COVID Email: May 19

In today’s email, I’m going to take a look at one of the main risk factors during this pandemic. A patient’s metabolic health when infected is a primary determinant of how they will fare. It’s a dense topic with far-reaching implications, so the goal here is to simply start to look at this issue.

Also, as a Podium patient, you now have a resource for antibody testing wherever you live!

In today’s email:

• Risk of Obesity

• LabCorp Antibody Testing

Obesity and COVID

One thing we continue to see with this pandemic is that a patient’s experience with SARS-CoV-2 is often related to their health status when infected. I don’t know of any good research to suggest that you are less likely to contract COVID when otherwise healthy, but it is evident that patients with certain underlying medical conditions are likely to suffer much more severe illness if they do catch the virus.

In the US, a shocking number of adults have a chronic metabolic diseas (or multiple such illnesses). These are “diseases of lifestyle”, often preventable or extremely modifiable by the choices and actions of the patient. Included in this list are:

• Diabetes (Type 2)

• Hypertension

• COPD or Emphysema

• Coronary Artery Disease (Heart Disease)

• Obesity

All of these are, for the most part, related to lifestyle. Also important is the fact most occur on a gradient or spectrum. In other words, it’s not like you put on a couple of pounds one weekend and you’re suddenly “obese”. Weight gain occurs over many years, progressing through a spectrum of overweight designations. All along this spectrum, detrimental health consequences exist, and they become more prevalent and severe with increasing weight gain. (Of course, we’re talking about body weight gained as excess fat, not muscle.) For a person who is 5’ 10”, a diagnosis of “obesity” is attained when they weigh 209 pounds or more. That does not mean that at 208 they are perfectly healthy. By the same token, the risks of obesity when facing COVID are not so markedly defined. Someone who is 5’ 10” and 195 pounds may classify as “overweight” rather than “obese”, but they still have higher risk than someone who is 175 pounds. (Again, these are general numbers, not taking body composition into account.)

In the US, 88% of adults have either an underlying chronic illness or are overweight or obese. Stated another way, only 12% of our adult population would be considered metabolically healthy. To make matters potentially worse, much of that 12% is likely concentrated among younger adults. Once we start looking at cohorts of American adults in their 40s and 50s, the percentage of healthy individuals declines sharply.

While we do not yet have the direct data, it stands to reason that our country is paying the price for these excesses during this pandemic. The vast majority of patients who experience severe illness or death with COVID-19 have an underlying metabolic illness, including obesity. On the other hand, most of those otherwise healthy patients with COVID-19 (non-diabetic, non-smokers, healthy weight…) have relatively mild courses when infected. There is a direct correlation between metabolic health and likelihood of death from this virus.

I find it interesting to dig into the reasons why this is the case, but I recognize that not everyone wants to read the specifics around how belly fat increases inflammation and may predispose a patient to cytokine storm. So instead, let’s just think about the ramifications of these statistics. If we as Americans took better care of our bodies, it is reasonable to expect that our death rate with COVID-19 would be remarkably lower. If we valued metabolic health, real food, and active lifestyles, it is conceivable that our economy would not be taking the hit that it is now. We talk about reopening the country while protecting the vulnerable. This seems to be a great strategy toward getting our economy back on line quickly. In fact, what if we had been able to do this from the outset, never fully shutting down? How do you achieve those things when 88% of your population constitutes “the vulnerable” though?

As a population, we have put ourselves in a very weak position. There are numerous reasons for this, each worth its own dissertation. We fail to exercise regularly. We allow for food policy that values corporate welfare over population health. We prefer pharmaceutical solutions over lifestyle modification. Now, we find ourselves in a position where all of this comes to a head. For those among the 88%, there is no cure to purchase. The best odds lie in investment. Investment in your body and your health.

Admittedly, the readers of this email largely fall into the 12%. However, I feel it is important to note what we are seeing with this disease. All of you, my patients, take your health and fitness seriously. We should recognize this moment as a reminder why that is important, and consider how you can help those you love be better prepared in the future. The message here is not one of “doom and gloom”. Instead, it is a positive reminder that our fate often lies in our own hands. Every small decision and habit makes a difference. When you lace up your running shoes tomorrow, you can add to the list another reason why it feels so good to make the choice to invest in yourself.

Antibody Testing at LabCorp

As discussed last week, antibody testing is becoming more widely available and more reliable. Such serologic testing tells us whether you have been exposed to the virus and if you have evidence of immunity. These tests are now available through our testing partner, LabCorp. If you’ve not been tested and would like to be, please let us know.