patients with intensive behavioral therapy for obesity, which involves working with a therapist to track your eating and increase your activity level. Education-based behavioral therapy can help adults make lifestyle changes to improve health. 

COVID-19 is not going away soon, and there will be other viral pandemics to come. Whereas you may not be able to change the environment around you, you can sure change your habits. A line of defense you can start taking now against future pandemics is healthy eating, physical activity, and controlling your weight.

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Roberto P. Treviño

Dr. Roberto P. Treviño founded the South Alamo Medical Group in 1986 for the practice of primary care medicine in poor and underserved areas. He is the executive director of the Social Health & Research...