Getting to the Gut of the Matter

Your Weight Matters More Than Ever.

Your weight matters more than ever. Almost half of the American population is obese and most of us don’t even know it. The CDC defines obesity as greater than a 30% body mass index. Your extra weight is not about how you look, it’s about how long you live! Now, obesity has emerged as a leading risk factor for severe cases of COVID-19.

You want to know why? Listen to our podcast as we help you heal one day at a time.

Healing America fights the epidemic of chronic disease in the United States and across the planet with actionable advice from the GutGuru, double board-certified gastroenterologist and internist, Dr. Robin Rose. Each episode entertains and educates on a myriad of healthcare issues and conditions that plague our nation. We discuss how to deliver precision, individualized medicine by incorporating cutting edge testing and genomic analysis, combined with a multi-interventional approach that can treat and prevent disease by optimizing nutrition, exercise, sleep, mindfulness, and mindset.

Every person is different, and now we have the scientific testing to laser focus on your individual biological systems.

First Study:

A recent study published in JAMA of 5700 patients hospitalized with confirmed COVID-19 in New York revealed a 21% mortality rate among the 2634 patients whose outcomes were known at study end.

The large patient sample reflects the diversity of the city and its environs. It is a large representative sample of very diverse patients ranging in age from under a year to 107 y/o, from all walks of life and socioeconomic levels. The study was conducted through Northwell Health

System using data from 12 of their participating NYC-area hospitals with locations including Long Island, Manhattan and Staten Island, and Queens.

The study represents the largest cohort of hospitalized patients with COVID-19 in the United States thus far, and has confirmed that the highest-risk groups other than being older and male, are those with preexisting conditions such as hypertension, diabetes, or obesity.

The most common comorbidities among all 5700 patients were hypertension (57%), obesity (41%), and diabetes (34%). As has been seen in other patient series, male sex and increasing age were associated with a higher risk for death.

Of patients receiving mechanical ventilation and whose outcomes (discharge or death) were known, 88.1% died. When stratified by age, the mortality rates for ventilated patients were 76.4% for those aged 18 to 65 years and 97.2% for those older than 65 years.

Among those who did not require mechanical ventilation and whose outcomes (discharge or death) were known, 19.8% of patients aged 18 to 65 years died, as did 26.6% of those older than 65 years. No patient under 18 years died during the study period.

Second major highlight of the study:

For both patients discharged alive and those who died, the percentage of patients who were treated in the ICU or received invasive mechanical ventilation was increased for the 18-to-65 age group compared with the older-than-65 years age group. And when the study ended there were still 490 patients in the ICU aged 18-65, 449 of whom were on mechanical ventilation, and 413 patients aged 65 or greater (less than the 18-65) receiving ICU care, 378 who were on mechanical ventilation.

Second Study: Obesity link to severe COVID-19, especially in patients aged under 60

Two new studies from NYU Langone Health are part of a growing body of evidence that suggests obesity may be one of the most important predictors of severe 2019 COVID-19.

The first study is one of the largest studies in the United States to identify obesity as a prominent risk factor for severe illness from COVID-19, analyzing data from more than 4,000 people with COVID-19 who sought care at NYU Langone between March 1 and April 2.

The second study found that of the 3,615 individuals who tested positive for COVID-19 in their series, 775 (21%) had a BMI of 30-34, and 595 (16%) had a BMI of at least 35. Obesity was NOT a predictor of admission to hospital or the ICU in those over the age of 60 years, but in those younger than 60 years, it was.

Obesity in under patients under 60 y/o at least doubles risk of hospital admission in U.S.:

Those under age 60 with a BMI of 30-34 were twice as likely to be admitted to hospital (hazard ratio, 2.0; P < .0001) and critical care (HR, 1.8; P = .006), compared with those under age 60 with a BMI less than 30. Likewise, those under age 60 with a BMI of at least 35 were 2.2 (P < .0001) and 3.6 (P < .0001) times more likely to be admitted to acute and critical care, respectively.

Just under half of patients (48.7%) were hospitalized, of whom 22.3% required mechanical ventilation and 14.6% died, or were discharged to hospice.

This again- Highlighting that obesity in people under 60 years old is a newly identified epidemiologic risk factor which may contribute to increased morbidity rates a/w COVID-19 experienced in the U.S.

Important note: Obesity is characterized by an impairment of the immune response and by a low-grade chronic inflammation. Also, obese people have a form of lung constriction just from the basis of having extra weight.This leads to alterations in pulmonary ventilation, with restricted movement of the diaphragm affecting how well you breathe.

CDC Obesity Guidelines

The CDC defines an adult (a person aged 20 years or greater) with a body mass index (BMI) of 30 or greater as obese, and an adult with a BMI of 25.0 to 29.9 as overweight. Obesity in adults is divided into three categories. Adults with a BMI of 30 to 34.9 have class 1 obesity; adults with a BMI of 35 to 39.9 have class 2 obesity; adults with a BMI of 40 or greater have class 3 obesity, which is also known as extreme or severe obesity.

A report from the National Center for Health Statistics stated that in US individuals aged 20 years or older, the prevalence of obesity has been rising steadily over the past two decades.

According to research done by the Harvard T.H. Chan School of Public Health, it is estimated that around 40% of Americans are considered obese, and 18% are considered severely obese as of 2019. Severe obesity is defined as a BMI over 35 in the study. Their projections say that about 50% of the US population will be considered obese and 25% will be considered severely obese by the year 2030.- ¾ of the U.S. population!

According to the CDC, “obesity is higher among middle age adults, 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%) or adults over 60 or above (35.4%) adults.

Prevalence of females with obesity has skyrocketed: prevalence rates up to 40% or more. Average across the U.S. is hovering close to 30% with Massachusetts having lowest prevalence at 18.5%, and Arkansas at 40.2%.

African American and Mexican American adolescents between 12 and 19 years old are more likely to be overweight than non-Hispanic White adolescents. The prevalence is 21%, 23% and 14% respectively

So let’s get to the gut of the matter:

The association between the gut microbiota and obesity has also been observed in humans. In overweight/obese humans, low fecal bacterial diversity is associated with more marked overall adiposity and dyslipidemia, impaired glucose homeostasis and higher low-grade inflammation.