Strong evidence that obesity is a major risk factor in Covid-19 severity and poses an increased risk of death has now been demonstrated across multiple studies around the world. The evidence all points to obesity as the preexisting condition with the largest impact on unfavorable outcomes, across all age groups.
The data is especially striking for younger adults, long thought to be at a much lower risk for serious illness from Covid-19. One NYU Langone study of 3,615 Covid patients under 60 years of age showed that “Patients with a BMI of 30-34 were twice as likely to get admitted to the hospital or to be admitted to acute care. Patients with a BMI of 35 or higher were twice as likely to be admitted to the hospital, and three times as likely to end up in the intensive care unit.”
A CDC study found that of its patients, “89% had at least one underlying condition, with obesity being the most common for those between 18 and 64.” A Chinese study showed that obesity tripled the risk of a severe case versus those of normal weights.
Data from UK hospitalizations is even more stark, showing that obesity and metabolic syndrome are associated with a 10 times increase in death. In an article entitled “Covid 19 and the elephant in the room”, Dr. Aseem Malhotra states it bluntly; “OBESITY, THE REAL KILLER BEHIND COVID”
Data from a set of studies in France recently published in The Lancet looked at the percentage of ICU patients with Covid that were obese versus the percentage of non-Covid ICU patients. It found a clearly higher rate of ICU admissions among obese patients for Covid vs other causes. This research is also anecdotally supported out of the NYC hospital data.
This blog has discussed the Obesity Epidemic many times before, and I’ve started examining some of the causes of it that are easier to control for. It was always clear that obesity & metabolic syndrome are important for far more than NASH, but this pandemic should serve as a clear wake-up call for the tens of millions of obese individuals around the world. We cannot hide from our health behind the well-intentioned shield of the Body Positivity movement. The warnings are now being shouted loud and clear:
Around this time last year there were a number of news articles declaring 2019 “The Year of NASH” . Four companies were due to release Phase 3 trial results. Optimism was surging and awareness was beginning to catch on. So how did 2019 turn out, and what does the outlook for NASH in 2020 look like?
A year later:
Gilead had several Phase 3 studies end that failed to live up to expectations, eliminating Selonsertib as a serious treatment option
Intercept released mixed results for Ocaliva, but is pushing ahead for FDA Approval. If granted, it would be the first approved NASH treatement. Decision on approval should come after April 2020.
Abbvie (acquired Allergan) pushed their Phase 3 results for cenicriviroc from 2019 to late 2020.
Genfit delayed Phase 3 elafibranor results to Q1 2020. It remains a promising undercard.
So while we didn’t get any truly amazing results for treatment in 2019, we did make progress. The 2nd International NASH Day helped reach people across the globe. Awareness has been steadily growing.
And while we have yet to hear from Genfit on their treatment data, they did recently announce tremendeous progress in their quest for a non-invasive diagnostic test. Using a unique 4-biomarker algorithm they have been able to accurately identify NASH and significant fibrosis. Genfit plans to file for FDA approval of the test in 2020.
A reliable non-invasive test for NASH is in some ways even more important than a medical treatment. The danger from NASH comes from years of undiagnosed progression, and we already know that the liver damage NASH can cause is reversible in earlier stages of the disease.
I do a lot of volunteer work with the American Liver Foundation. This frequently puts me in social settings at food & drink events where, upon hearing the name of the organization, I’m immediately confronted with the biggest stigma of Liver Disease. “Isn’t it a little odd to be talking about liver disease while holding a beer?”
I love these conversations, because the juxtaposition creates a teachable moment that is more likely than not to be remembered.
My response blows up their preconceptions. “Actually, there are over one-hundred types of liver disease that have nothing to do with alcohol. NASH is a serious progressive liver disease affecting over twenty million American’s alone”.
One of the questions I see asked all of the time is what kind of testing is the best to determine if someone has NASH. I’ve written about the challenge of diagnosis before, but there are a lot of scared individuals out there trying to get answers from their under-educated primary case physicians, and everyone wants to skip the preliminary steps and go straight to a definitive diagnosis. If only it were that easy!
For the 2nd International NASH Day yesterday I took part in a webinar along with Dr. Tuan Pham of the University of Utah. Dr. Pham gave a great overview of the latest in the NASH space and I shared the story of my mom to provide an advocate perspective.
I recently posted my American Liver Foundation Advocacy video where I told Mom’s tragic story. Along with myself, several other patients currently living with various stages of NASH plus several medical professionals took part in the advocacy campaign.
The videos are now all available on the ALF Youtube page. Below are the embedded Youtube Playlists. Watch and share!
For #NASHDAY I’m asking everyone I know to “Give It Up” for NASH Awareness. It could be sugar, coffee, alcohol, TV, politics…literally anything! Write about what you are giving up on the sign attached and share it all over social media next Wednesday June 12th to help spread the word.
And if you can take the $5 that would have gotten you a cup of coffee and instead donate it to the American Liver Foundation’s NASH Day page, you can help raise awareness, provide education and support, and help fund treatments for NASH patients in the future.
A few months ago I was honored to take part in an American Liver Foundation effort to educate and raise awareness for NASH. I travelled to University of San Diego’s Altman Clincial and Translational Research Institute where I recorded a video telling my mom’s story so that others could learn and benefit from our loss. I was joined by a panel of individuals currently living with various stages of NASH and a few distinquished medical experts in the field.
The videos are finally being released as part of our leadup to the 2nd International NASH Day on June 12th. You can watch the entire video below.
For #NASHDAY I’m asking everyone I know to “Give It Up” for NASH Awareness. It could be sugar, coffee, alcohol, TV…literally anything. Post about what you are giving up on social media to help spread the word. And if you can take the $5 that would have gotten you a cup of coffee and instead donate it to the American Liver Foundation’s NASH Day page, you can help raise awareness, provide education and support, and help fund treatments for NASH patients in the future.
I have a friend who once lost a whole bunch of weight by removing two simple things from his diet. Cheese and soda. This was well before the current Paleo diet craze, when sugary drink taxes weren’t even whispered in the most progressive of city councils. It was also well before I knew anything about the liver or the difference between sucrose and fructose in the sugar I consumed. His story always stuck with me, though I never realized why it had worked.
Ever since the untimely death of my mother from NASH, I have spent a lot of time learning about the underlying causes that likely led to her liver failure. Along the way, I had to reexamine a number of misconceptions and prejudicies I’ve had about health and eating. Whether from genetics or pure luck, I’ve been blessed all my life with never having to worry about weight or what I eat. I never put a lot of thought about what I was putting inside my body until i started to read research about how obesity and metabolic syndrome developed, and why we were suddenly facing a worsening crisis over the last 50 years.
What I’ve found has changed my entire view on food & health.
When my mom passed away at 62 years old six weeks after being diagnosed with a disease I’d never heard of before, it sent me searching for answers. NASH is still widely unknown and the etiology is not well understood. Yes, it is largely linked to obesity, but there are many other risk factors that seem to be playing a role. One such factor that I discovered last year was the link between hypothyroidism and NASH, which my mom had for decades.
Recently I have been working on some projects on how the liver works, and found myself intrigued when writing about the function of the gallbladder. For those that are unaware, its main function is storing bile to be used in the digestion of fats. As I wrote about it, alarm bells began ringing in my head. NASH is the end stage of fatty liver disease, caused by an excess buildup of fat in the liver.
Gallbladder surgery (known as cholecystectomy) is one of the most common surgical procedures in the world, with over 600,000 procedures performed annually in the USA. It is considered completely safe with no long-term negative effects. My mom had her gallbladder removed years ago after suffering gallstones, as is the standard medically recommended procedure. I wondered if there was any studies on possible links between it and NASH, and began searching.