America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine

Jerri-Lynn here. Naked Capitalism has been consistently skeptical that the techno fix fairy, in the form of a safe effective vaccine – is going to make an appearance anytime soon and restore things as before. Obesity is yet another reason to heed the adage: Cave! Hic dragones.

By Sarah Varney,  senior correspondent, Kaiser Health News, who reports on the implementation of the federal health law in the states and the effect of state budget woes on public programs, county governments and vulnerable populations including children and the elderly.  She also reports regularly for NPR’s Morning Edition and All Things Considered, for print publications and, more recently, PBS NewsHour. Originally published at Kaiser Health News

For a world crippled by the coronavirus, salvation hinges on a vaccine.

But in the United States, where at least 4.6 million people have been infected and nearly 155,000 have died, the promise of that vaccine is hampered by a vexing epidemic that long preceded COVID-19: obesity.

Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that COVID-19 vaccines will be any different.

“Will we have a COVID vaccine next year tailored to the obese? No way,” said Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill.

“Will it still work in the obese? Our prediction is no.”

More than 107 million American adults are obese, and their ability to return safely to work, care for their families and resume daily life could be curtailed if the coronavirus vaccine delivers weak immunity for them.

In March, still early in the global pandemic, a little-noticed study from Chinafound that heavier Chinese patients afflicted with COVID-19 were more likely to die than leaner ones, suggesting a perilous future awaited the U.S., whose population is among the heaviest in the world.

And then that future arrived.

As intensive care units in New York, New Jersey and elsewhere filled with patients, the federal Centers for Disease Control and Prevention warned that obese people with a body mass index of 40 or more — known as morbid obesity or about 100 pounds overweight — were among the groups at highest risk of becoming severely ill with COVID-19. About 9% of American adults are in that category.

As weeks passed and a clearer picture of who was being hospitalized came into focus, federal health officials expanded their warning to include people with a body mass index of 30 or more. That vastly expanded the ranks of those considered vulnerable to the most severe cases of infection, to 42.4% of American adults.

Obesity has long been known to be a significant risk factor for death from cardiovascular disease and cancer. But scientists in the emerging field of immunometabolism are finding obesity also interferes with the body’s immune response, putting obese people at greater risk of infection from pathogens such as influenza and the novel coronavirus. In the case of influenza, obesity has emerged as a factor making it more difficult to vaccinate adults against infection. The question is whether that will hold true for COVID-19.

A healthy immune system turns inflammation on and off as needed, calling on white blood cells and sending out proteins to fight infection. Vaccines harness that inflammatory response. But blood tests show that obese people and people with related metabolic risk factors such as high blood pressure and elevated blood sugar levels experience a state of chronic mild inflammation; the inflammation turns on and stays on.

Adipose tissue — or fat — in the belly, the liver and other organs is not inert; it contains specialized cells that send out molecules, like the hormone leptin, that scientists suspect induces this chronic state of inflammation. While the exact biological mechanisms are still being investigated, chronic inflammation seems to interfere with the immune response to vaccines, possibly subjecting obese people to preventable illnesses even after vaccination.

An effective vaccine fuels a controlled burn inside the body, searing into cellular memory a mock invasion that never truly happened.

Evidence that obese people have a blunted response to common vaccines was first observed in 1985 when obese hospital employees who received the hepatitis B vaccine showed a significant decline in protection 11 months later that was not observed in non-obese employees. The finding was replicated in a follow-up study that used longer needles to ensure the vaccine was injected into muscle and not fat.

Researchers found similar problems with the hepatitis A vaccine, and other studies have found significant declines in the antibody protection induced by tetanus and rabies vaccines in obese people.

“Obesity is a serious global problem, and the suboptimal vaccine-induced immune responses observed in the obese population cannot be ignored,” pleaded researchers from the Mayo Clinic’s Vaccine Research Group in a 2015 study published in the journal Vaccine.

Vaccines also are known to be less effective in older adults, which is why those 65 and older receive a supercharged annual influenza vaccine that contains far more flu virus antigens to help juice up their immune response.

By contrast, the diminished protection of the obese population — both adults and children — has been largely ignored.

“I’m not entirely sure why vaccine efficacy in this population hasn’t been more well reported,” said Catherine Andersen, an assistant professor of biology at Fairfield University who studies obesity and metabolic diseases. “It’s a missed opportunity for greater public health intervention.”

In 2017, scientists at UNC-Chapel Hill provided a critical clue about the limitations of the influenza vaccine. In a paper published in the International Journal of Obesity, they showed for the first time that vaccinated obese adults were twice as likely as adults of a healthy weight to develop influenza or flu-like illness.

Curiously, they found that adults with obesity did produce a protective level of antibodies to the influenza vaccine, but they still responded poorly.

“That was the mystery,” said Chad Petit, an influenza virologist at the University of Alabama.

One hypothesis, Petit said, is that obesity may trigger a metabolic dysregulation of T cells, white blood cells critical to the immune response. “It’s not insurmountable,” said Petit, who is researching COVID-19 in obese patients. “We can design better vaccines that might overcome this discrepancy.”

Historically, people with high BMIs often have been excluded from drug trials because they frequently have related chronic conditions that might mask the results. The clinical trials underway to test the safety and efficacy of a coronavirus vaccine do not have a BMI exclusion and will include people with obesity, said Dr. Larry Corey, of the Fred Hutchinson Cancer Research Center, who is overseeing the phase 3 trials sponsored by the National Institutes of Health.

Although trial coordinators are not specifically focused on obesity as a potential complication, Corey said, participants’ BMI will be documented and results evaluated.

Dr. Timothy Garvey, an endocrinologist and director of diabetes research at the University of Alabama, was among those who stressed that, despite the lingering questions, it is still safer for obese people to get vaccinated than not.

“The influenza vaccine still works in patients with obesity, but just not as well,” Garvey said. “We still want them to get vaccinated.”

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  1. The Historian

    While I don’t disagree at all with what this author is saying, to an obese person this article is going to sound like more fat-shaming. I see it as more putting the cart before the horse.

    I have many friends that are obese and I had a mother who weighed close to 300 lbs when she died at the age of 98. After seeing what my friends have gone through, including bariatric surgeries, I know obesity is just more than a lack of will-power.. While I don’t expect US doctors to do much about investigating the causes of obesity, I am heartened that Canada is now trying a different approach:

      1. kareninca

        Yes, that’s right. Two years ago I had to be with a relative in the hospital, and there was nothing to eat but what was around. So for the first time in forty years I ate a McDonald’s cheeseburger. I don’t ordinarily eat any processed food. That cheeseburger totally took over my brain, and it is still there. I just couldn’t believe how good it tasted. I haven’t had another since for a variety of reasons, but I can understand how someone could not resist.

        When we moved to Silicon Valley 24 years ago I never saw extremely overweight people here, but I do now. I read a couple of years ago that the fastest growing group of obese people was the well off (I can’t find the link). Since the poor and middle class had already been taken over, presumably.

        I don’t eat out at all. I guess that is why I am nearly the only person in my extended family who is not overweight. But guess what – my overweight relatives are mostly healthier than I am! So there is that.

        1. CT

          McDonald’s sells salads, including a chicken salad with 22g protein, 1g fat and 6g carbs for 3$. I eat it frequently.

          I know, I know, everybody knows someone who is “super overweight and like, totally, like healthy” but the science is settled and clear. It is extremely unhealthy to be overweight.

          It is also a choice. It is a choice to be overweight. Americans are unable to make decent choices, so their choices should be restricted.

          1. Code Name D

            Being overweight is a choice in the same way becoming and staying a smoker is a choice. With smoking, “choice” ignores the addictive properties of nicotine as well as the constant gaslighting and propaganda campaigns. Sugar also has addictive properties, and its everywhere, literally on every street corner. To eat better to stay healthy requires monumental efforts that are beyond the means of most Americans.

            I often seem arguments that “Oh its so easy to eat healthy, it just takes 15 minutes in the kitchen.” Really. For a person who works three jobs, my AREADY have health problems, has three kids, and doesn’t even HAVE a kitchen, let alone a stove, cooking pots & utensils, refrigerator, or never exposed to basic cooking techniques, and you are going to have them cook three 15 minute meals for five people, three times a day, every day? You start to see the problem poverty generates.

            At the end of the day, there isn’t really any “choice” at all. Most people are setup to fail by the system, then have the nerve to blame the victim.

            1. Anthony G Stegman

              The majority of obese Americans are not extreme poverty stricken. The obesity epidemic has many causes – lack of self discipline, laziness and sloth, culture, healthy food deserts, emotional/psychological issues, medical issues, government policy. Not having time to prepare healthy meals is a personal choice, not something thrust upon us by evil doers.

              1. SAKMAN

                LOL, and you know because you are not overweight.

                Just like the people that claim coronavirus is a lie because they havent gotten yet or didnt really get sick.

                Get in the body of a fat person and then tell me about it. Sure, everything is a choice, but many people have been making unhealthy choices for far too long, and habits are very hard to break.

            2. oakland

              Comparing smoking to overeating is ridiculous. As a 20 year smoker, almost 2 packs a day, let me tell you that quitting smoking is easy compared to losing and keeping off weight. Smoking all you have to do is stop – not even one. Food must be managed. You cannot not just quit eating all together unless you want to die to get thin. Reducing caloric intake only makes our efficient bodies burn fewer calories. As we age, the number of calories we naturally burn goes down. Some people can’t even eat 1200 calories in a whole day without taking in more than their bodies burn.

          2. kareninca

            Wait – first you say that it is a choice. Then you say that people are unable to make good choices. If people are unable to make good choices, then it is not really a choice.

            It’s not just Americans. There is a terrible problem in India with fast food, and in Mexico and in Saudi Arabia.

            I consider my ability to resist manufactured food to be a matter of good luck on my part. I do not presume to be holier. But then I have a degree in philosophy and I think freedom of the will is a helpful illusion that is typically used to make people feel bad about themselves.

          3. a different chris

            >It is also a choice. It is a choice to be overweight. Americans are unable to make decent choices, so their choices should be restricted.

            That is such a level of BS I hardly know where to begin.

            I guess height is a “choice”. Sexual orientation, well all those gay people just want to p*ss off their parents. That 2 year old on a ventilator? Get with the program, kid!

            There are serious problems with the way Americans, and more and more the Western world in general eats. But people like you have the cause/effect, that is the blame, completely reversed.

        2. stan6565

          You are dead right about the instant hooking effect of Mac feed. I get to have a big mac , maybe once a year or so, but when I do, I want some more and I want it now!

          When I check the ingredients, of course, there is bun freshly baked from the heavenly highlands of wheat nirvana, the wagyu beef raised on Mozart and freshest tomato that never ever even went past the hydrophonic Monsanto bath.

          But, but, where is the note of the addiction making substance ?

          Heroin? Crack? Meth? What gets inserted there the last second before the counter?

          1. a different chris

            Hmmm. They taste like soggy toilet paper to me with a too generous helping of salt, but I guess opinions differ.

        3. Darius

          Make your own cheeseburgers. It’s pretty simple. They taste better and they’re more satisfying. Season with salt and pepper, or other things, as you like. Put a big ol’ tomato slice on it. Spicy brown mustard. I get frozen preformed patties at the grocery store. But you can get lean ground beef. Customize it any way you want. Experiment. It’s more work than going to Mac’s, but that is a good thing. And it’s less work than a lot of other foods.

          Save the grease and cook other things in it. It’s tasty. Or make gravy.

    1. marieann

      This is a topic close to my heart.I have struggled with weight gain all my life.

      I think doctors are not equipped to deal with obesity issues or any food/diet related problem. They get little nutrition teaching when in school.

      We cannot deal with obesity without dealing with the food industry that has adulterated all of our food. The only way to eat well is not to buy any prepackaged food unless one can read the labels and understand them.

      For example I stopped buying regular peanut butter a few years when I started reading labels. I discovered it contained icing sugar, the peanut butter today contains(besides peanuts) sugar, hydrogenated vegetable oil, salt and molasses(another sugar) Everything on the shelves today contains more and more added ingredients,the lists are long and difficult to read….and who besides a senior has time to read and understand everything in the food.

      I belong to a weight support group I am the leader. We have a few obese members and one who has had the bariatric surgery,she still struggles with her weight. She tells us awful stories about how she was abused because of her weight, from the family doctor making her get on the scale every visit even if she was just there for a flu shot, to strangers on elevators telling her to just stop eating.

      There are many reasons why we are an obese nation. I believe some of the blame is with our out of control food companies and the fact that all our holidays/events celebrations are all about food.

      1. Arizona Slim

        You can make your own peanut butter. I do. It involves grinding peanuts in a food processor. No added ingredients necessary.

          1. a different chris

            Weirdly enough there is a really good peanut butter available from….Smucker’s. Yes you read that right, must have just slipped by corporate somehow. It’s made in New Bethlehem, PA and you get to smell it cooking when you bicycle by on the (really, really, really nice) Redbank Creek Trail.

            There is no identification on the label that it’s made there, just Smucker’s All Natural “made in the USA” but the ingredient list is just peanuts.

      2. WhoaMolly

        Adams makes an ‘only peanut’ butter. Good but expensive.
        Making one’s own nut butter is surprisingly easy.

        1. wilroncanada

          We buy Adams peanut butter. It is produced by Smuckers. Buy the 500ml jar because it is easier to blend (the oils rise to the top). And store it upside-down in the cupboard, or the refrigerator after opening. It is on sale here–Vancouver Island–by one or other of the major food chains regularly (or buy one get one free, or with a coupon hanging on the jar itself).

      3. JohnnySacks

        A highly cynical market focused take would be that there’s no money to be had in preemptively addressing the obesity epidemic, but diabetes, heart disease, etc. are the gifts which keep on giving.

        Many insurance plans are trying to do their part to offset the health impact using wellness plans and fitness reimbursements, but access to benefits is spotty and they’re easily gamed by participants and smell more like superficial performative actions.

        A logical observation is that there’s been (as ususl) legislative capture by conglomerates producing highly processed foods in order to maintain their subsidies vs. subsidies for healthier food sources. This should be addressed similar to the way we addressed the tobacco epidemic which wiped out a generation.

    2. JohnMc

      There are two kinds of overweight: one kind where the person is metabolically healthy (fat stored subcutaneously) and the other where the person is metabolically unhealthy (fat stored in and around the abdominal organs). In addition, a person can have a reasonable BMI but be metabolically unhealthy (know as TOFI, or thin on the outside, fat on the inside). In other words, obesity is merely a symptom of metabolic dysregulation. The other symptoms, in addition to central adiposity, are hypertension, low HDL, high triglycerides and elevated fasting glucose. Does the medical community treat these conditions as manifestations of a single physiological problem? No they do not. They’ll give you a prescription for each individually and do nothing to identify or resolve the underlying cause.

      Which is? I won’t venture anything more conclusive than, ‘It’s complicated.’ But personally i put my money on excess processed food consumption. My rule is to attempt to eat nothing with a nutrition label on it.

      Here’s another timely article on the obesity/covid connection which puts much of the responsibility on the food industry:

      1. Carolinian

        Thanks for informed comment. Of course the food industry would say they are just giving Americans what they want, throwing the “who’s to blame” question back on the consumer. And price and convenience undoubtedly play a role for less affluent Americans who have to hold down jobs without time to prepare time consuming home made meals.

        There was a story today in the local paper talking about the high proportion of Spanish speakers among the local worst stricken. And African Americans also seem to get Covid at a higher rate. None of this gets talked about much, but perhaps should be when stories are written about high rates in the South or food processing plants (almost entirely staffed by documented and undocumented immigrants).

        Is the Safe (mental) Space craze at war with safe health necessity?

        1. Keith

          One theory regarding this issue regards Vitamin D deficiency. I do not have the link, it was from a Mark’s Daily Apple a while back (link love edition). The doctor was a Brit and observed that darker skinned people died at a higher rate than white or Oriental Asian. To refute possible socio-economic issues, he pointed out that doctors of Pakistani and Indian origin also died at higher rates. He then pointed out to people with lighter skins being better adapted at processing sunlight to convert to Vitamin D, which in Britain, is harder due to the longitude (or latitude- I mix those up). I read something similar regarding WA state, namely that Vit D can be synthesized by the body only in the summer. I suspect nutrition does play a big role, but being as medical schools are often funded by big pharma, it is not necessarily a subject taught, as why eat healthy when you can pop a pill.

          1. Mildred

            Or, you can do both. Organic food only, hard work, sunbathing, and high quality Vitamin D tablets, as well as zinc.

            1. Dan

              high quality Vitamin D tablets, as well as zinc

              Any particular brand you recommend? I’ve found Thorne pharmaceuticals to be good quality, but they’re somewhat expensive. I also like Oregon’s Wild Harvest supplements. But end-stage capitalism makes it hard to trust any of these companies.

              1. drumlin woodchuckles

                I wonder if we could work up some rules of thumb for gauging the trustworthiness of a company unknown to us.

                Things like . . . the less advertising, the more trustworthing? Especially, the less self-reputation-polishing advertising, the more trustworthing?

                Companies which have declined buy-out opportunities or growth opportunities? Companies whose product is not ” new and improved”?
                WD40 hasn’t been “new and improved” for many decades, for instance.

                Sometimes rules of thumb aren’t going to be enough. Particular knowledge of the subject matter and one’s own taste may be necessary.
                I used to like and use Bragg’s Aminos.
                I liked it so much I bought a bunch of it on special sale. Just recently I ran out and bought another bottle at regular price. It was too salty to bear. What had happened? I compared the new label to the old legacy label I had saved. ” Old” Bragg’s had 120mg of Sodium per 5ml. ” New” Bragg’s has 390 mg of Sodium per 5ml. I can never use Bragg’s Aminos again. Why did they do that?

          2. Janie

            Keith at 1.28 – some memory aids. Longitude lines are long, pole to pole. Latitude lines are broad, as in “you have wide latitude to do …”. Latitude lines are called parallels of latitude; longitude lines can’t be parallel because they run like segment lines on citrus fruit.

            Thanks for comment and note about Mark’s site :-)

      2. Paul O

        Some may find this useful. I think Royal Institute content is available from most locations.

        He has done use useful stuff on the BBC. Though many people here (UK) still think the problem is greed and lack of will.

        A subject close to my heart but not sure my personal story would add much.

    3. Hayek's Heelbiter

      Fat shaming blames the individual and personality. But scientists have figured out that gut buggies do have an enormous impact on obesity, which has nothing to do with psychological factors (other than the fact that the Food Industrial Complex designs foods to be addictive).

      It is known that most of the human’s populations microbiota is composed by 5 phyla: Bacteroidetes, Firmicutes, Actinobacteria, Proteobacteria, and Verrucomicrobia [9] being Bacteroidetes and Firmicutes around 90% of the total bacterial species [9, 10].
      The composition of the bacterial diversity seems to change between lean and obese, increasing the number of Firmicutes to the detriment of Bacteroidetes [9, 11–13] in obese patients and also in type 2 diabetes, which is pathology in close relationship to obesity.

      The following article is from 2004.

      The increased use of HFCS in the United States mirrors the rapid increase in obesity. The digestion, absorption, and metabolism of fructose differ from those of glucose. Hepatic metabolism of fructose favors de novo lipogenesis.

      I believe the word “mirrors” (implying an inversion) should actually be “parallels”.

      And putting them both together

      The HG[lucose]D- and HFr[uctose]D-fed mice lost gut microbial diversity, characterized by a lower proportion of Bacteroidetes and a markedly increased proportion of Proteobacteria…High levels of glucose or fructose in the diet regulate the gut microbiota and increase intestinal permeability, which precedes the development of metabolic endotoxemia, inflammation, and lipid accumulation, ultimately leading to hepatic steatosis and normal-weight obesity

      1. Janie

        Hmmm. I wonder if microbiota imbalance stubbornly remains during and after weight loss, making it so hard to maintain the loss.

        1. Hayek's Heelbiter

          Though it works in the other direction. You might find this interesting:

          Changes in Gut Microbiota Composition after Bariatric Surgery:
          In our study, Roux-en-Y gastric bypass induced major microbial differences and greater weight loss compared with laparoscopic sleeve gastrectomy. Analyzing the microbiota composition, a proliferation of potential pathogens and the onset of beneficial bacteria was observed.

      2. Justin Time

        Well, now talking about gut biomes, we should also consider the overuse of antibiotics as well. A course of antibiotics to wipe out the native biome combined with a diet high in processed foods and HFCS will breed a very narrow range of microbes.

    1. Mildred

      Because that’s all some people have, since their minds have been colonized by the anti Trump fungus that causes them to climb to the highest place and shout about him. If Biden’s elected these people are going to go into shock. Their entire intellectual repertoire will have zero value.

    2. John Anthony La Pietra

      It doesn”t. Because it isn’t. No matter how good it may be for corporate media to pretend to believe it is.

    1. Keith

      They suffer as they are unhealthy. Obesity is often linked to diabetes, too, which can be blamed for almost any ailment.

  2. Synoia

    IMHO Two major contributors to Obesity are Cars, aka the Suburban lifestyle, and Air Conditioning which makes going outside in a hot humid climate extra unpleasant.

    Loose your car, get a bike.

    Turn off the a/c. Go for walks.

    I can remember comments about “Fat Americans” from my childhood in the ’50s.

    1. Tinky

      I grew up in the U.S. in the ’60s and ’70s, and the number or percentage of significantly overweight Americans was very small relative to today. In fact, according to the CDC, these eye-popping changes occurred since (as recently as) 1999:

      From 1999–2000 through 2017–2018, the prevalence of obesity increased from 30.5% to 42.4%, and the prevalence of severe obesity increased from 4.7% to 9.2%

      Since 1975, adult obesity has more than doubled from around 15% to ~42% today. Childhood obesity was around 5%, and is now ~18%.

      Having said all of that, I can understand how Europeans (for example) might have considered the average American tourist to be “fat”, relative to local populations, and particularly given that a good percentage of such tourists had money, and were likely “well fed”.

        1. John Anthony La Pietra

          One of the old Doonesbury collection books is titled “A Tad Overweight, but Violet Eyes to Die For”.

  3. Henry

    According to Dr Jason Fung in his book ‘The Obesity Code‘, obesity is a hormonal disorder, in that persistently high levels of insulin drive fat storage.

    In the West, our high level of processed carb consumption keeps our insulin levels high, but do not leave us feeling full, hence more carb cravings, more fat storage, and on and on…

    Type 2 diabetes is the result of the eventual failure of our body to generate enough insulin to cope with these constant peaks. Rates of Type 2 Diabetes are high, but underestimated, not least because the medical establishment diagnoses it by testing blood glucose levels (secondary indicator) NOT insulin levels (primary indicator).

    All the other stuff we hear like ‘eat less move more’, ‘calories in, calories out’ serves as a useful distraction from the real causes of obesity.

    TL:DR Here’s a 2 minute video of Dr Jason Fung on how insulin drives obesity:

    What happens when you eat…

    1. Yves Smith

      I have trouble with this theory. I was a very fat kid, now a not fat adult, and I never have hunger pangs and similarly never ate to feel full, which says insulin never was the driver of when I eat. Now I will get cranky, look at a clock, and realize it might be low blood sugar if I haven’t eaten in 6+ hours.

      1. KLG

        Insulin is not the driver of when anyone eats. That hormonal biology is complicated, and it differs between rodents and humans. Which complicates this particular science.

        The science, outside of that associated with the “Great American Food System,” is clear. Starting in the 1950s dietary fat was demonized based on errant common sense (eat fat-get fat) that drove Ancel Keys of the University of Minnesota to develop the diet-heart hypothesis. The American Heart Association went all-in on the hypothesis, and what is called “nutrition science” followed, as lemmings over the proverbial cliff. Fat calories were replaced with carbohydrates, mostly in food-like substances that come in boxes in the center aisles of the typical American grocery store. The resulting increase in glucose levels as people ate too much of this crap (crapification of the human diet has a ring to it here), raised insulin levels. Insulin is the major anabolic hormone. Glucose is converted into 2-carbon units in the form of acetyl-CoA and stored as fat. Chronic overeating of glucose (doesn’t matter the source) results in abnormally high, persistent levels of insulin. The dysregulation of this normal hormonal balance leads to metabolic syndrome…obesity, high serum triglycerides, reduced HDL, elevated blood pressure, elevated fasting glucose (Type 2 diabetes).

        Cholesterol is a separate but related issue. How many have read the 2015 USDA Guidelines on dietary cholesterol? The 2015 guidelines will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol, consistent with the AHA/ACC report. Cholesterol is not a nutrient of concern for over-consumption. I’m guessing no one. But many will remember the Time magazine cover from 26 March 1984 and the subsequent hysteria about eggs, bacon, meat…Turns out the current response from those who should know better, channels Emily Litella: Never mind, sotto voce. No need to ask how much money Pfizer et al. have made hawking statins as the cure-all.

        This is not the place to go deeper into this, which I presented in Grand Rounds to our Department of Internal Medicine last year, but you can get started reading the work of Gerald Reaven, who came up with the metabolic syndrome hypothesis, and the popular but serious work of Gary Taubes, Nina Teicholz, and John Yudkin (who was the first to show the danger of a diet high in glucose. Robert Lustig of UCSF is also useful for the scientifically minded among the NC readership).

        The contested issue of fructose (half of a molecule of table sugar; high-fructose corn syrup) is another issue, covered in a review entitled “Carbotoxicity,” which may be available from the journal Cell (Volume 175: 605-614, 18 October 2018). It is not an accident that the authors of this comprehensive review are generally not from the US.

        Anyway, my one-slide summary:

        1. Dietary lipids (including cholesterol, which is not a lipid) are demonized based on little more than “That makes sense: Eat fat, get fat.”

        2. The public follows the Great (sic) American Food System, and fats in the diet are replaced by (mostly) refined carbohydrates.
        Insulin dysregulation ensues in a large subset of otherwise ‘normal’ people.

        3. Obesity, Type-2 diabetes, and Metabolic Syndrome are the result.

        Want to lose weight by changing your diet rather than going on a diet? Cut out soft drinks, most bread and pasta, and eat more protein and fat. Really. It works, and it is healthy. Unless you are a competitive swimmer or Tour de France cyclist, exercise will not do the trick.

        Now, back to work.

        1. eg

          Excellent comment and consistent with my own review of the literature and personal experience. Unfortunately, psychological triggers from my misspent past and a weakness for alcohol leave me struggling with my weight despite my knowledge of what must be done to minimize my metabolic dysregulation.

          Once an addict, always an addict …

        2. carl

          Best most informed comment on the thread. Might differ with you a bit on Taubes: it’s a pretty dense work to wade through. Worth it, though.

        3. Krystyn Podgajski

          “Cut out soft drinks, most bread and pasta, and eat more protein and fat.”

          Hey, just stop this, please, these generic “do this” statements, I beg you. Eat more fat is fine for people in the middle of the bell curve but not for those on the genetic fringes who probably make up more people with metabolic disorders.

          “TCF7L2 genetic variants modulate the effect of dietary fat intake on changes in body composition during a weight-loss intervention” is one good example. And it is my personal example.

          And what kind of fats? Omega 6, Omega 3, saturated Monounsaturated? And what about plant cholesterol and sitosterolemia? No, sorry, we are all so individual, watch your own body, get frequent labs, and ignore what everyone says.

        4. baldski

          How does one explain the far east with regard to carbs? I have been to southeast Asia many times and I do not see a problem in the populations with obesity even though they are huge rice consumers.

      2. anon

        The number of fad diets is endless, as well as seemingly credible people pushing said diets. Whoever you subscribe to, make sure they cite peer reviewed studies from credible journals to justify their recomendations.

        I’m a fan of Dr. Greger of

      3. Krystyn Podgajski

        There are probably a hundred causes of metabolic obesity. Genetics will drive your own risks regarding activity and food so anyone promoting a single cause (carbs! fat!) should be dismissed. For myself, I like to store the fat I eat (Inuit) and I loose a lot more weight in a cooler environment.

        Just be aware of your body. No more needs to be said. The only cure for the majority of obesity is self awareness. If that fails, see a genetic specialist.

        But for most, the body will be healthier with low calories and low activity since it will lower oxidative stress. So just do less as well.

      4. David Nataf

        Dr. Fung doesn’t claim that insulin is the only hormone responsible for anybody bring obese. Rather, it’s that hyperinsulinemia is responsible for the increasing rates of obesity.

        He does discuss how other hormones such as cortisol and the sex hormones can contribute as well.

    2. kareninca

      I’m not overweight but I bought Fung’s book and tried his fasting method to try to get my blood sugar down. It worked great for that but it made my blood pressure skyrocket. I tried it several times, months apart, with the same results. I then went online and it turns out that this is not rare for women. But Fung pretends it isn’t the case; he claims that fasting is just fabulous for nearly everyone. Well, it is good for some people, I presume. So do your own due diligence when reading Fung.

      1. Keith

        I have read fasting affects the genders differently, with men doing better than women. An explanation I find quite plausible is that a women’s body starts to shut down when fasting, as the body interprets it as a period of shortage and a danger to become pregnant. It wants to wait for a period of plenty. Men in contrast, is the opposite reaction. The body views fasting as a scarcity of resources and a last chance for promote its gene pool, and so goes into hyperdrive. Anecdotally, when I am in fasted mode, I feel great and can conquer the world, whereas if my girlfriend hasn’t eaten, murdering me is seemed sometimes a reasonable reaction to my antics.

    3. WhoaMolly

      Tried Fung’s recommended intermittent fasting. After one week:
      – Glucose down.
      – Blood pressure down.
      – Resting heart rate down.
      – Lost about five pounds, which pretty much stayed off.

      I’ve been a fat kid and fat adult all my life. Seems like I have tried every diet and exercise routine known to humankind. Maybe not the Masai ‘blood drinking one’… but most of others.

      Only things I know for sure:
      – There is absolutely no one-size-fits-all diet.
      – High carb foods like rice, potatoes, fruit and bread mean I gain weight immediately.
      – The only time I’ve been at normal-ish weight is when I’ve been exercising an hour a day, six days a week, doing something that leaves me dripping with sweat. Anything less doesn’t work.
      – No eating/weight control strategy works for me without an hour a day of vigorous exercise.
      – At least twice a year, I can plan on a well meaning (?) person to take it upon themselves to explain to me what I’m doing wrong, and how I should eat and exercise to be ‘healthy’ like them. The underlying message is always that I’m fat because I’m stupid, slovenly and morally deficient. Maybe.
      – I grew up in the 50’s and 60’s and extremely fat people were extraordinarily rare. Now I go to WalMart and it seems that 70% of the people I see are obese, including kids.

        1. Wukchumni

          I noticed we started getting fat when the all-you-can-drink soda counters started showing up @ fast food & convenience stores.

          Would’ve been around 30 years ago…

  4. Plague Species

    Obesity, by and large, is a matter of self-discipline, plain and simple. Any other explanation for the epidemic is apologia and cover for bad choices.


    1. pebird

      Respectfully disagree.

      When we see such a marked increase in obesity and diabetes in a relatively short time corresponding with a dramatic change in the food supply composition, believing it is due to individual choice is not convincing.

      But I understand why people like to think so.

      1. Plague Species

        Well, one thing I know for sure, we’ll soon enough find out. With America slipping into second and then third world status within a decade or two, and the food supply dwindles, we’ll see what happens with the obesity epidemic. Last time I checked, there were no obese prisoners in the Nazi concentration camps. Sure, the quality of your calories matters, but the amount of calories taken in versus the amount burned ultimately dictates weight. There is latitude within that equation for various metabolisms, but metabolism doesn’t negate the equation altogether.

        1. Massinissa

          That was due to starvation for months or years at a time. We won’t see any effects ‘soon’, at least not unless you mean sometime in 2021 is ‘soon’.

        2. KLG

          “…but the amount of calories taken in versus the amount burned ultimately dictates weight…”

          No, again. This is another example of errant common sense, one that has been used for years to shame people. A colleague has a grant from some obscure federal agency to encourage obese rural women who live in food deserts to “exercise every day” to lose weight. This will only further discourage and shame these fellow citizens, because the approach will not work (unless they begin seriously preparing to participate in triathlons). This doesn’t excuse the glutton, but most obese people are not gluttons. They eat crapified food-like substances because that is what has been largely available to them, beginning in the mid-1960s. Especially for the poor and otherwise underserved who don’t have the wherewithal to buy “artisanal” real food.

          If a calorie is a calorie, then what is to stop me from using coal in my natural gas furnace? A calorie is not a calorie except in a bomb calorimeter, which is used to determine the caloric content of organic materials, including “food.” Which equation do you mean? The thermodynamics of metabolism is not path-independent, as with complete oxidation by combustion in that calorimeter. It matters a great deal what is consumed by an individual. 500 calories of high-fructose corn syrup seasoned with table sugar, artificial fat, and salt, bought from the corner convenience store is much different from 450 calories of protein and fat, with 50 calories of mixed carbohydrates thrown into the mix. Eat the former and get fat, which is exacerbated by a very fleeting satiety. Eat the latter and most of the calories are used in fatty acid oxidation instead of being stored, plus you will not get hungry again for hours. The amino acids from the protein will be used as building blocks for turnover and growth and to maintain the normal blood glucose level necessary for brain and red blood cell function through gluconeogenesis, with ketone bodies derived from fat accounting for the remaining need.

          Richard Feinman, Nutrition in Crisis, Chelsea Green, 2019. Chapter 9 is an excellent place to begin, but I admit it caused bad flashbacks to Advanced Physical Chemistry with me, where the biologist was outclassed by the chemistry and physics majors. Some nutrition textbooks make a passing wave at thermodynamics, but not much more than to misstate something about entropy and enthalpy. A note on Chelsea Green: They are better with organic gardening, biographies, and such, but this particular book is well documented, if justifiably polemical in places. The author is a bit obstreperous on fructose, seeming to think that one hexose (6-carbon sugar: glucose, galactose, mannose, and fructose for the current discussion) in human food is the same as another. In many bacteria, yes. In most, if not all animals, not so much.

          Sorry for being tl;dr, but this is important.

          BTW, Kudos on the Nazi concentration camp straw man! When the world shrinks and food is produced as it should be, we might be poorer by neoliberal standards, but we can be better nourished as were our forebears who ate real food produced by themselves or their neighbors.

          1. Krystyn Podgajski

            “Nazi concentration camp straw man”


            Calories absolutely do matter, as several famines have proven true. Your issues is that you are equivocating people consuming different foods at adequate caloric intakes with people eating zero food. I am not saying these people are well nourished but they do loose weight. One should push for a Calorie Restricted diet Optimal Nutrition diet.(CRON) I mean what, no mention of how magnesium is lost with glucose loading?

            In 1973 there was a 470lb man who went on a fast for 380 days with doctors testing him along the way. (“Features of a successful therapeutic fast of 382 day’s duration”) He just needed some supplements but he managed to get to his ideal weight. So yes, calories matter, and so does the food you eat. No need to take sides.

    2. carl

      The food industry embraces this concept. Do more exercise, and our products are part of a healthy diet. If you’re fat, you didn’t exercise. See how this removes them from any responsibility for shoveling poison in front of people?

    3. kareninca

      “Obesity, by and large, is a matter of self-discipline, plain and simple. Any other explanation for the epidemic is apologia and cover for bad choices.”

      Here we have found the terminal moraine of Old Time Christian Moralizing.

  5. rtah100

    This article was more interesting than the headline. I was not aware of a defective acquired immune response in obese patients. However the headline sounded like yet another “obesity is a risk factor for severe COVID-19” sermon when all the UK ICU data point to IC admittance matching the weight structure of the wider population, adjusted for the age structure of admittance.

    I wonder if the immune dysfunction in obese patients is really a result of chronic inflammation. It may be a result of poor diet (lack / malabsorbtion / diversion of essential minerals and nutrients). It does not sound like there are enough studies that it can have been checked.

  6. will nadauld

    I’ve been heavy almost my entire adult life from about the age of 12 on. One year in my early twenties I lost all the weight , eating whole foods , lots of salmon and salad and egg whites. I was also running roughly four hours a day and riding my bike as a primary source of transportation. Also weight training 4 days a week.
    Found a girl and got married and quit working out so much. Then started making poor food choices again. 3 years later I had put most of my weight back on (120lbs.)
    I worked as a framing carpenter for 15 years and ate what I felt like and drank beer often and was able to maintain being about 70 or 80 lbs overweight burning so many calories working.

    Got a less strenuous job and really packed the weight on for a year. I am slowly taking it back off now.
    I just eat dinner now, 1500 calories is my limit. Been at it for a month and have lost 30 lbs. Its easier to control my eating just not eating then it is to try and eat right all day.

    My doctor says i dont have high blood pressure, I’m not pre diabetic, and if I stay active I will be fine.
    Being obese is like being in a prison you cant escape from.

    Discipline and will power are a large part of the problem, but not the whole story. I am quite disciolined in other areas, just struggle with food and over eating.

    I am never sick. I have had one cold in 5 plus years. I am surely not wanting to be a vector for covid spread due to diminished vaccine response. I’m actually kind of an essential worker and wont be able to isolate much.

  7. ahimsa

    This is on of those times I feel I have to compliment the NC commentariat for its considered discussion of an emotive topic!

    As a European who has visited and lived in the USA it was quite clear to me that the major contributing cause was the quality of food widely available in US . Of course, the sedentary car/tv lifestyle certainly doesn’t help.

  8. Plague Species

    Not to worry, no self-discipline needed. No empowerment. Everyone can still mire in the misery and still eat all they want to drown their sorrows and satiate their genetic defects that prevent them from processing calories effectively. Vlad Putin’s scientists have developed a vaccine for obesity so now you can gorge to your heart’s delight with no consequences except a newfound penchant for vodka. If you sign up for your shot today, you get a free Harley.

    Seriously, the lengths people will go to in order to perpetuate bad habits. Having spent some time around addicts, all this jumping through hoops is precisely the rationalizations used by addicts to perpetuate their addiction. It’s not a coincidence that drug addiction is also increasingly rationalized as a disability versus a cascade of bad choices, one after another on the road to disempowerment.

    1. cripes

      Plague Species

      Your “personal responsibility” diatribes, age bashing etc are an affront and insult to anyone over the age of 6 and not still nursing from a silver spoon. But your juvenile, flippant disregard for facts renders you unfit for adult conversation.

      Everything you post is a sack of pompous reactionary libertarian, poors-hating trash lifted straight from the Pete Peterson Foundation’s war on social security, M4A and “welfare.” Perhaps you got a free copy of the Fountainhead there and mistook it as a bible instead.
      Why are you posting here, instead of sending your resume there? Lazy?

      No, “drug addiction is (not) also increasingly rationalized as a disability versus a cascade of bad choices,” it has actually been removed from every state’s qualifying criteria for disability during the 1980’s and 1990’s, or 20-30 years ago, thanks to Reagan and Clintons’ war on poor people.

      I don’t have time to refute your incessant lies, so stop making sh*t up,

      I’m sure Sleepy Joe will need more speech writers to launch his austerity campaign come 2021.
      Take your repulsive poison there. Where you belong.

  9. Anonymous

    How about this hypothesis:

    Excess consumption (of food, drugs, alcohol, etc.) is the pitiful compensation the population receives for being reduced to rent, wage and debt slaves by an unjust economic system?

    I.e. the “mess of pottage” for legally stolen family farms, businesses, and the commons?

    Then reverse the theft and the health of the population should improve.

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