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Big May be Beautiful but Covid and Obesity are Deadly

This week, on the internet I saw the cover of Cosmopolitan magazine with an obese woman on it. The caption on the cover read “This is Healthy”. It immediately caught my attention because I can assure you as a doctor that being obese and carrying a lot of belly fat is NOT healthy. I also believe that fat-shaming or making people who are obese feel “less than” isn't healthy either.


Here is the real dilemma as far as I see it. The world and the U.S. in particular have gotten bigger, not just a little bigger, a lot bigger. Obesity hasn't doubled. It's nearly tripled in the United States over the last fifty years. In the early 1960s, fewer than 14 percent of the individuals possessed a body mass index (BMI) of over 30. Today, the figure collected by the CDCs National Health and Nutrition Examination Survey (NHNES) is closer to 40 percent. Wow, let's face facts, we’ve gotten FAT! 4 out of every 10 of us are now obese? That’s unacceptable and it’s killing our great country in SO MANY ways.


Let’s just talk about Obesity and Covid-19. “Since the pandemic began,” Science Magazine reported in September, “dozens of studies have reported that many of the sickest COVID-19 patients have been people with obesity.” According to one study out in August cited by the flagship journal, overweight patients who contracted COVID-19 were 113 percent more likely to land in the hospital than patients of a healthy weight. Obese patients were 74 percent more likely to end up in intensive care and were 48 percent more likely to die.


Why is this? Well, according to one of my teachers and mentors, Dr. Robert Silverman, in a recent article entitled: Covid Immunity, focus on what you can control, the human host, “Americans are more vulnerable to COVID-19 infection because a primary pathway for the virus to enter the body is through the angiotensin-converting enzyme 2 (ACE2) receptors on the surface of cells in the lungs, heart, blood vessels, kidneys, liver, gastrointestinal tract, brain, epithelial cells, and fat cells. Because fat cells have even more ACE2 receptors than lung cells, those with high adipose tissue levels are more likely to be infected. He goes on to say, “Obese people may already have compromised respiratory function before infection. At the same time, abdominal obesity can compress the diaphragm, lungs, and chest capacity, reducing the lungs’ ability to mobilize. Most significantly, obesity causes chronic low-grade inflammation and an increase in circulating proinflammatory cytokines. Preexisting inflammation plays a significant role in the worst COVID-19 outcomes.”


So, while Cosmopolitan may recognize that 40% percent of women are obese and represent a large “target market” for sales of their magazine, let’s not confuse facts with a sales pitch. I agree that you can be beautiful at any size and beauty is in the eye of the beholder. Everyone needs to feel loved! However, if you are FAT or obese (BMI over 30 and/or waist circumference over 35" for female 40" for a male) you will die younger and suffer older. Period, end of the story.


And by the way, it’s not your genetics.

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