Why this common health problem can make COVID so much more difficult for you

COVID-19 cases are surging nationwide and public health experts are worried that the upcoming holidays, starting with Thanksgiving, will cause cases to spike even more in Miami-Dade County, which reported more than 2,100 new cases on Wednesday.

But Arlette Perry, a professor of clinical exercise physiology in the Kinesiology and Sport Sciences Department at the University of Miami, is worried that as talks have focused on vaccines and the politicization of wearing a mask, one major health factor has been overlooked: Obesity.

Obesity — defined as a body mass index figure of 30 or greater in most people — can contribute to significantly worse outcomes from COVID-19.

“The bottom line: Americans are actually fighting two pandemics: the COVID-19 pandemic and the obesity pandemic that makes it more difficult to fight off and survive COVID,” Perry said.

For decades, Perry has worked with local YMCAs and Miami-Dade Public Schools to run after-school programs on UM’s Coral Gables campus. Her work is dedicated to help youngsters stay in shape — or get in shape — before obesity becomes a lifelong health issue.

Perry’s THINK program, for instance, partnered with the YMCA’s after-school program to teach children at predominantly Black and Hispanic schools in South Florida how to make better health choices.

Higher risk of dying from COVID if you’re obese

“Statistics show that if your BMI is above 35, you have a 40% greater risk of dying from COVID. Even if you are mildly obese, the chances are five times greater that COVID will land you in the intensive care unit. Even younger people less than 50 years with obesity have a 36% increased risk of death from COVID, compared to their average weight counterparts,” Perry said.

The issue: Fat tissue.

“Obesity does not just signify a place to store excess fat tissue. The fat tissue acts as a giant endocrine gland releasing proteins that cause widespread systemic inflammation, impaired lung function and ... immune responses,” Perry said. “In addition to worse outcomes associated with obesity, scientists are concerned that obesity may reduce the effectiveness of vaccines on the horizon to fight the epidemic.”

UM researchers found that once the novel coronavirus gets into the body, fat tissue acts as a reservoir for the virus. The more visceral fat a patient has — excess weight around the belly and fat deposits on the heart, kidneys and liver — the more the virus is amplified, said Dr. Gianluca Iacobellis, a researcher at the Diabetes Research Institute at the University of Miami Health System.

“Preliminary data have indicated that the new COVID-19 cases are increasing among younger adults with obesity,” Iacobellis said in a paper he co-authored for Obesity, the journal of The Obesity Society.

“Based on my studies, when it comes to COVID-19, it’s worse to be obese than diabetic,” said Iacobellis.

Losing weight can boost many health conditions

Shedding weight can improve a series of health issues beyond COVID complications, including type 2 diabetes, hypertension, high cholesterol, heart disease and sleep apnea.

“If you improve your cardiorespiratory fitness, you can improve your immune response, reduce your inflammatory response and better handle the virus,” Perry said. “Just by increasing your muscle-to-fat ratio, you can improve immune response. Unfortunately, no one talks very much about these types of issues.

“Not a lot of information is disseminated about the increase in high fat, processed, calorie dense, comfort foods that are so much greater now with COVID. Hispanic and Black Americans are at the highest risk and there are reasons for this,” Perry said.

“We see a lower level of physical activity participation and higher rates of obesity and obesity-related problems in the minority students,” Perry added. “It is important to us to go into minority schools to make sure that they know the importance of living a healthy, active lifestyle.”

From Bill Maher in L.A. to Miami

Perry is not alone in sounding the obesity-COVID alarm.

Since March, “Real Time” host Bill Maher has devoted numerous panel discussions and closing monologues on his HBO talk show to Americans’ obesity problem and its role in complicating the COVID battle.

“Bill Maher has nailed the issue, hasn’t he?” Perry said. “He also lives in L.A., where there seems to be a certain community awareness about weight, fitness and personal health, which makes it easier for consumers. I hope we can improve that mindset in Miami. ... It appears COVID has generated more interest in health and fitness from many of our students and faculty at UM.”

Obesity rates among ethnic groups

The Centers for Disease Control and Prevention has tried to get the word out, too.

“Everyone has a role to play in turning the tide against obesity and its disproportionate impact on racial and ethnic minority groups,” the CDC warns on its website.

The 2019 CDC Adult Obesity Prevalence Maps report shows that 12 states have an adult obesity prevalence at or above 35%: Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee and West Virginia. This is up from nine states in 2018.

Florida, overall, is at 25%-30%, or in the overweight range. Florida, which reported 961,676 total COVID cases on Wednesday, is third behind California and Texas in the total number of confirmed COVID cases, according to the New York Times’ database.

The 2019 maps show that obesity notably impacts some groups more than others.

Six states had an obesity prevalence of 35% percent or higher among non-Hispanic white adults. Florida was in the overweight range of 25%-30%.

Among Hispanic adults, 15 states had an obesity prevalence of 35% or higher. Florida was in the obese range among this group at 30%-35%.

And among non-Hispanic Black adults, the majority of the country — 34 states and the District of Columbia — had an obesity prevalence of 35% percent or higher — including Florida.

What can you do

Getting physically active is a start.

▪ Take a walk outdoors, ride a bike.

The combination of aerobic and strength training exercise works best to increase the burning of calories, Perry said. She suggests building up to five days of exercise a week for 30 minutes apiece, with warm-ups and cool-downs included.

Perry also recommends exercising outdoors as much as possible to increase vitamin D levels. “The sunlight increases your body’s synthesis of vitamin D and high levels of D promote fat cell breakdown while low vitamin D levels promote fat cell synthesis.”

▪ Move around the house more.

Watching more TV? If you can stream exercise videos, great. If not, why not jog in place while watching TV or doing push-ups or some other cardiovascular activity during the commercials?

▪ “Good nutrition can help support optimal immune function,” the CDC says. Try to add more fruits and vegetables, lean protein and whole grains to your daily diet and avoid processed foods, which have high caloric counts and high sodium and sugar levels.

▪ Get enough sleep. According to the CDC, a third of U.S. adults report that they usually get less than the recommended amount of sleep — about nine to 12 hours for school age children, 6-12 years of age; eight to 10 hours for teens; and seven to eight hours for adults.

Lack of sleep is linked with many chronic diseases and conditions, including type 2 diabetes, heart disease, obesity and depression.

▪ Manage stress. We know that the pandemic is stressful, but manage stress with an exercise program or other calming techniques rather than turning to alcohol or smoking, the CDC says.

▪ Be patient for long-term results. A sustainable weight loss plan is two pounds a week, according to Perry.

“The slower, the better,” she said. “People tend to lose more muscle tissue and water the first two weeks of dieting. Only after two weeks of dieting, do we start to see significant losses in fat tissue. The more slowly people lose weight, the more slowly they gain it back.”

Mimi Whitefield, a former Miami Herald reporter, contributed to this story. She can be reached at mimiwhitefield@gmail.com or on Twitter @heraldmimi.