Obesity, Race/Ethnicity, and COVID-19

Obesity is a common, serious, and costly chronic disease. Having obesity puts people at risk for many other serious chronic diseases and increases the risk of severe illness from COVID-19. Everyone has a role to play in turning the tide against obesity and its disproportionate impact on racial and ethnic minority groups.

Adult Obesity is Increasing

The 2019 CDC Adult Obesity Prevalence Maps¹ show that obesity remains high – twelve states now have an adult obesity prevalence at or above 35 percent: Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia. This is up from nine states in 2018.

Obesity Worsens Outcomes from COVID-19

Adults with excess weight are at even greater risk during the COVID-19 pandemic:

• Having obesity increases the risk of severe illness from COVID-19. People who are overweight may also be at increased risk.
• Having obesity may triple the risk of hospitalization due to a COVID-19 infection.
• Obesity is linked to impaired immune function.^2,3
• Obesity decreases lung capacity and reserve and can make ventilation more difficult.⁴
• As BMI increases, the risk of death from COVID-19 increases.⁵
• Studies have demonstrated that obesity may be linked to lower vaccine responses for numerous diseases (influenza⁶, Hepatitis B^7,8,9, tetanus¹⁰).

Obesity Disproportionately Impacts Some Racial and Ethnic Minority Groups

Combined data from 2017-2019 show notable racial and ethnic disparities:

• Non-Hispanic Black adults had the highest prevalence of self-reported obesity (39.8%), followed by Hispanic adults (33.8%), and non-Hispanic White adults (29.9%).
• 6 states had an obesity prevalence of 35 percent or higher among non-Hispanic White adults.
• 15 states had an obesity prevalence of 35 percent or higher among Hispanic adults.
• 34 states and the District of Columbia (D.C.) had an obesity prevalence of 35 percent or higher among non-Hispanic Black adults.

Hispanic and non-Hispanic Black adults have a higher prevalence of obesity and are more likely to suffer worse outcomes from COVID-19.  Racial and ethnic minority groups have historically not had broad opportunities for economic, physical, and emotional health, and these inequities have increased the risk of getting sick and dying from COVID-19 for some groups.  Many of these same factors are contributing to the higher level of obesity in some racial and ethnic minority groups.

What Can be Done

Obesity is a complex disease with many contributing factors. Neighborhood design, access to healthy, affordable foods and beverages, and access to safe and convenient places for physical activity can all impact obesity.  The racial and ethnic disparities in obesity underscore the need to address social determinants of health such as poverty, education, and housing to remove barriers to health. This will take action at the policy and systems level to ensure that obesity prevention and management starts early, and that everyone has access to good nutrition and safe places to be physically active. Policy makers and community leaders must work to ensure that their communities, environments, and systems support a healthy, active lifestyle for all.

Steps to Take Now

Systemic change takes time, as does long-term weight loss. In addition to the steps everyone should take to slow the spread of COVID-19, individuals can help protect themselves and their families during this pandemic by:

Eating a healthy diet

Eating a healthy diet with plenty of fruits and vegetables, lean protein, and whole grains as well as the appropriate amount of calories is important for your health, and can help with weight loss and preventing weight gain.¹¹  Good nutrition can help support optimal immune function.^12,13 A healthy diet can help prevent or support self-management of diseases such as heart disease and type 2 diabetes11, which also increase the risk of severe illness from COVID-19.

Being active

Regular physical activity helps you feel better, sleep better, and reduce anxiety. It can also help with preventing weight gain and when combined with calorie reduction, helps with weight loss.¹⁴ Physical activity can also help prevent diseases that increase a person’s chances of having severe illness from COVID-19 such as heart disease and type 2 diabetes.¹⁴ Emerging research suggests it may also help boost immune function.^15,16

Getting enough sleep

Insufficient sleep has been linked to depression, as well as chronic diseases¹⁷ that may increase the risk of severe illness from COVID-19 such as heart disease, type 2 diabetes, and obesity.

Coping with stress

Stress during an infectious disease outbreak can sometimes cause changes in sleep or eating patterns, increased use of alcohol and tobacco, or worsening of chronic health problems.

Over time, these actions can help individuals with obesity improve their overall health. And if they result in even modest weight loss, there are health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars.¹⁸ And with a lower BMI, the risk of severe illness from COVID-19 is reduced.⁵

What CDC, Partners, States, and Communities are Doing

Our work with partners, states, and communities makes it easier for everyone to move more and eat a healthy diet where they live, learn, work, and play. Together, we work to remove barriers and promote health and wellness for all by:

• Bringing communities together to plan and carry-out local, culturally tailored interventions to address poor nutrition, and physical inactivity and tobacco use
• Promoting healthier food and beverage choices in childcare, schools, workplaces, hospitals, and public venues
• Making healthy foods more available by connecting local producers with retailers and organizations such as childcare, schools, hospitals, and food hubs
• Promoting nutrition standards in early care and education settings, food pantries, and faith-based organizations
• Designing communities that connect sidewalks, bicycle routes, and public transportation with homes, early care and education settings, schools, parks, and workplaces
• Ensuring screening for obesity and access to healthy lifestyle programs for children and their families

The epidemic of obesity is impacting the severity of the COVID-19 pandemic. Given the added risks associated with COVID-19, we need to support all individuals, especially members of racial and ethnic minority groups, to live active healthy lives.

References

1. The 2019 CDC Adult Obesity Prevalence Maps show the prevalence of self-reported adult obesity using data from the Behavioral Risk Factor Surveillance System. Data is available for 49 states (New Jersey data unavailable), the District of Columbia, Guam, and Puerto Rico.
2. Tanaka, S. I., Isoda, F., Ishihara, Y., Kimura, M., & Yamakawa, T. (2001). T lymphopaenia in relation to body mass index and TNF‐α in human obesity: adequate weight reduction can be corrective. Clinical endocrinology, 54(3), 347-354.
3. Alwarawrah, Y., Kiernan, K., & MacIver, N. J. (2018). Changes in nutritional status impact immune cell metabolism and function. Frontiers in immunology, 9, 1055.
4. Simonnet, A., Chetboun, M., Poissy, J., Raverdy, V., Noulette, J., Duhamel, A., … & LICORN and the Lille COVID‐19 and Obesity study group. (2020). High prevalence of obesity in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) requiring invasive mechanical ventilation. Obesity.
5. Tartof, S. Y., Qian, L., Hong, V., Wei, R., Nadjafi, R. F., Fischer, H., … & Saxena, T. (2020). Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Annals of Internal Medicine.
6. Neidich, S. D., Green, W. D., Rebeles, J., Karlsson, E. A., Schultz-Cherry, S., Noah, T. L., Chakladar, S., Hudgens, M. G., Weir, S. S., & Beck, M. A. (2017). Increased risk of influenza among vaccinated adults who are obese. International journal of obesity (2005), 41(9), 1324–1330.
7. Weber DJ, Rutala WA, Samsa GP, Santimaw JE, Lemon SM (1985) Obesity as a predictor of poor antibody response to hepatitis B plasma vaccine. JAMA 254: 3187-3189
8. Simó Miñana J, Gaztambide Ganuza M, Fernández Millán P, Peña Fernández M (1996) Hepatitis B vaccine immunoresponsiveness in adolescents: a revaccination proposal after primary vaccination. Vaccine 14: 103-106.
9. Young MD, Gooch WM 3rd, Zuckerman AJ, Du W, Dickson B, et al. (2001) Comparison of a triple antigen and a single antigen recombinant vaccine for adult hepatitis B vaccination. J Med Virol 64: 290-298.
10. Eliakim A, Schwindt C, Zaldivar F, Casali P, Cooper DM (2006) Reduced tetanus antibody titers in overweight children. Autoimmunity 39: 137-141.
11. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at https://health.gov/our-work/food-and-nutrition/2015-2020-dietary-guidelines/external icon.
12. Childs, C. E., Calder, P. C., & Miles, E. A. (2019). Diet and immune function.
13. Christ, A., Lauterbach, M., & Latz, E. (2019). Western diet and the immune system: an inflammatory connection. Immunity, 51(5), 794-811. Blackburn G. (1995). Effect of degree of weight loss on health benefits. Obesity Research 3: 211S-216S.
14. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.
15. Nieman, D. C., & Wentz, L. M. (2019). The compelling link between physical activity and the body’s defense system. Journal of sport and health science, 8(3), 201-217.
16. Jones, A. W., & Davison, G. (2019). Exercise, Immunity, and Illness. In Muscle and Exercise Physiology (pp. 317-344). Academic Press.
17. Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017;32:246-256. doi:10.1016/j.sleep.2016.08.006
18. National Institutes of Health, National Heart, Lung, and Blood Institute. Managing Overweight and Obesity in Adults: Systematic Evidence Review from the Obesity Expert Panel, 2013. https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adultsexternal icon. Accessed May 7, 2019.