As Obesity Takes A Greater Toll In COVID Deaths, Health Officials Are Quiet
The children with COVID-19 in Dr. Eugene Daugherty’s pediatric intensive care unit often have one thing in common: obesity.
“At least 9 out of 10 patients that we’re seeing who are sick enough especially to be in the ICUs throughout the state, obesity plays a part in this,” said Daugherty, who is with Novant Health’s Children’s Hospital in Charlotte.
Since the start of the pandemic, there have been numerous studies worldwide showing the heightened dangers that COVID-19 poses to people who are overweight. The World Obesity Federation, for instance, has shown that death rates from COVID-19 have been 10 times higher in countries where more than half of the population is overweight.
But some doctors and health experts are questioning whether public health officials have done enough to convey that message, especially to younger people.
“It feels like — at least in the messaging that I’ve seen — as though it’s being treated as more of a footnote than anything else and something I feel like a lot of people have missed,” said Dr. Daniel Donner, a physician at Novant’s Pediatric SouthPark Clinic.
Donner says it’s particularly important because the number of obese children he’s seeing is increasing, with roughly 1 in 5 children 6 and older that comes to his practice having obesity. He believes it’s due to stay-at-home orders that closed schools and kept children indoors.
A recent Centers for Disease Control and Prevention study found that the rate of increase in body mass index in a group of roughly 432,000 children doubled during the pandemic compared to a pre-pandemic period, possibly due to the impact of stay-at-home orders and school closures.
The rate of obesity among the general population is also rising.
“So I think obesity has been fascinatingly ignored in this pandemic,” said Monica Gandhi, an infectious disease specialist, and professor of medicine at the University of San Francisco.
With nearly 90% of North Carolinians 65 and over fully vaccinated, COVID deaths among the elderly have declined.
And that’s shifted the disease’s toll to a younger population, who often have underlying health conditions. That’s often obesity, according to a WFAE review of death reports from the Mecklenburg County health department.
Silence On Obesity For Six Months
In North Carolina, Health and Human Services Secretary Mandy Cohen is the state’s top messenger about COVID-19. She often appears with Gov. Roy Cooper during bimonthly or even weekly news conferences about the disease.
Cohen has talked often about the greater risk that COVID-19 poses to elderly people. And she has discussed disparities in vaccination rates among racial and ethnic groups.
But a review of her media briefings with Cooper shows she last mentioned the word “obesity” in mid-March when she was listing underlying health conditions that allowed people to get vaccinated early. In those briefings, she has not made a special point to encourage people who are overweight to get vaccinated.
She has instead taken a blanket approach, urging everyone to get a shot.
“It could be there’s an element of ‘Well, let’s not blame the victim,’" Gandhi said. “With obesity, it seemed like it was simply not discussed. And it’s so important.”
What Mecklenburg County Death Reports Show
To try and determine the role obesity plays in deaths from the disease, WFAE requested six months of data on COVID-19 deaths in Mecklenburg County.
It’s often difficult to determine an exact underlying condition since many are connected, like being a smoker and lung cancer. And the records are dependent on the notes of physicians at the hospital and could vary depending on who filled them out.
But the data shows:
- There were 136 COVID-19 deaths among people ages 65 and younger during that time in which an underlying cause of death was listed.
- Of those deaths, 76 had either obesity or diabetes listed as an underlying risk factor.
- Asthma was only listed as an underlying cause in five deaths among people 65 and younger. In one of those cases, the person was also described as morbidly obese.
- Tobacco use was listed as an underlying cause in five deaths.
- Cancer was listed as a risk factor in six deaths.
- Being immunocompromised was a risk factor in two deaths.
The data also shows that among younger people, obesity is more often cited as a risk factor in a COVID-19 death than among the elderly.
Among people older than 65, obesity was listed as a risk factor in 9% of the COVID-19deaths. For people younger than 65 it was a risk factor in 34% of COVID-19 deaths.
Earlier this month, Mecklenburg Health Director Gibbie Harris spoke at a meeting of county commissioners and discussed the profile of recent COVID-19 deaths.
“And many of those (deaths) — 95% — were among people with underlying chronic conditions,” Harris said. “So we know how important the vaccines are especially for those with underlying chronic conditions. And the one thing I want to emphasize is that we have children that fit into that category that have underlying chronic conditions.”
She did not mention any chronic underlying health condition by name.
Mecklenburg County Medical Director Meg Sullivan said the health department might have done more to make sure people understand different risk factors for COVID-19.
“The honest answer is I’m not sure if there has been that specific messaging to the extent that it needs to be,” Sullivan said.
Scott Gottlieb, who was Food and Drug Administrator from 2017 to 2019, said that public health officials could be more specific.
“It’s a fair point,” Gottlieb said. “Because this is the challenge with public health messaging. So it’s true that a lot of the dialogue is around risk factors broadly and they haven’t been clearly enumerated.”
With boosters now being available, Gottlieb said it’s important that people speak with their physicians about whether they are at high risk.
“When public health officials go out and speak about COVID they speak about risk factors generally because it’s difficult to enumerate all of them,” he said. “And a lot of them are nuanced. If you are diabetic and obese you are at higher risk than someone who is just obese or just diabetic.”