COVID-19 and Obesity-A Link Too Dangerous To Ignore

Obesity and overweight

More than one-third of U.S. adults have obesity, which is defined as having a BMI > 30. According to the World Health Organization, obesity has nearly tripled worldwide since 1975. In 2016, > 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese. A staggering 38 million children under the age of 5 were overweight or obese in 2019. Most of the world’s population live in countries were overweight and obesity kills more people than underweight. Do I have your attention yet? If not, did you know that 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese. Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016. All the aforementioned facts are per the WHO . Obesity is preventable. We need to wake up and do better, not just for ourselves but the next generations to come. The COVID-19 pandemic has forever changed our lives and we must revisit our lifestyle choices in honor of health and disease prevention.

This article will highlight the association of obesity and Covid-19. First and foremost, for adults, the WHO defines overweight as BMI > or equal to 25; and obesity is a BMI > 30. BMI provides a rough measurement tool to correspond fatness in different individuals. It is not the best indicator of health as it is a population-level measure which is the same for both sexes and all ages and adults. BMI does not tell us bio-metrics, energy levels, sleep, relationship with food and other areas that predict health. However, it does provide a common way to classify

overweight or obesity in adults. BMI is defined as a person’s weight in kilograms divided by the square of his or her height in meters (kg/m2).

Causes of Obesity

  • Imbalance of calories from physical inactivity or surplus of calories consumed chronically over time
  • Family history and genetics
  • Medications: Some anti-seizure medications, antidepressants, steroids and beta blockers can lead to undesirable weight gain
  • Environment: Surrounding yourself with friends and family who may be overweight making poor food and beverage choices can lead to greater risk of obesity
  • Too little sleep which can increase appetite and desire to consume low nutrient foods

Why is obesity a risk factor for Covid-19?

Obesity is considered a large risk factor for risk of severe COVID-19 because of the respiratory dysfunction. Those with obesity have a greater likely hood of experiencing restricted airways, decreased lung volumes, and weaker respiratory muscles which are an essential defense against COVID-19. Such factors make an individual more susceptible to pneumonia, and experience additional cardiac stress. Furthermore, obesity is also linked with diabetes, heart disease, and kidney disease, which overall increase the risk of developing pneumonia. Other ailments like hypertension, hyperlipidemia, and pre-diabetes enhance the susceptibility to infection.

The current science:

  •  Data from 383 patients showed that having obesity was associated with a 142% higher risk of developing severe pneumonia associated with COVID-19.
  •  A larger study of over 4,000 patients with COVID-19 in New York City found that severe obesity was a major risk factor for hospitalization, second only to age.
  • Analysis of critically ill COVID-19 patients in Seattle found that 85% of patients with obesity required mechanical ventilation, compared to 64% of patients without the condition. Moreover, 62% of the patients with obesity died of COVID-19, compared with 36% of those without obesity.
  • Limitation: Study only assessed 24 patients, all of whom were critically ill, making it difficult to draw attention to the conclusions from the data.
    • Another analysis of 124 patients in Lille, France, found that patients with obesity were more likely to require invasive mechanical ventilation.

Collectively this evidence suggest that obesity may be a significant risk factor for COVID-19. Dr. Norbert Stefan, of the German Center for Diabetes Research stated that “obesity may put people infected with Covid-19 at more severe risk and possibly risk of death.” Many of the recent articles published in the last 2 months regarding comorbidities and the association with COVID-19 did not produce data surrounding body composition or metabolic health. The gap in data warrants further research to investigate how body composition, waist circumference, and blood glucose levels play a role in contraction and recovery from the virus, specifically metabolic syndrome.
Metabolic syndrome is a serious health condition that affects roughly 23 percent of adults and increases their risk of cardiovascular disease, type 2 diabetes, stroke and diseases related to fatty buildups in arterial walls according to the American Heart Association. The overall underlying cause of metabolic syndrome includes being overweight, obese, inactivity along with other genetic factors associated with aging.

However, given the limited studies there is not sufficient evidence to definitively say that those with obesity at higher risk for more severe COVID-19. The limited literature does suggest a connection and we can note that obesity is indeed a risk factor for worse outcomes in regard to health. Research does support the notion that those who are obese tend to experience more severe forms of infections according to a publication in the International Journal of Obesity .

Strategies to Overcome Obesity: Tips for a Healthier Tomorrow

Now that we are aware of the connection obesity has with disease and infection let’s talk about practical strategies and tips to improve body composition and overall health! First and foremost, obesity prevention begins at a young age. It’s important to help young growing adolescents maintain a healthy weight without a focus on the scale.

Obesity prevention for children

  • Help your toddlers learn appropriate portion sizes. The American Academy of Pediatrics states children from the ages of 1 to 3, every inch of height should equate to approximately 40 calories. As children age you can teach them what appropriate portion sizes look like.
  • Eat healthy foods as a family and create a healthy experience with eating at the table with no distractions like tablets, computes, phones and other games.
  • Encourage eating slowly and eating only when hungry. Eating out of boredom can lead to excess calorie consumption. If you find yourself eating out of boredom be sure to have healthy snacks like fresh cut fruits and veggies available to snack on.
  • Limit unhealthy foods that lack nutrients in the household. If it ends up in your cart at the store, it will end up in your mouth and eventually your tummy. Stock the fridge and pantry with healthy foods, and limit low nutrient foods as a “treat” that is not consumed daily.
  • Establish a healthy sleep routine and focus on managing stress. Those that tend to sleep more heave a healthier weight and crave less unhealthy foods that are often low in nutrition. Higher stress is also associated with weight gain due to poor coping mechanisms.
  • Incorporate regular physical activity which includes at least 60 minutes per day. A byproduct of being more active is less time in front of the screen.

Obesity prevention for adults
It is no secret obesity prevention tips are the same for losing or maintaining a healthy weight. Consuming a healthy diet, sufficient sleep and participating in regular physical activity can help prevent obesity.

  • Consume plenty of healthy fats. A study published in the Nutrition Journal illustrated that intake of healthy fats, such as polyunsaturated fats, can attenuate cholesterol levels and decrease obesity risk.
  •  Eat regular meals on a schedule. Eat a proper breakfast, lunch and dinner that has appropriate portion sizes. Make half your plate fruits and vegetables. Adults should consume five to nine servings of fruits and veggies each day.
  • Granola, oats, yogurt and fruit with coffeeFruits and veggies are low in calories, high in nutrients, water and full of dietary fiber that supports satiety. Research shows dietary fiber plays a key role in maintaining a healthy weight. A 2019 trial published in Journal of Nutrition found that dietary fiber intake promotes weight loss and dietary adherence in adults with overweight or obesity consuming a calorie-restricted diet.
  • Consume less processed and high sugar foods. According to a study published in the American Journal of Clinical Nutrition, processed and ultra-processed foods are linked to increased risk for obesity. Most processed foods are high in fat, sodium, and refined sugar which can promote over-eating.
  • High calorie, high sugar foods often contain limited nutrients and tend to promote over-eating. Processed foods that should be limited to avoided include cereals, white bread, potato chips, cookies, ice cream, granola bars, crackers and other snack foods. Be mindful of marketing claims for certain snack foods that may list “low-fat” or ‘low-carb” but still contain a significant amount of sugar and limited nutrients. Should you choose granola bars or grains ensure they are whole-grain.
  • Participating in regular activity that includes both strength training and aerobic activity. Regular physical activity of 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity is encouraged per week according to the CDC . Find a movement that you enjoy doing and set a goal to complete it each week with the family. Establish smart goals and hire a coach that can assist you in completing appropriate exercise safely to prevent injury. If you’re new to exercise, begin by walking, stretching and strive to improve your time spent exercising each week.
  • Focus on meal prep and have a plan. It is much easier to shop for healthy foods when you have a list that meets your budget. If you walk into a store with a list you are less likely to be tempted by unhealthy foods. Avoid walking down the aisles looking for items that are not on your list. A good grocery list should contain plenty of fruits, vegetables, fish,  healthy whole-grains, lean proteins, healthy fats and spices. Be sure to make a regular list and post it on the fridge for items as you run out.
  • Eat more protein and veggies as snacks. Higher protein intake is associated with better weight management, glycemic index and bone health according to several studies.  A review published in the Journal of Food Science specifically illustrates the metabolic advantages of higher protein diet and benefits of dairy. Higher protein intake is associated with greater satiety and healthier better composition. Some great high-protein options include eggs, Greek yogurt, beef, chicken, fish, lentils, wild game and other dairy products. A study published in the European Journal of Obesity examining the effect of a high-protein diet versus a standard protein diet on weight loss and biomarkers of metabolic syndrome found significantly greater weight loss with higher protein diet.

Many are looking for ways to stay calm during one of the most unprecedented health crises our country has ever seen. Shift your focus to these 3 areas to improve your health during the pandemic.

Establish a routine:

Which includes regular wake, bedtime, movement, mealtimes, schoolwork, work projects and “leisure time” built in to create stability. Eat breakfast every day! Those that consume the majority of their calories early on are less likely to be overweight and obese. Be sure to incorporate a high-quality protein, fiber and fluids. By getting into the habit of completing tasks on a regular basis along with mealtimes you set yourself up for a new normal.

Nutrition 101

Be mindful of fluids, what you are eating at meals and snacking on. High-stress situations can lead to an impact on our ability to make healthy choices. By stress eating high-calorie and low nutrient foods you are more likely to put on undesirable weight. By creating a schedule of mealtimes and having a calendar of meals you are less likely to eat out of boredom.

  • Have fruits and veggies cut and prepared in the fridge should you be hungry and snack on nutrient dense foods versus processed food.Grocery shopping is critical, be sure to have a list prepared ahead of time and stock up on plenty of frozen along with fresh fruits and veggies.
  • Eat the rainbow and incorporate as many whole foods as possible. By eating colorful fruits and vegetables you can support a healthy immune system. Vitamins and minerals support a healthy immune system which are found in pigment rich foods (color!).
  • Be sure to also incorporate unsalted, nuts, seeds, lean proteins and healthy fats can truly help optimize your immune function land even support good sleep. What we eat has a direct impact on our sleep which can also help keep unwanted pounds at bay!

Supporting positive mental health with movement and meditation!

Getting plenty of regular movement, aerobic activities like walking, biking, hiking, swimming along with resistance training with household items or weights at home. Exercise boosts physical, mental and emotional health which can help reduce stress overall. By reducing stress, you are also fighting off the risk of disease and illness. 30-40 minutes a day of yoga, meditation, walking, running or biking is a great way to stay healthy! Many apps, videos and programs are available on demand online.

Work with a Dietitian to Fight Off Obesity and Establish Healthy Habits

Many find great success working with a registered dietitian nutritionist. Research indicates that a few sessions with an RDN can lead to healthier habits, optimal food choices and successful weight loss. As an RDN I personally work with many on improving their relationship with food, eating more fruits and veggies, selecting high-quality proteins, and preparing foods at home. RDN’s can assist in developing a calorie-controlled plan and calculating out energy needs that support appropriate weight loss, weight maintenance goals. Additionally, a personal trainer or fitness coach can also assist you in setting goals for routine physical activity. I work with several individuals on creating a periodized program for appropriate progression of physical activity. The goal is to move more and to feel good about the exercise you are doing. The journey to 100 miles begins with taking that first step. I am here to help you and support you, join me and take that first step to a healthier tomorrow!

In good health,

Wendi Irlbeck, MS, RDN

 

Wendi Irlbeck, MS, RDN is a registered dietitian, nutritionist, and fitness coach. Wendi utilizes evidence-based science to tailor nutrition programs for those looking to improve their health and energy. Along with supporting athletes desiring to optimize performance, minimize health risks, and enhance recovery from training while focusing on injury prevention. Wendi partners with parents, sports performance staff, special needs and recreational athletes to offer nutritional guidance and optimal athletic performance & lifestyle plans. Wendi is based in East Lansing, Michigan and is very active on social media platforms such as facebook , twitter and Instagram.

Carbohydrate and Protein Needs for Young Athletes Desiring to Make the Jump from Good to Great!

Bowls filled with granola and berries

There’s No “One-Size-Fits-All” Nutrition Approach

An athlete’s energy and nutrient needs depend individually on his or her age, body composition, goals, and training volume, and depends globally on the demands and intensity of the sport. Put simply, the greater the intensity, duration and frequency of the activity combined with the athlete’s weight or body composition, the higher the demand of protein, carbohydrate and calorie intake.

If you’re a coach, parent or athlete reading this, don’t become overwhelmed. This article intends to introduce to you some general guidelines on optimizing energy needs (i.e. calories, protein, and carbohydrates) to sufficiently support overall health and advance athletic performance.

First rule of thumb, ALL adolescent athletes should consume breakfast, lunch and dinner with 2-3 snacks in between meals to fully optimize energy levels. You must build a plate that includes a source of lean protein, a fruit, a vegetable, a healthy fat and a serving of dairy if you wish to get real and progress with your nutrition. A visual of the plate and practical nutrition strategies can be found in my previous blog here.

Fuel Up to Avoid Stalling Out

Youth athletes have significantly higher nutritional needs than their less-active classmates because athletes need more calories to support performance demands, normal growth, general development and maturation. According to the Academy of Nutrition and Dietetics, female teen athletes need roughly 2,200-3,000 calories and male teen athletes need roughly 3,000-4,000 calories per day (depending upon the individual and sport). Additionally, adolescent athletes training in multiple sports may need upwards of 5,000 calories per day to maintain weight and support growth needs. It’s paramount to encourage adequate calorie consumption during times of heavy training. For perspective, low-energy availability in female adolescent athletes can lead to short stature, increased injury, delayed puberty, poor bone health, metabolic and cardiovascular issues, menstrual irregularities, disordered eating behaviors – this according to a review published in the International Journal of Sport Nutrition and Exercise Metabolism published by Desbrow et al., 2019.

Relative Energy Deficiency Syndrome (RED-S) is a more comprehensive label that builds on the condition of low-energy availability, also known as “female athlete triad,” to describe an energy deficiency gap that results when energy intake is insufficient to support daily activities, living, growth and function. RED-S affects primarily females, but also young males.

Premium Fuel for the Young Athlete – Carbohydrates!

Carbohydrates are an athlete’s most important source of energy for optimal athletic performance. Several studies carried out during the last 50-60 years have consistently highlighted carbohydrates as the primary macronutrient to sustain and enhance physical performance. The Institute of Medicine (IOM) has established that 45-65 percent of calories in one’s diet should come from carbohydrates or between 3 and 8 grams per kilogram of body mass, depending upon the exercise intensity. For example, a 14-year-old female athlete should consume 2,000-2,400 Granola and yogurt with fruit, juice, and eggscalories per day, with 225 – 270 g (45% of total calories) to 325 – 390 g (65% of total calories) from carbohydrates. Keep in mind the dietary reference intake (DRI) remains at 100 g per day and recommended daily allowance (RDA) at 130 g day for all age and sex categories (children ≥ 1 year), both measures not related to physical activity. High-quality carbohydrates for athletes to consume include, but are not limited to, 1. whole grains like pasta, rice, tortillas, bread, oatmeal, low-fat dairy, and energy bars, 2. fruits like berries & bananas, and apples, 3. starchy vegetables like squash, potatoes and eggplant. To experience a boost in energy, consider adding items from this longer list of quality carbohydrate-rich foods to achieve enhanced athletic performance.

Performance tip: Make half your plate carbohydrates if you’re an endurance athlete, especially on heavy training days. The average athlete should be eating around 360-500 grams of carbohydrates per day. Failing to consume enough carbohydrates will cause a decline in performance, cognition, focus, and athletic performance. Time-to-fatigue and injury risk will also increase without enough dietary carbohydrates. To keep it simple, carbohydrates are not “optional”; they are essential. You can take it from an RDN whom stands for science or examine the science for yourself by checking out Nutritional Considerations for Performance in Young Athletes published in the Journal of Sports Medicine.

Power Up with Protein!

Protein is critical for building, maintaining and repairing many cellular structures, like skeletal tissues. Consuming enough protein supports synthesis of hormones, neurotransmitters, energy production, gene activity and transportation of biological molecules. The Institute of Medicine (IOM) has established that 15 to 20 percent of total calories, or about 70-160 grams should derive from high-quality protein sources.

To breakdown the science, consuming adequate protein is critical for proper growth, development and normal physiological function during adolescence leading into adulthood. Distinctive demands during adolescence, especially those that engage in high-intensity sport, call for a greater daily protein intake than that of adults. Currently the RDA for protein is 0.95 g/kg/day for children ages 4-13 years and 0.8 g/kg/day for adolescents between the ages of 14-18. Those that engage in regular training and endurance sports like swimming, rowing, distance running, and soccer may need 1.2-1.4 g/kg/day while power sports like weightlifting, gymnastics, football, wrestling shall require 1.0 – 1.5 g/kg/day .

High-quality protein sources include beef, poultry, bison, pea protein, pork, tuna, turkey, seafood, fish, and dairy products, such as milk, yogurt, whey, cheese and cottage cheese. To find out how much protein some of your favorite sources provide, check out this list from the Academy of Nutrition and Dietetics. Keep in mind that not all proteins are created equal. To deter you from going down the rabbit hole of plant proteins vs. animal proteins, I will simply link an article for you to review here. It’s important to just remember that foods rich in leucine, a branched chain amino acid found in animal proteins, will have the greatest positive affect on driving muscle protein synthesis. We could get really complex on this topic but it’s enough to simply emphasize the importance of consumption of high-quality proteins that are listed above due to their rich leucine content, especially since we are addressing protein intake for adolescent athletes. Most young athletes barely consume enough calories and protein as it is. To keep it simple, make sure your adolescent athlete consumes ¼ of their plate or a 4 oz. serving of a high-quality protein three-five times per day. As I always say, success starts with the basics and carrying them out on a consistent basis.

Failure by your adolescent athlete to consume adequate protein intake will cause declines in energy, weight, muscle growth, and strength, while increasing the likelihood of onset fatigue. Does this mean your adolescent athlete should be slamming protein shakes? Of course not, but they should be consistently consuming whole foods at regular mealtimes. Consuming good old fashioned chocolate milk on-the-go can even be a great way to increase calories while meeting additional protein intake demands. This is especially a great addition to refuel and re-hydrate post-practice or game! Make no mistake, a protein shake or chocolate milk will not make up for missed nutrients from consuming regular meals. Furthermore, supplements like protein powders are not regulated by the FDA and so it is important to select a protein powder that has been third-party tested with a NSF stamp of approval, which deems it certified for sport. This is paramount to ensure there are no banned substances on the label, that the product is manufactured in a facility that follows acceptable manufacturing standards, and that the contents of the supplement match what is printed on the label, ultimately being safe for consumption. To search supplements that are third-party tested and free of any banned substances, check out Informed-Sport.

Stirring it Altogether:

Knowing your carbohydrate and protein intake recommendations is great, but I encourage using the plate as a method of hitting your intake requirements. If you consume a balanced plate with all the components 3-5 times per day with high-quality snacks in between, you’re likely going to meet the energy demands of your sport. Again, it’s important to remember that carbohydrates are the body’s preferred source of energy.

Keeping with the basics such as eating breakfast, lunch and dinner with small snacks in between meals will help improve your health and sport performance. Don’t skip meals and make sure your plate is full of colorful fruits and vegetables. Always choose water or milk over sugary beverage to support hydration and better overall health. It’s time we get back to the basics, which I discuss in detail in the last article I published, available for reference here. As always, nutrition is a secret weapon that can help you perform optimally in the classroom and in sport.

Your sports nutritionist,

Wendi Irlbeck, MS, RDN