Laura Hollis / Oct. 29, 2020

Obesity: The American Health Crisis We Should Be Talking About

One major factor complicating the COVID-19 death toll in the U.S. is our obesity rate.

In the last days of the presidential election cycle, Democratic nominee Joe Biden and his surrogates in the media and elsewhere are trying to blame the COVID-19 death toll on President Donald Trump. One recent tweet I saw compared South Korea’s death toll — 461 — with that of the United States — 232,000-plus and counting.

South Korea has a population of just over 51 million people. The United States has 330.5 million people. If all things were equal, South Korea would have lost over 35,000 people to COVID-19.

But clearly, they’re not equal. South Korea’s death rate is just 9 per 1 million people, while ours is 700 per 1 million people. That’s a staggering difference. And while our death rate per million people is not the highest (with the exception of Belgium, all the countries with higher death rates are in South America), it’s still shockingly high.

Democrats would like to lay this at the feet of Donald Trump. But the truth is much more complicated, diffused and personal.

One major factor complicating the COVID-19 death toll in the U.S. is our obesity rate. Trust for America’s Health recently published a report titled “The State of Obesity 2020.” According to data available from the Centers for Disease Control and Prevention, from 2017-2018, 42% of American adults were obese. Not merely overweight — obese. Nine percent were “severely” obese. (How do we compare with the rest of the world? America has the 12th highest obesity rate among 191 countries. South Korea, by comparison, is 183rd, with only 4.7% of its population obese.)

This is the highest number ever recorded, and it is part of a disturbing trend. Not only are more adults obese but levels of obesity in children and young people are increasing as well. The Global Pediatric Health journal calls obesity in youth an “epidemic,” reporting that obesity has doubled in children and tripled in adolescents just since 1990.

These numbers are terribly important because obesity is closely associated with other serious health disorders including respiratory problems such as asthma, sleep apnea, arthritis, gout, hypertension (high blood pressure), heart attacks, strokes, Type 2 diabetes and even certain cancer. The human toll obesity exacts is heartbreaking and immeasurable. The financial toll, however, is measurable. The CDC also estimates the health care costs associated with obesity to be $147 billion each year.

America’s weight problem and related disorders are also playing a huge and underarticulated role in COVID-19’s fatality rate in the United States. A much-misinterpreted CDC report revealed that 94% of all COVID-19 deaths occurred in individuals with one or more co-morbidities — serious health problems that were contributing causes to death. Some of those co-morbidities — most notably, pneumonia — were caused by COVID-19 itself. But many others, such as heart disease, hypertension, diabetes and renal failure — preexisted the viral infection; COVID-19 dealt the final blow.

Just last month, Science magazine summarized the results of several recent studies. One, published by the Obesity Reviews journal, examined the medical histories of nearly 400,000 patients and showed that obese people who contracted COVID-19 were “113% more likely than people of healthy weight to land in the hospital, 74% more likely to be admitted to an ICU, and 48% more likely to die.” A study conducted by Genentech examined 17,000 hospitalized COVID patients; almost 80% were overweight or obese.

The obesity factor is also increasingly being used to explain the impact COVID-19 is having on certain segments of the U.S. population. By way of example, although younger people tend not to be as seriously affected by COVID-19 as the elderly, of those killed by COVID-19 who were under age 45, more than 60% were obese. Similarly, obesity rates by ethnicity or racial identification are relevant to death rates but disproportionate to their share of the U.S. population. Non-Hispanic Blacks represent 13% of the U.S. population but have the highest COVID-19 mortality rate of any group — two times that of whites and Asians. The next highest mortality group is among indigenous peoples (less than 1% of the population), followed by Latinos (only 16.7% of the population). Asian Americans have the lowest mortality rate from COVID-19.

Correlation is not causation, but these results are closely tracking obesity rates. Non-Hispanic Blacks have the highest obesity rate in the U.S. (49.6%), followed by Native Americans (48.1%), Hispanics (44.8%) and non-Hispanic whites (42.2%). Non-Hispanic Asians have the lowest rate (17.4%).

As with so many other things these days, the important information contained in this data is being buried in political wrangling and finger-pointing. This is doing the American public a grave disservice. No, obesity does not explain every COVID-19 death, any more than it would explain every heart attack, stroke or death from pneumonia in a “normal” year. But if we want to address the real reasons why we’re suffering in greater numbers than so much of the rest of the world, we need to move beyond politics and create policies that encourage real lifestyle changes.

No matter who is elected president next week, this country needs to get serious about the health of its citizens. Our government — at every level — must make reducing obesity in Americans a top public health priority.


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