September 28, 2021

By Anne Christiansen-Bullers

The effects of weight, especially excessive weight, on those individuals with COVID-19 is being studied at KU Medical Center. Kansas joined the top tier of the Centers for Disease Control's obesity prevalence, making the research all the more impactful.

As COVID-19 surges back into the headlines in Kansas City, people may feel a growing sense of unease, even if they have been vaccinated.

For people who are overweight, obese or excessively obese, the threat of COVID-19 looms larger. Researchers aren't exactly sure of all the COVID-19 complications for obese patients and whether these patients respond in the same way to therapy and prevention as those with a more average body weight.

So, University of Kansas Medical Center researchers are trying two ways to mitigate that threat. First, clinical trials are testing obesity as one of five variables that could affect the treatment of COVID-19. Second, maintaining a healthy weight remains the goal of both National Institutes of Health-funded research and an increasing number of individuals seeking out weight-loss services during the pandemic.

Are you at risk? Check your BMI

The Centers for Disease Control and Prevention (CDC) has listed Overweight and Obesity as one of the medical conditions that can make individuals more likely to become severely ill from COVID-19. The key to understanding whether you're at higher risk is your body mass index. The higher the number, the higher the risk. That risk is not just a straight line that goes up in tandem with your weight. Instead, risk levels seem to jump dramatically given a high BMI.

Mario Castro, MD, MPH, director of Frontiers: University of Kansas Clinical and Translational Science Institute, is leading studies on the impact of COVID-19 on specific groups of patients. One such group is obese patients.
From his expertise as a pulmonologist, Castro said he knows obesity can affect the lungs because it restricts movement of the chest wall around the lungs.

"You can imagine that's very important when you develop an infection," Castro said. "You start to develop mucus that plugs your airways, and you can't clear that because you're not able to expand your lungs completely. That's going to allow the virus to propagate even more in the lower airway."

Adding to the risk level could be less muscle strength around those lungs. "There's a very strong relationship between obesity and low levels of physical activity," Castro said. "Patients who are obese could have less muscular strength and physical performance to fight off infections." When that lower airway is besieged by mucus, the chance of serious breathing complications skyrockets.

Then there's comorbidities

Learning weight-management techniques from each other

How do you get to a healthy weight and then maintain it for the rest of your life? Why do some people and cultures have more success in doing that?

The answers might come from a new initiative supported by the Division of Physical Activity and Weight Management at the University of Kansas School of Medicine. Founded upon the idea that we all can learn from each other, the International Weight Control Registry is surveying participants around the world about their firsthand experiences with weight management.

The University of Kansas is one of only five American universities working to gather information for this registry.

"The idea is to gather information from successes and failures and everything in between. These citizen scientists who complete the surveys are participating with a group of scientists to try to figure out what works for weight management in the real world," said Joseph E. Donnelly, Ed.D., director of DPAWM.

Donnelly was part of the National Weight Control Registry 20 years ago. But that registry was limited to the United States only.

"The IWCR is truly an international picture. Studies can be done based on different geographical areas of our country, then between countries, such as Argentina versus Finland. It's horrendously complicated, logistically trying to coordinate something like this with language barriers and different countries' government regulation," Donnelly said. "But if it works, it's going to be a brand-new tool with massive potential for obesity research."

Obese individuals also tend to have other health conditions that go along with being significantly overweight, such as diabetes, heart disease or high blood pressure. These accompanying conditions, known by doctors as comorbidities, bring their own increased risk for severe COVID-19.

But even comorbidities might not be as serious as BMI. In one study, being male and having a high BMI were shown as far more crucial factors for COVID-19 patients needing to be put on a ventilator, even more than age, diabetes or high blood pressure. In fact, patients with a BMI of more than 35 were seven times more likely to be placed on a ventilator than those with a BMI of less than 25. And the CDC had already established that obese individuals had triple the chance of hospitalization from COVID-19.

Why that's a Kansas problem

In the same year that COVID-19 was discovered, Kansas joined the CDC "fat" list. The list tracks the prevalence of obesity in each state. To make the top tier, at least 35 percent of the state's population must be classified as obese.

Kansas slid into the top tier at 35.2% obesity prevalence. Missouri, which had been in the top tier in 2017, improved to the second-worst tier with 34.8 percent.

Joseph E. Donnelly, Ed.D., professor of internal medicine at the KU School of Medicine and director of the Division of Physical Activity and Weight Management (DPAWM), has studied obesity for more than three decades. Some of his recent research has been in rural areas of Kansas, where obesity levels are increasing dramatically.

"The effects of obesity are worse in rural communities because of a lack of resources. Think of somebody who lives 100 miles from a clinic versus 5 miles," Donnelly said. "Those living farther away lack the ability to get the care because distance prohibits ease of engagement in the system that strives to make them healthier."

Telehealth for weight-loss research

Telehealth is one tool to level the playing field. Donnelly and his team had been using telehealth in rural obesity research even before the pandemic, and they bring exercise and weight management sessions across the state.

Anna M. Gorczyca, Ph.D., assistant research professor in the KU School of Medicine, said these programs were much appreciated when the pandemic lockdown blocked face-to-face social interaction. "There's a community component" to group classes, and a sense of connection with those who had one-on-one time with a health educator, she said.

"We received feedback from participants that their time with the health educator might have been the only person they spoke to for the entire day," Gorczyca said. "It was a lifeline, to have someone to talk to."

Services moved to telehealth at the DPAWM's fee-for-service clinic, too. The weight-loss center is affiliated with KU Medical Center for research purposes, and clinic participants have the opportunity to participate in studies and clinical trials that fuel the research of the department. But it also is aligned with The University of Kansas Health System as medical clinic, offering medical support and help with nutrition, activity and behavior.

Mary Hastert, RD, co-coordinator of the KU Weight Management Clinic and research assistant for DPAWM, noted an unlikely silver lining in the pandemic. Her research, recently presented at the Food and Nutrition Conference & Expo, showed that people who meet with a registered dietician lose more weight than those who don't. Telehealth services sped up those meetings and let dieticians counsel twice as many people as pre-pandemic face-to-face meetings.

Weight-loss services see increase

The KU Weight Management Clinic saw greater demand for its weight-loss services in 2020, with 36% percent more referrals from physicians and 32% more weight-management participants than in 2019.

Kim Johnson, program manager for the KU Weight Management Clinic, said she couldn't definitively say why the clinic received the influx. Maybe obese individuals feared how COVID-19 could affect them. Maybe people had more time for goal setting and self-care during the pandemic. Or maybe the clinic's outreach efforts started paying off as more people heard of what services the clinic offers, she said.

"We were doing a lot of communication with groups as they reached out to us. And not just that initial communication but following up and arranging meeting times and seeing how we could work together," Johnson said.

Going forward

While experts agree that obese patients with COVID-19 can suffer more severe symptoms, research is still being conducted on whether obese patients have a greater chance of long-term complications, the so-called "long-hauler syndrome."

KU Medical Center is one of 14 universities that banded together for a shared research project called RECOVER funded by the National Institutes of Health. Each of the 14 universities has a high proportion of rural residents.

"We were very interested in having a group from rural states, because patients from rural regions that develop COVID actually do worse in terms of their COVID. They have a higher mortality rate and more severe disease," Castro reiterated.

In the meantime, Castro urges overweight, obese and excessively obese individuals to be cognizant of their increased risks. "Unfortunately, people have been gaining weight during the pandemic with lower activity levels and spending extra time in front of a TV or computer," Castro said. "The most important message is that if you're obese, you need to get vaccinated. That's the thing you can do to help your chances the most."

Last modified: Sep 28, 2021