Coronavirus Chronicles — More About Bariatric Surgery and COVID-19

A few weeks ago, correspondent Lindsay Peyton wrote for the Houston Chronicle that bariatric surgeries have increased during the pandemic because people understand the link between obesity and COVID-19, and believe that acting promptly in proceeding toward surgery will help them avoid the virus. Heather Sarten, who is director of bariatric navigation at HCA Gulf Coast Division, explains that most of the massive amount of work involved in preparing for this type of surgery can be done remotely. Consequently, she said, “As soon as we opened up and were able to do surgery again, we were jam packed.”

It has been known for some time that patients who are overweight or obese are more likely to develop severe COVID-19, and more likely to die as a result. Suspicions ultimately came closer to certainty: the virus can directly infect fat cells. In fact, it loves to go after “certain immune cells within body fat.” Then, it causes an immune response that makes everything worse. Journalist Roni Caryn Rabin clarifies,

Body fat used to be thought of as inert, a form of storage. But scientists now know that the tissue is biologically active, producing hormones and immune-system proteins that act on other cells, promoting a state of nagging low-grade inflammation even when there is no infection.

Dr. Catherine Blish said, “We’re seeing the same inflammatory cytokines that I see in the blood of the really sick patients being produced in response to infection of those tissues.” Dr. David Kass of Johns Hopkins notes that, as the inflammatory response picks up momentum, cytokines cause additional inflammation, which in turn calls for the release of more cytokines. In trying to defend itself, the body sabotages its own integrity. (The good news is, this discovery could lead to treatments that specialize in penetrating fat.)

In league with others

SARS-CoV-2 is not the first villain to hide in fat. Dr. Vishwa Deep Dixit, who teaches comparative medicine and immunology at Yale, notes that flu and HIV are both prone to conceal themselves there. Somehow, the virus seems to understand that the immune system is at a disadvantage when dealing with what, for a truly obese person, is effectively their largest bodily organ — the mass of fat.

The senior study authors, Dr. Blish and Dr. Tracey McLaughlin, point out the societal implications:

Most American adults are overweight, and 42 percent have obesity. Black, Hispanic, Native American and Alaska Native people in the U.S. have higher obesity rates than white adults and Asian Americans; they have also been disproportionately affected by the pandemic, with death rates roughly double those of white Americans.

Although this particular study had not yet been peer-reviewed, its publication struck a chord with many other researchers. An academic unrelated to the study, Dr. Philipp Scherer, paraphrased a popular Las Vegas advertising slogan — “Whatever happens in fat doesn’t stay in fat.”

At the same time, and although the pandemic has caused an increase in demand for obesity treatment in the United Arab Emirates, a childhood obesity clinic in Abu Dhabi has been telling parents that surgery is not necessarily the quick fix they envision it as. These doctors want parents to take more responsibility, and stop feeding their kids — because if they can’t handle that change of lifestyle today, they will not be successful in losing weight despite surgical intervention.

Your responses and feedback are welcome!

Source: “Here’s why bariatric surgeries have increased during the pandemic,”, 11/28/21
Source: “The Coronavirus Attacks Fat Tissue, Scientists Fin,”, 12/14/21
Source: “UAE child obesity clinic tells parents that diet not surgery is the answer,”, 12/18/21″
Image by Damian Zech/CC BY 2.0

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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