COVID-19 is a Cruel Reminder that Obesity IS a Disease, says Thought Leader Donna Ryan, MD

"COVID really did bring home the message that obesity is a disease," says renowned obesity researcher and thought leader Donna Ryan, MD. In all age groups and across racial and ethnic groups, she points out in a recent interview, higher BMI has been associated with greater risk of hospitalization, ICU admission, and mortality.

Speaking in early January with Patient Care^® Online, Ryan also reviewed and had high praise for a newly published Cleveland Clinic study that showed the remarkable impact of bariatric surgery on reducing vulnerability to COVID infection among patients with obesity. She explains the details.

Donna H Ryan, MD, is professor emerita at the Pennington Biomedical Research Center in Baton Rouge, LA, and immediate past president of the World Obesity Federation. She directed clinical research for 22 years at Pennington Biomedical and her own research encompasses key roles in the DASH (Dietary Approaches to Stop Hypertension), POUNDS Lost, DPP (Diabetes Prevention Program) and Look AHEAD studies. Ryan's continuing research interests focus on translation of effective weight management into primary care practices.

The following transcript has been edited lightly for style.

Patient Care Online. Have there been lessons learned during COVID-19, about research about treatment, about patient care, that you think will help support treatment going forward?

Donna Ryan, MD. You know, Grace, COVID, really did bring home the message that obesity is a disease. People who have obesity—and the higher the BMI, the greater the risk for all the bad outcomes of COVID—have increased risk of hospitalization, of landing in the ICU, of requiring invasive mechanical ventilation, and death. And this is in all age groups. As you know, age is another big risk factor for big COVID outcomes. But in all age groups, the higher the BMI, the higher the risk, and in all races. So, it really has brought home that obesity is a disease, it's not a cosmetic problem. It is a disease.

And so, some of the studies that have been done around obesity and COVID—well, but first all the vaccine trials demonstrated that no matter what your BMI, you had a very good chance, an excellent chance of getting immunized appropriately. So, we worried that people with obesity, that their immune systems would not respond to the vaccines as well. But in the studies that were done with our vaccines, trials with incredible efficacy of preventing severe disease of COVID, it’s equally true—no matter what your BMI. BMI doesn’t play a role. What this means is that our patients with obesity need to get vaccinated, and they need to be advocates for vaccination.

Another really important study came out this year and it was it was published just recently by Ali Aminian who is a bariatric surgeon at Cleveland Clinic. He went into the Cleveland Clinic databases, their electronic health records, and he identified people who had had bariatric surgery and had lost weight. And he compared the outcomes of COVID infection in those patients to matched controls, who had the same BMI, but who did not have bariatric surgery. The patients who lost weight with bariatric surgery had much reduced complications of their COVID disease; they were diagnosed less frequently, because they were less symptomatic. They were hospitalized less, they were less likely to get in the ICU, they had lower rates of mechanical ventilation, and they also had lower mortality rates. Weight loss is good for you. That's what that study shows.

PCO. And a very interesting way to go about matching the two groups.

Ryan. You know, we're seeing more use of real-world data, of the electronic health record, and it's a good thing. I really give Cleveland Clinic and Ali Aminian some kudos and a round of applause for bringing us that study.