I’ve been observing for the last several weeks is the relationship between people getting very sick and dying from COVID-19 and obesity.


That’s what we’re going to talk about today.


There were two fairly large studies out of France and the United States, and from those studies came a huge insight.


Besides beings very elderly, obesity is known as being the number one risk factor for being very ill with COVID-19.


Fighting against obesity is something I’ve worked on my whole career. I established Performance Medicine to help treat this complex problem. So when these studies came out it was very interesting to me.


So let’s talk about it.


Who is Obese?

As you may know, the BMI (Body Mass Index) is just weight for height so it’s kind of a crude measurement.


Here are the BMI standards:
  • BMI of over 25 you’re considered over weight.
  • BMI of over 30 you’re considered obese.
  • BMI of over 35 you’re considered morbidly obese.
  • BMI of over 40 you’re considered severely obese.


40% of Americans are obese with a BMI of over 30.


There are lots of other things I look at in addition to the BMI.


The waist to hip ratio is one that I look at the most.


For men, if your waist to hip ratio is over 1:1 you are obese. For women, if your waist to hip ratio is over 0.8 you’re obese.


Obesity and COVID-19

These two studies were a real shocker. At NYU, which is the epicenter for COVID-19 in the United States, they found that except for the elderly, obesity had the strongest association with hospitalization from COVID-19 by 6 times.




This correlates very well with the French study done last week. They couldn’t figure out why younger people were getting this.


The obese young become sick very very quickly.


No other risk factor in the young could explain this.


Patients with a BMI of over 35 were 7 times more likely to be put on a ventilator. This is based just on their weight.


This is a shocking statistic.


At NYU, people under 60 with a BMI over 35 were 3 times more likely to be admitted into the ICU.


The chronic condition with the strongest association with COVID-19 illness is obesity with substantially higher odds than either cardiovascular disease or pulmonary disease.


Why is this? Well, it’s because of inflammation. We know that inflammation is at the heart of every illness.


COVID-19 is not acting like typical pneumonia’s. It’s not the virus, it’s the inflammatory reaction. It’s that cytokine storm.


And it’s mediated by fibrin deposits in the circulation which block oxygen passage to the blood. It’s not as much a lung problem as it is a blood oxygenation problem. This is why ventilators don’t work that well for this.


As a matter of fact, 8 out of 10 people die on the ventilator.


It’s a problem with your hemoglobin. Fibrinogen is the first thing they should check if you go into the ER.


The answer to all of this is to get rid of inflammation. This is why experimental drugs are working. They are fighting the inflammation, not the virus itself.


Obesity is characterized by a low grade chronic inflammation of your whole system.


Obese patients also have impaired immune systems, which is why they come down with diabetes, hypertension and arthritis more frequently.


Also, their diaphragm doesn’t move as well to ventilate.


They are chronically inflamed, and their immune systems don’t work as well.


COVID-19 is an immune system disease without a doubt.


The thing about obesity is that it’s a metabolic disease that needs to be treated like one. It’s not a laziness issue at all.


There are poor food choices of course. But there’s also genetic factors, hormonal factors, and sleep factors.


Sleep apnea for example is a major risk factor for obesity.


Trying to figure out why people are obese is one of the hardest things I’ve dealt with as a physician.


The thing is, it’s treatable!


You can figure this out. We’ve had great success with getting hundreds of pounds off of patients. Our top weight loss patient lost 220 pounds.


If you lose the weight you can get off medications for diabetes, high blood pressure, high cholesterol, arthritis and depression. You’ll be at less risk of dying from any disease like this current pandemic, or even the flu.


Obesity is also a major risk factor for cancer.


The way we look at obesity is we do a complete metabolic workup for patients, and then detail a comprehensive plan.


One thing that’s interesting to me is that only 5% of obese people are on medication for it. A lot of people need a chronic medication to treat obesity. And then of course it needs to be monitored.


Right now is a good time to start thinking about obesity, and getting the weight off.


Are you obese? What can you do about it?


It can truly save your life. Now is a great time to start focusing on this.


Please, take care of yourself so you can take care of somebody else.