September 8, 2020

Dr. Feldman Talks Obesity and COVID-19 in Brain & Life

Doctors have observed obesity significantly increased the threat of severe and sometimes deadly coronavirus-related complications.

from Brain & Life Magazine by Sari Harrar

Brain&Life August-September cover graphic
August/September 2020 cover

The August/September issue of Brain & Life focused on conditions, like obesity, that complicate COVID-19. In the article "Losing Weight May Protect Against COVID-19," Eva L. Feldman, MD, PhD, director of the NeuroNetwork fo Emerging Therapies, provided her insights into the obesity/COVID-19  relationship. Dr. Feldman also discussed COVID-19's impact on neurological health.

 In a letter to the editor in Clinical Infectious Diseases, researchers at NYU Langone Health noted that of 3,615 people who tested positive for COVID-19 in the emergency department of one New York City hospital, about 37 percent had a body mass index (BMI) of at least 30, the threshold for obesity. People younger than 60 who were mildly obese were about twice as likely to be admitted to acute or critical care than those with a BMI under 30.

For patients with COVID-19, excess weight can interfere with healthy lung function and increase the risk of blood clots. Excess body fat, particularly abdominal fat, contributes to systemic inflammation, which can hinder a healthy immune-system reaction to infection. "In people with obesity and type 2 diabetes who have COVID-19, we've seen cytokine storm syndrome [a dangerous immune response to infection that damages cells, including in the lungs] in response to huge surges in blood glucose levels," says Eva Feldman, MD, PhD, FAAN, director of the NeuroNetwork for Emerging Therapies and the ALS Center of Excellence at the University of Michigan. "We are also seeing kidney and cardiac complications in these patients." Dr. Feldman and her colleagues plan to track more than 400 COVID-19 survivors with diabetes and obesity to see if the virus has effects on thinking, memory, peripheral neuropathy, and more.

In addition to its exacerbation of COVID-19, extra body weight increases the risk of many neurologic conditions, including mild cognitive impairment, dementia, and Alzheimer's disease, Dr. Feldman says. It also can fuel relapses and progression of multiple sclerosis (MS), increase risk for chronic migraines or a stroke, and boost the likelihood of developing obstructive sleep apnea, which can have neurologic consequences that affect thinking, mood, and alertness.

For people with neurologic conditions who were overweight before the pandemic or have put on pounds due to stress or inactivity during lockdown, here are recommendations from health care professionals for reaching and maintaining a healthy weight.

Check with your doctor. Ask your physician about the best weight loss strategy for you. He or she also can review your medications to see if any trigger weight gain, like pregabalin (Lyrica) and gabapentin (Neurontin), which are used for neuropathic pain in MS, fibromyalgia, and peripheral neuropathy, says Brian Callaghan, MD, MS, FAAN, associate professor of neurology at the University of Michigan. "Don't try to lose weight if you have a neurodegenerative disorder such as Parkinson's disease, amyotrophic lateral sclerosis (ALS), or Huntington's disease," says Dr. Feldman. "It could worsen symptoms."

Brain & Life is an official publication of the American Academy of Neurology. The magazine is focused on the intersection of neurologic disease and brain health.

portrait of Dr. Eva Feldman

Eva Feldman, MD, PhD

James W. Albers Distinguished University Professor of Neurology
Russell N. DeJong Professor of Neurology
Director, NeuroNetwork for Emerging Therapies
Director, ALS Center of Excellence