It’s not a secret that carrying extra weight can lead to increased risks for heart attacks, strokes, diabetes and other diseases. However, people who are overweight or obese need to be aware of another risk — COVID-19. According to a study conducted by the Cleveland Clinic shows that people carrying increased weight are at a higher risk for developing a more severe form of the virus, which may require hospital admission, need for intensive care and the use of a ventilator. Obesity can cause multiple issues that weaken a person’s immune system, creating a chronic inflammatory state causing the body to make excessive amounts of cytokines, small proteins involved in the immune response. “Infection with the coronavirus also triggers the immune system to release cytokines, which may lead to excessive cytokine production that damages organs,” said Ali Aminian, director of the Bariatric and Metabolic Institute at Cleveland Clinic. “That may partly explain the severity of infection in patients with obesity.” The Obesity Society corroborates the Cleveland Clinic’s study, reporting, “people with severe obesity, management of COVID-19 may also be compromised by challenges in diagnosis and treatment caused by the physical effect of their obesity.” The organization, which is comprised of medical professionals around the world working together to overcome obesity, has assembled online resources to help providers, patients and support staff treat people with obesity during the COVID-19 pandemic. “In patients with increased abdominal obesity, pulmonary function is further compromised in supine patients by decreased diaphragmatic excursion, making ventilation more difficult,” the website states. “… These observations also emphasize the need for increased vigilance, priority on detection and testing, and aggressive therapy for patients with obesity and COVID-19 infections.” More than 70% of adults in the United States are overweight or have obesity, the Centers for Disease Control and Prevention reports on its website. Medical providers use the body mass index, or BMI, to determine if a person is overweight or obese. BMI ranges are calculated by using a person’s height and weight measurements to calculate a number. Adults with a BMI between 25 and 25.9 are considered overweight while adults with a number of 30 or higher are considered obese. Scientists and medical professionals have stated that the probability of the virus completely disappearing is highly unlikely and as more mutated strains start to appear, people with obesity or extra weight continue to be at risk. For many people who are overweight or obese, losing weight has been a never-ending battle. The inability to exercise due to pain or lack of mobility, combined with poor eating habits, have cause many people to give up on their health and weight loss goals, further putting them at risk during the pandemic. “It’s a tough battle and a majority of us are overweight or obese,” said Dr. Samuel Saltz is a bariatric surgeon with Banner Health Clinic in Fort Collins. “It is a big problem in our country. It’s part cultural but it’s also part genetic.” According to Saltz, a person who have struggled with obesity will fail 90% of the time in just using conservative methods like diet and exercise. “While they do need those measures to help them succeed, bariatric surgery is really the tool that is going to help them the best,” Saltz explained. “When we can get them to that, they can decrease their risk for COVID. Some of them will reverse their hypertension and get off their medication. There’s definitely some answers our there for people who need it.” However, the Cleveland Clinic’s study also showed COVID patients who had undergone bariatric surgery didn’t need an intensive care unit stay while 13% of the control group did, with 1.5% of that group needing ventilation or dialysis and 2.4% dying. “This is very intriguing and certainly highlights the importance of weight loss in protecting and reversing comorbid features,” Saltz said. “For decades now we’ve known the benefits of bariatric surgery as is applies to comorbid features like hypertension and diabetes. But with this last year, there’s been a number of articles that have come out to explore the effects of COVID on the population that become the sickest.” Bariatric surgery, also known as gastric bypass, involves one of a number of surgical changes to a person’s digestive system. Sleeve gastrectomy, one of the most popular types of bariatric surgery, involves removing 80% of the stomach and leaving a long, tube-like pouch. The smaller stomach is unable to hold large amounts of food. This procedure requires a shorter hospital stay than other gastric bypass surgeries. “Sleeve gastrectomy has become widely endorsed because it is a relatively safe procedure for bariatrics,” Saltz said. “The morbidity/mortality of this procedure similar to that of gallbladder surgery and knee replacements. It’s not as scary as it was 15 years ago.” Roux-en-Y gastric bypass is where part of the stomach is sealed off, resulting in a pouch the size of a walnut that is able to hold around an ounce of food. Food goes into the small pouch and then directly into the middle of the small intestine sewn to it. Biliopancreatic diversion with duodenal switch is a two-part surgery. The first part is similar to the sleeve gastrectomy. The second part involves connecting the end part of the intestine to duodenum near the stomach. This surgery not only limits what a person can eat, but how much nutrients their body can absorb. People interested in bariatric surgery will need to satisfy certain requirements including BMI measurement, limits on comorbidities like diabetes and/or hypertension, and certain insurance requirements. “I think as we emerge through this, our providers will start to recognize that when we address this (obesity) head on in a supportive fashion, that these folks can get help,” Saltz said. “And surgery is not the answer for everybody but it certainly is a huge help in the right direction.” While the surgery can help kick-start weight loss, it’s not a one-and-done type of process. Patients will need to continue to watch what they eat and exercise. “You have to have a supportive culture and environment that is going to help institute change and diet patterns,” Saltz said. “You are going to have a dietician, you are going to have a psychologist, exercise and physiologist; there’s going to be a number of different players all invested in your success. And that success begins on Day 1.” As the rate of juvenile obesity continues to rise, physicians are also seeing younger bariatric patients. “There are places that do pediatric bariatric surgery and that can be sometimes as young as 13 years old,” Saltz said. As with any surgery or procedure, there are risks of complications with bariatric surgery. Some of the risks include: Excessive bleeding Infection Blood clots Leaks in a patient’s gastrointestinal system Lung or breathing problems Adverse reactions to anesthesia Long-term risks can include: Bowel obstruction Gallstones Hernias Malnutrition Ulcers Acid reflux The need for a second or revision surgery or procedure The success rate varies across programs and how intense providers are with their follow through with patients, Saltz said. “I think it’s better than 50% that have good maintenance of their outcome over the course of years,” he said. “But again, a lot of that success is going to be based on their commitment to engage with their program and accountability and that kind of thing.” Source
