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How Can People with Obesity Reduce Their COVID Risk?
— By Andrea M. Pampaloni, Ph.D.
Immunocompromised groups, including people with obesity, continue to have poor outcomes related to coronavirus.
As we enter the third year of the COVID-19 pandemic, vaccinations and other precautions have been effective in reducing hospitalizations and deaths resulting from the disease. However, immunocompromised groups, including people with obesity, continue to have poor outcomes related to coronavirus.
From early on it quickly became clear that obesity was a high risk factor for severe illness related to COVID-19 and that it increased the likelihood of hospitalization by nearly 30 percent. Obesity is also the cardiometabolic condition that contributes the highest health risk, followed by hypertension and diabetes, which are often comorbidities of obesity.
However, with the introduction of new and more contagious variants, vaccine effectiveness decreased in certain immunocompromised groups. The introduction of Omicron, which is highly transmissible even among those who are vaccinated, creates additional challenges for people with obesity because it infects adipose cells and adipose tissue macrophages, causing a damaging inflammatory response. This is evidenced by a death rate that is nearly 10 times higher in countries with high levels of obesity, including the U.S.1
Reducing COVID Risk among Obese Populations
A recent study published in JAMA Surgery found that substantial weight loss can be a modifiable risk in terms of COVID severity. Patients who lost weight had lower risk for hospitalization, need for supplemental oxygen, and risk of severe COVID-19 infection. They also experienced better outcomes after becoming infected.2
Although the referenced study used bariatric surgery as the weight loss mechanism, the overall conclusion was the negative health outcomes can be reversed with weight loss for patients with obesity that have COVID-19.
Indeed, one of the authors emphasized that weight loss, not the means used to achieve it, is the critical factor to be considered. This suggests that other methods leading to significant weight loss, such as a Very Low Calorie Diet (VLCD), could have equally beneficial outcomes. In addition to substantial weight loss, VLCDs improve blood sugar levels and decrease the risk of heart disease, which also are associated with poor outcomes related to COVID.
A further recommendation from the study was a call for public health strategies that put a greater emphasis on weight loss, not only to limit the consequences of this pandemic but also to minimize the impact of future outbreaks of other infectious diseases. Given the growing number of people with obesity in the U.S., creating more prominent awareness of the negative health outcomes of obesity through a long overdue public health campaign could have an important impact across populations and help stop or potentially even reverse the effects of this epidemic.
Sources:
- Omicron Increases the need to Understand Elevated COVID Mortality Rates in the Obese
- Association of Weight Loss Achieved Through Metabolic Surgery with Risk and Severity of COVID-19 Infection
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BENEFIT OF MEAL REPLACEMENTS IN WEIGHT MANAGEMENT
The benefit of replacing grocery foods with balanced nutritional Meal Replacements is a useful clinical tool to support calorie restriction and provide optimal levels of macro and micro nutrients. It is known that incorporation of added protein during calorie restriction aids in satiety as well as supporting lean body mass and metabolic rate.
In 2009 the American Dietetic Association supported inclusion of Meal Replacements in their position statement on Weight Management.(1) It was reported that Meal replacements, containing known energy and macronutrient contents, are a useful strategy to eliminate problematic food choices or complex meal planning while trying to attain a daily caloric deficit. Substituting one or two daily meals or snacks with meal replacements in the form of liquid meals, meal bars or calorie-controlled packaged meals may be used as part of the comprehensive weight management program. In a review by Hymesfield, randomized controlled studies that used meal replacements for at least three months were compared to a conventional reduced calorie diet. It was determined that while both groups lost weight, dieters using of meal replacements lost more weight after 1 year.(2)
Weight loss after one year averaged 7-8% from base line which was comparable or above the level observed with pharmacologic weight loss studies and the level known to lower disease risk. Meal replacements have also been an effective alternative for dieters with diabetes.
In addition to simplifying meal planning it can help dieters achieve healthy blood glucose levels while they are learning skills to balance their dietary carbohydrate intake. Cheskin et.al.(3) reported that a diet using a portion-controlled meal replacement diet (PCD) yielded significantly greater initial weight loss and less regain after 1 year of maintenance than a standard, self-selected, food-based diet. Meal replacements were also utilized in the multi-center Look AHEAD (Action for Health in Diabetes) study (4) with over 5000 participants. During the weight loss phase it was found that the number of meal replacements consumed was significantly associated the amount of weight loss. At the end of one year the group using meal replacements lost 6.8% of their initial weight compared to only 0.7% for the group without meal replacement use. After initial weight loss participants in this multi-year study were encouraged to continue to replace one meal and one snack per day with liquid shakes and meal bars. Weight loss maintenance is another good fit for meal replacements. Continuing to substitute a meal replacement for one or two daily meals or snacks has been found to support long term weight maintenance.(5)
REFERENCES:
1. Position of the American Dietetic Association: Weight Management Journal of the American Dietetic Association. 2009; 109;330-346.
2. Heymsfield SB, van Mierlo CA, van der Knaap HC, Heo M, Frier HI. Weight management using a meal replacement strategy: meta and pooling analysis from six studies. International Journal of Obesity and Related Metabolic Disorders. 2003 May;27(5):537-49.
3. Cheskin LJ, Mitchell AM, Jhaveri AD, Mitola AH, Davis LM, Lewis RL, Yep MA, Lycan TW. Efficacy of Meal Replacements Versus a Standard Food-Based Diet for Weight Loss in Type 2 Diabetes. The Diabetes Educator. 2008; 34: 118-127.
4. Wadden TA, Neiberg RH, Wing RR, Clark JM, Delahanty LM, Hill JO, Krakoff J, Otto A, Ryan DH, Vitolins MZ; Look AHEAD Research Group. One Year Weight Losses in the Look AHEAD Study: Factors Associated with Success Obesity. 2009; 17: 713-722
5. Layman DK, Evans EM, Erickson D, Seyler J, Weber J, Bagshaw D, Griel A, Psota T, Kris-Etherton P. A moderate-protein diet produces sustained weight loss and long-term changes in body composition and blood lipids in obese adults. Journal of Nutrition. 2009. 139(3):514-21.
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IMPORTANCE OF MEAL REPLACEMENTS IN WEIGHT MANAGEMENT
A two-year randomized trial of obesity treatment in primary care practice. (Wadden TA, Volger S, Sarwer DB, Vetter ML, Tsai AG, Berkowitz RI, Kumanyika S, Schmitz KH, Diewald LK, Barg R, Chittams J, Moore RH. New England Journal of Medicine. 2011 Nov 24;365(21):1969-79.) Primary care physicians (PCPs), collaborating with medical assistants, helped obese patients lose an average of 4.7% of their initial weight at 24 months. This loss, which was accompanied by improvements in cardiovascular risk factors, was achieved with enhanced brief lifestyle counseling, which combined quarterly PCP visits, brief lifestyle coaching delivered monthly, and provided for the use of meal replacements to enhance weight loss.
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Picture source: https://Author: Monique of AmbitiousKitchen.com
Sweet Potato, Black Bean & Egg White Breakfast Burritos
Ingredients
- 6 8-inch whole wheat tortillas (you can also use low carb)
- 3 medium sweet potatoes
- 1 (15 ounce) can black beans, rinsed and drained
- 1/2 teaspoon cumin
- 1/4 teaspoon chili powder
- few dashes of red pepper flakes, if desired
- 6 large eggs (or 8 large egg whites)
- 1 avocado, diced
- 1/2 cup shredded Mexican or Colby jack cheese
- 1/3 cup red enchilada sauce
Instructions
- Cook sweet potatoes: Pierce sweet potatoes with fork a few times. Place in microwave and microwave on high for 4-6 minutes or until cooked though. This may take up to 10 minutes depending on how thick your sweet potatoes are. Alternatively you can roast them in the oven at 375 degrees for 45 minutes or until fork tender. Once sweet potatoes are cooked, remove the skins and place potatoes in a medium bowl. Mash with a fork; set aside.
- In a separate large bowl, add black beans, cumin, chili powder and red pepper flakes, if desired. Stir to combine then set aside.
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In a separate medium bowl, beat eggs (or egg whites) together. Spray a skillet with nonstick cooking spray and place over medium-low heat. Add in eggs and cook. Fold every few minutes to get fluffy eggs. Once cooked, remove from heat.
- To assemble burritos, make sure you have slightly warm tortillas; it makes them easier to roll. You can warm them up for 10-20 seconds in the microwave before assembling. Lay out warm tortillas and evenly distribute and spread mashed sweet potato on each as demonstrated in the video. Evenly distribute scrambled eggs, diced avocado, black beans, and shredded cheese on each tortilla. Next drizzle about tablespoon of enchilada sauce in each. Season with salt and pepper, if desired. Tuck ends in, then roll up burritos.
- To warm up: Place on baking sheet in oven at 300 degrees for 5-10 minutes or simply microwave them for a minute or two. Serve with sour cream, greek yogurt, salsa, or hot sauce. Makes 6 burritos. Freezer instructions are in the notes!
Recipe Notes
Nutritional information is based on using whole wheat tortillas that were 120 calories each. Gluten free tortillas aren't that flexible, so I wouldn't suggest using them.
These burritos are freezer-friendly. Simply wrap in plastic wrap, then in foil and place in freezer. To reheat, remove foil and plastic wrap and microwave until warmed, about 2-3 minutes.
Nutrition Facts:
Amount Per Serving (1 burrito)
Calories 398
Calories from Fat 124 % Daily Value* Fat 13.8g21%
Carbohydrates 54.3g18%
Fiber 10.5g44%
Sugar 5.5g6%
Protein 18.1g36%
* Percent Daily Values are based on a 2000 calorie diet.
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"A decline in the immune system is most often characterized by increased levels of inflammation, reduced innate immune function and reduced T-cell function," said Adrian Gombart, professor of biochemistry and biophysics at Oregon State University, and a principal investigator at the Linus Pauling Institute. "Since multiple nutrients support immune function, older adults often benefit from multivitamin and mineral supplements."*
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