Currently, there is no specific data or a comprehensive study on the link between obesity and Covid-19 deaths in Karnataka. The state government’s list of comorbidities does not include obesity, and deceased patients’ obesity status is not formally checked.
But doctors tracking patterns in severe Covid-19 cases and fatalities say that being overweight complicates treatment. According to Dr Ambanna Gowda, an internal medicine specialist at Fortis Hospital, Cunningham Road, many studies have flagged obesity as a risk aspect for Covid-19 patients. “In most countries today, more than 20 per cent of the general population is overweight and obese. Obesity increases the odds of death as multiple conditions are associated with it, such as insulin resistance, diabetes, hypertension, kidney problems, chronic liver disease, metabolic dysfunction and immune system impairment. All this leads to increased ICU admissions, long hospital stays and poor outcomes,” he said.
Though many Covid-19 patients who died were senior citizens with comorbidity, there have been cases of youngsters succumbing to the disease. According to Dr Srinivasa Kakkilaya, a physician in Mangaluru, obesity is one of the main contributing factors in such cases.
“Comorbidity possibly went undetected in young patients who died of Covid-19. Unless one is tested for diabetes, hypertension or coronary artery disease, it won’t be known. Many severe patients who passed away were obese. But obesity is not considered a disease at all,” Dr Kakkilaya said. “In the initial days of the pandemic, two Mangaluru men in their thirties died. They weighed more than 120kg each. The problem will continue to exist as long as we don’t consider obesity as an illness.”
Dr Gowda recalled the case of a 29-year-old man from Raichur who weighed 85kg and had diabetes. “He was brought to Bengaluru after his condition worsened in August. He died. His lymphocyte count was just 1 per cent as against the normal count of 20 to 30 per cent. Lymphocytes are white blood cells that constitute one of the main types of immune cells,” Dr Gowda said.
Experts say people who are overweight also suffer from endothelial dysfunction or impaired functioning of the lining of blood vessels. Obesity is also associated with oxygen deprivation or hypoxia.
Dr Rajesh Mohan Shetty, a consultant for critical care medicine at Manipal Hospitals, Whitefield, believes obesity should be considered a comorbidity. “It is associated with impaired immune response. It is part of the metabolic syndrome, and obese people are more likely to have conditions such as diabetes and hypertension. Mechanical ventilation and prone ventilation are associated with higher complications in obese patients. All these factors may contribute to increased mortality among Covid-19 cases,” he said.
Dr Manoj Kumar R, a gastrointestinal and bariatric surgeon at Sakra World Hospital, said overweight patients faced risk of thrombosis. “A young and lean Covid-19 patient would generally have better chances of recovering than a young obese patient in the ICU,” he added.
Health commissioner Pankaj Kumar Pandey also said that obesity posed risks in the case of coronavirus infection. “We will look into the matter and see if it can be included in the list of comorbidities,” he added.
Why the obese are vulnerable
A protein called the Angiotensin-converting enzyme 2, or ACE2 ‘receptor’, provides an entry point to coronavirus to hook into and infect a wide range of human cells. “Researches have confirmed that among obese persons, there is an increased expression of ACE2 receptors in adipose tissues that have high affinity for SARS-CoV2,” said Dr Shetty.