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Covid 19 and Obesity, part Two
Dr. Michael Bilof explains why COVID-19 affects those with obesity, why treatment might be more difficult, and how those who suffer from obesity can protect themselves from the virus.
Featuring:
Michael Bilof, MD
Dr. Bilof is a leader among his peers. His fellow bariatric surgeons in New Jersey chose him as President of the New Jersey Chapter of the American Society of Metabolic and Bariatric Surgeons (ASMBS) from 2014-2016. Transcription:
This Garden State Bariatrics and Wellness Center podcast was recorded on October 6th, 2020.
Scott Webb (Host): Though obesity is a disease, and people suffering from it are at higher risk for COVID-19, bariatric weightloss surgery can help with the short term goal of avoiding or suffering a less severe case of COVID and the long term health goals of people who are obese. And joining me today for part two of the series on obesity and COVID-19 is Dr. Michael Bilof, Bariatric Surgeon and Founder of Garden State Bariatrics and Wellness center.
This is the Winning Through Losing Podcast from Garden State Bariatrics and Wellness Center. I’m Scott Webb. So, doctor, thanks so much for being on today. We talk last in April and a lot has changed. So, let’s go through some of that. What do we know about COVID-19 today or what can we confirm today that we couldn’t last time you were on?
Michael Bilof, MD (Guest): I wouldn’t say we’ve learned anything new, but we’ve confirmed what we suspected I think in April is probably the best way to say it. So, back then, there were hints and clues that the folks who were obese, too main things, that one, they were more likely to get COVID and then number two, should they get COVID, they are more likely to get the more severe version. That is, end up in the hospital or if they end up in the hospital, end up in the ICU. So, both more likely to get it and more likely to get the severe version.
And now, so six months later, we have six months more of we’ll say data to look at and patient outcomes to look at and what we suspected then has been confirmed that that is in fact the case. There’s more and more evidence to confirm that that speculation is really not speculation anymore, it’s really a known aspect of this disease.
Host: Yeah, I think you’re right. I think that’s a great way of thinking of this that we’ve just confirmed some things that we suspected back then. So, I think the natural follow up here is why are people who are suffering from obesity, why are they at greater risk for COVID complications or a more severe form of COVID-19?
Dr. Bilof: I think there’s a couple of reasons for that. So, one is folks who are obese have other medical problems, high blood pressure, diabetes, sleep apnea and all of those things conspire to make someone more susceptible to COVID and then should they get COVID, more susceptible to the more aggressive version so to speak. So, someone out there listening to this who is in that higher weight category, a higher BMI category, first thing is you want to make sure that any of those medical problems that you may have, are well controlled. So, for instance if you are diabetic, you want to really, really make sure your sugars are well controlled. If your blood pressure is high, you want to really make sure that your blood pressure is controlled. And if you have sleep apnea, that you are using your machine to get a good night’s sleep.
So, those are things you want to – if you are obese, you want to make sure that all the medical problems that come along with obesity are at least well controlled. Then there’s some other things about obesity that we think may be contributing in terms of folks’ immune system. When someone is obese, their immune system may not be as we’ll say robust or as aggressive or as effective at defending the patient against infections. So, one thing we know is when someone who is obese gets a vaccine; they produce less antibodies against that vaccine than someone who is not obese. Obviously, there’s not much a patient who is obese can do about that other than lose weight. But it probably is a factor in why the obese folks are more likely again to get it and then get the more severe version.
So, in the short term, you definitely want to make sure any medical problems you have are well controlled but in the longer term, you kind of want to do something that really treats the obesity itself.
Host: Yeah, so let’s talk about that. Let’s talk about obesity being a disease, one that can be treated mentally, physically and in some cases, surgically, right? So, that’s what you do there so let’s talk about that when we talk about somebody who is obese, addressing their other risk factors, their other medical issues, but then specifically about the weightloss and the bariatric surgery, what options are available for them?
Dr. Bilof: Well we were just speaking about the likelihood of getting COVID and the reasons why obese folks may be more at risk and on our website, we have a full page devoted to just that very issue and anyone who is interested can do a bit of a deeper dive on those particular issues on our website. So, I would direct anyone who has an interest in delving further into that to our website. It’s on the home page, the tab COVID-19 and obesity.
So, with respect to treatments. Yeah, I mean we obviously offer surgical treatments for obesity. So the first thing is, we don’t do surgery to lose five or ten pounds. Having said that, the extra five or ten pounds may in fact affect your likelihood of getting COVID and I don’t want to minimize it that’s something that should be perhaps looked at as well. But we reserve surgical treatment for folks who are basically 100 pounds or more above what’s considered ideal for their height. And that measure is the BMI, body mass index. And again, there’s tabs on our website to calculate your BMI or you can just Google search engine just type BMI calculator and it will take you to a number of websites. So, if your BMI is over 40, then you are a candidate for weightloss surgery and you clearly are in that high risk category for COVId-19 infection and subsequently the more aggressive form of that section.
And so, if you find yourself in that category, surgery really is – is really just the most effective option. So, there’s different surgeries that we do depending on the patient’s medical condition and what their goals are and any other medical problems that they may have. The one we do most commonly these days is the gastric sleeve and again, there’s on our website, we have tabs and pages that kind of delve deeply into the specifics of that particular procedure. But basically, I think for our purposes here today, you just want to be aware of what your body mass index is and if it’s above 40; that would mean you are a candidate for surgery and also relative to the COVID-19 issue, you are definitely at higher risk for getting the infection and then getting a more aggressive and dangerous form of that infection.
Host: Yeah it sounds like it. You mentioned your website and I’ve checked that out. It’s very comprehensive and very easy to navigate, the tabs are right there. And you’ve spent some time really connecting those dots for people between COVID and obesity. I also know in your newsletter last month, you mentioned specifically talked about COVID-19. So I think it’s really great and really relevant right now. And I just want to ask, about the different surgeries, what’s that process like for patients from the minute they walk in the door, they know what their BMI is, it’s over 40. What’s that process like for people of going from being obese and you helping them?
Dr. Bilof: Yeah, it’s actually pretty dramatic. I don’t think this is actually an exaggeration. It’s pretty life changing for folks and one of the things that people can do, anyone who is listening to this, can again, on our website, we have a patient of the month. Those folks obviously have been quite successful, and they’ll essentially tell their story which I think is much more compelling than anything I would say. They will talk about what their life was like before and it’s always specific to their particular situation and then how things have changed after the surgery. And it’s not just about the weightloss although of course there is weightloss, it’s more yeah, I was taking 50 units of insulin every day and now my diabetes is gone. My wife and I were sleeping in separate rooms because I was snoring so bad and now my snoring is gone, and we can sleep in the same room together. And just really dramatic and quite poignant stories about how people’s live have been changed by this procedure.
And hopefully actually when we come back to the COVID thing, the most dramatic thing will be you just didn’t get COVID. That would really be the most – which is obviously, somewhat hard to prove that someone didn’t get COVID because they lost weight, but there’s no question that losing the weight will dramatically decrease your risk of getting this disease and then should you unfortunately get it, you’re much more likely to have a more mild or sort of benign course to that disease. Obviously, it’s somewhat speculative at this point, but it doesn’t look like the disease is – COVID is going away any time in the immediate future. I mean obviously, who knows, a year or two from now, I don’t think anything is going to happen in the next six months that’s suddenly going to make Coronaviruses just disappear. Hopefully there will be a vaccine but again, depending on those sorts of things; I think is a little bit – it takes things out or your own hands and I like to think that we’re really about empowering people to be in charge of their own healthcare and their own lives and the most effective thing you can do if you are overweight and if your BMI is over 40, is to get the BMI down to a more ideal range and just have these things not be issues anymore. And then you don’t have to worry about is there a vaccine, is there a treatment and do I have to worry about these other things. you are in charge of your own care at that point.
Host: As we wrap up here today, anything else you want to tell people about COVID-19, about bariatric weightloss surgery, how it can help them now and really more importantly, assuming that they survive COVID-19 or as you say, never get COVID-19, how it can really help their lives moving forward?
Dr. Bilof: I think that Scott the take home message would be you want to do all the things that we all should be doing and the masks, the social distancing, the washing the hands; that’s regardless even if you a picture of health and you’re not overweight, you should be doing those things. However, if you are overweight, particularly if the BMI is over 40; any medical conditions that you have, that are associated with that obesity; need to be very well controlled. I mean we could say that they should always be well controlled but particularly in this time. But really, the thing to do is to just not be obese and if your BMI is over 40, the most effective treatment is bariatric surgery. There’s just – there’s a mountain of evidence so to speak, that that is in fact the case. And getting the BMI down to the more ideal range is really the best thing you can do for health. Whether you are talking about the immediate issue of COVID or you’re talking about more long term issues like diabetes, heart disease, and other things that will develop over time if folks don’t lose that weight.
Host: Yeah, and there are just so many mental and physical benefits to losing the weight. And as you say, we’re not in this to lose ten or 15 pounds, right we’re talking about people who are suffering from obesity, the disease of obesity. The 100 pounds or more and so many benefits and so many ways that you can help folks there. And I want to remind everybody again to go to www.gsbwc.com, that’s the website. Check out the special COVID and obesity page, the tab is right there. Look for your newsletter and we’ve got you covered. We got all the information people need and Doctor, it’s always a pleasure to have you on. Great to have you back here for part two of this episode. Hope to talk to you in the future and you stay well.
And again, for more information please visit the Garden State Bariatrics and Wellness Center website at www.gsbwc.com, that’s www.gsbwc.com. And if you found this podcast helpful, please share it your social channels and check out the full podcast library for topics of interest to you. This is Winning Through Losing, a weightloss surgery podcast with Garden State Bariatrics and Wellness Center. I’m Scott Webb. Thanks for listening.
This Garden State Bariatrics and Wellness Center podcast was recorded on October 6th, 2020.
Scott Webb (Host): Though obesity is a disease, and people suffering from it are at higher risk for COVID-19, bariatric weightloss surgery can help with the short term goal of avoiding or suffering a less severe case of COVID and the long term health goals of people who are obese. And joining me today for part two of the series on obesity and COVID-19 is Dr. Michael Bilof, Bariatric Surgeon and Founder of Garden State Bariatrics and Wellness center.
This is the Winning Through Losing Podcast from Garden State Bariatrics and Wellness Center. I’m Scott Webb. So, doctor, thanks so much for being on today. We talk last in April and a lot has changed. So, let’s go through some of that. What do we know about COVID-19 today or what can we confirm today that we couldn’t last time you were on?
Michael Bilof, MD (Guest): I wouldn’t say we’ve learned anything new, but we’ve confirmed what we suspected I think in April is probably the best way to say it. So, back then, there were hints and clues that the folks who were obese, too main things, that one, they were more likely to get COVID and then number two, should they get COVID, they are more likely to get the more severe version. That is, end up in the hospital or if they end up in the hospital, end up in the ICU. So, both more likely to get it and more likely to get the severe version.
And now, so six months later, we have six months more of we’ll say data to look at and patient outcomes to look at and what we suspected then has been confirmed that that is in fact the case. There’s more and more evidence to confirm that that speculation is really not speculation anymore, it’s really a known aspect of this disease.
Host: Yeah, I think you’re right. I think that’s a great way of thinking of this that we’ve just confirmed some things that we suspected back then. So, I think the natural follow up here is why are people who are suffering from obesity, why are they at greater risk for COVID complications or a more severe form of COVID-19?
Dr. Bilof: I think there’s a couple of reasons for that. So, one is folks who are obese have other medical problems, high blood pressure, diabetes, sleep apnea and all of those things conspire to make someone more susceptible to COVID and then should they get COVID, more susceptible to the more aggressive version so to speak. So, someone out there listening to this who is in that higher weight category, a higher BMI category, first thing is you want to make sure that any of those medical problems that you may have, are well controlled. So, for instance if you are diabetic, you want to really, really make sure your sugars are well controlled. If your blood pressure is high, you want to really make sure that your blood pressure is controlled. And if you have sleep apnea, that you are using your machine to get a good night’s sleep.
So, those are things you want to – if you are obese, you want to make sure that all the medical problems that come along with obesity are at least well controlled. Then there’s some other things about obesity that we think may be contributing in terms of folks’ immune system. When someone is obese, their immune system may not be as we’ll say robust or as aggressive or as effective at defending the patient against infections. So, one thing we know is when someone who is obese gets a vaccine; they produce less antibodies against that vaccine than someone who is not obese. Obviously, there’s not much a patient who is obese can do about that other than lose weight. But it probably is a factor in why the obese folks are more likely again to get it and then get the more severe version.
So, in the short term, you definitely want to make sure any medical problems you have are well controlled but in the longer term, you kind of want to do something that really treats the obesity itself.
Host: Yeah, so let’s talk about that. Let’s talk about obesity being a disease, one that can be treated mentally, physically and in some cases, surgically, right? So, that’s what you do there so let’s talk about that when we talk about somebody who is obese, addressing their other risk factors, their other medical issues, but then specifically about the weightloss and the bariatric surgery, what options are available for them?
Dr. Bilof: Well we were just speaking about the likelihood of getting COVID and the reasons why obese folks may be more at risk and on our website, we have a full page devoted to just that very issue and anyone who is interested can do a bit of a deeper dive on those particular issues on our website. So, I would direct anyone who has an interest in delving further into that to our website. It’s on the home page, the tab COVID-19 and obesity.
So, with respect to treatments. Yeah, I mean we obviously offer surgical treatments for obesity. So the first thing is, we don’t do surgery to lose five or ten pounds. Having said that, the extra five or ten pounds may in fact affect your likelihood of getting COVID and I don’t want to minimize it that’s something that should be perhaps looked at as well. But we reserve surgical treatment for folks who are basically 100 pounds or more above what’s considered ideal for their height. And that measure is the BMI, body mass index. And again, there’s tabs on our website to calculate your BMI or you can just Google search engine just type BMI calculator and it will take you to a number of websites. So, if your BMI is over 40, then you are a candidate for weightloss surgery and you clearly are in that high risk category for COVId-19 infection and subsequently the more aggressive form of that section.
And so, if you find yourself in that category, surgery really is – is really just the most effective option. So, there’s different surgeries that we do depending on the patient’s medical condition and what their goals are and any other medical problems that they may have. The one we do most commonly these days is the gastric sleeve and again, there’s on our website, we have tabs and pages that kind of delve deeply into the specifics of that particular procedure. But basically, I think for our purposes here today, you just want to be aware of what your body mass index is and if it’s above 40; that would mean you are a candidate for surgery and also relative to the COVID-19 issue, you are definitely at higher risk for getting the infection and then getting a more aggressive and dangerous form of that infection.
Host: Yeah it sounds like it. You mentioned your website and I’ve checked that out. It’s very comprehensive and very easy to navigate, the tabs are right there. And you’ve spent some time really connecting those dots for people between COVID and obesity. I also know in your newsletter last month, you mentioned specifically talked about COVID-19. So I think it’s really great and really relevant right now. And I just want to ask, about the different surgeries, what’s that process like for patients from the minute they walk in the door, they know what their BMI is, it’s over 40. What’s that process like for people of going from being obese and you helping them?
Dr. Bilof: Yeah, it’s actually pretty dramatic. I don’t think this is actually an exaggeration. It’s pretty life changing for folks and one of the things that people can do, anyone who is listening to this, can again, on our website, we have a patient of the month. Those folks obviously have been quite successful, and they’ll essentially tell their story which I think is much more compelling than anything I would say. They will talk about what their life was like before and it’s always specific to their particular situation and then how things have changed after the surgery. And it’s not just about the weightloss although of course there is weightloss, it’s more yeah, I was taking 50 units of insulin every day and now my diabetes is gone. My wife and I were sleeping in separate rooms because I was snoring so bad and now my snoring is gone, and we can sleep in the same room together. And just really dramatic and quite poignant stories about how people’s live have been changed by this procedure.
And hopefully actually when we come back to the COVID thing, the most dramatic thing will be you just didn’t get COVID. That would really be the most – which is obviously, somewhat hard to prove that someone didn’t get COVID because they lost weight, but there’s no question that losing the weight will dramatically decrease your risk of getting this disease and then should you unfortunately get it, you’re much more likely to have a more mild or sort of benign course to that disease. Obviously, it’s somewhat speculative at this point, but it doesn’t look like the disease is – COVID is going away any time in the immediate future. I mean obviously, who knows, a year or two from now, I don’t think anything is going to happen in the next six months that’s suddenly going to make Coronaviruses just disappear. Hopefully there will be a vaccine but again, depending on those sorts of things; I think is a little bit – it takes things out or your own hands and I like to think that we’re really about empowering people to be in charge of their own healthcare and their own lives and the most effective thing you can do if you are overweight and if your BMI is over 40, is to get the BMI down to a more ideal range and just have these things not be issues anymore. And then you don’t have to worry about is there a vaccine, is there a treatment and do I have to worry about these other things. you are in charge of your own care at that point.
Host: As we wrap up here today, anything else you want to tell people about COVID-19, about bariatric weightloss surgery, how it can help them now and really more importantly, assuming that they survive COVID-19 or as you say, never get COVID-19, how it can really help their lives moving forward?
Dr. Bilof: I think that Scott the take home message would be you want to do all the things that we all should be doing and the masks, the social distancing, the washing the hands; that’s regardless even if you a picture of health and you’re not overweight, you should be doing those things. However, if you are overweight, particularly if the BMI is over 40; any medical conditions that you have, that are associated with that obesity; need to be very well controlled. I mean we could say that they should always be well controlled but particularly in this time. But really, the thing to do is to just not be obese and if your BMI is over 40, the most effective treatment is bariatric surgery. There’s just – there’s a mountain of evidence so to speak, that that is in fact the case. And getting the BMI down to the more ideal range is really the best thing you can do for health. Whether you are talking about the immediate issue of COVID or you’re talking about more long term issues like diabetes, heart disease, and other things that will develop over time if folks don’t lose that weight.
Host: Yeah, and there are just so many mental and physical benefits to losing the weight. And as you say, we’re not in this to lose ten or 15 pounds, right we’re talking about people who are suffering from obesity, the disease of obesity. The 100 pounds or more and so many benefits and so many ways that you can help folks there. And I want to remind everybody again to go to www.gsbwc.com, that’s the website. Check out the special COVID and obesity page, the tab is right there. Look for your newsletter and we’ve got you covered. We got all the information people need and Doctor, it’s always a pleasure to have you on. Great to have you back here for part two of this episode. Hope to talk to you in the future and you stay well.
And again, for more information please visit the Garden State Bariatrics and Wellness Center website at www.gsbwc.com, that’s www.gsbwc.com. And if you found this podcast helpful, please share it your social channels and check out the full podcast library for topics of interest to you. This is Winning Through Losing, a weightloss surgery podcast with Garden State Bariatrics and Wellness Center. I’m Scott Webb. Thanks for listening.