Renée Schafer Horton: Exercise, vaccines make for happy Thanksgiving

Thanksgiving is just around the corner, and for many of us, this will be the first holiday in quite a while that we’ll be celebrating sans pandemic anxiety.

I, for one, am here for it all. Bring on the turkey and stuffing and green beans and cheesecake and toddlers making mashed potato mountains and family board games without three bottles of hand sanitizer.

I’m less thrilled about the extra pounds that often accompany Thanksgiving, and if my email in-box is an accurate indication, I’m not alone. However, my waistline concern stems from vanity, while my readers’ concern is about vaccination.

Specifically, the vaccine-averse want to know why health officials don’t widely publicize that being overweight or obese leads to poor COVID-19 outcomes. Lose weight, this theory goes, and you don’t have to take the vaccine.

Heading into the nation’s overeating marathon seems the perfect time to see exactly how strong the connection between fat and COVID fate is.

It is true that excess weight around the waist and deep in the abdomen near organs is associated with higher hospitalization and death rates with COVID. But, as physician Elizabeth Connick, chief of infectious diseases at Banner-University Medical Center, explained, it’s not black and white.

“People who think only obese people are in the hospital should come to Banner and see, like I do every day, that not everyone who dies is obese. The main issue is that COVID is unpredictable,” she said.

The numbers bear out this unpredictability. According to the Centers for Disease Control and Prevention, more than 900,000 adult COVID-19 hospitalizations occurred in the United States between March 2020 and early this month, and only about 30.2% were attributed to obesity. While one-third isn’t a majority, it ain’t chopped liver, either, so we should pay attention.

And scientists and physicians are paying attention, with the working theory on the obesity connection focusing on inflammation. Obesity — defined as a body mass index (BMI) of 35 or higher — causes inflammation. Since COVID is also an inflammatory illness, adding that virus to an already inflamed body can cause an “inflammatory storm” in blood vessels that sometimes leads to pulmonary fibrosis and organ failure.

Certain treatments have proven effective in lowering inflammation in people with COVID, especially Tocilizumab, which limits the Interleukin 6 (IL-6) receptor produced in humans in response to infections.

“For whatever reason, obese people have a stronger IL-6 response, leading to too much inflammation,” Connick explained. “Our problem as scientists is trying to figure out how much inflammation is from COVID and how much is from something else. Theoretically, we could then develop a treatment that would be a bow in our quiver. But in the meantime, the better thing is to get vaccinated. The vaccine decreases the risk for having bad inflammatory outcomes because your immune system controls the virus quickly once you get sick. Obese people should absolutely get immunized.”

Obesity is a complex disease and has many contributing factors, many of which have to do with access and resources, according to Melanie Hingle, a University of Arizona associate professor of nutritional sciences and public health.

“We know from the literature that both people who are normal weight and people who have excess weight benefit from diet changes and physical activity, even if no weight is lost,” Hingle said. “But you have to look really hard for healthy food options because the food that is most readily available and cheaper foods are often the most tasty and not best for you. Folks who are lower income or live in areas without grocery stores or have unreliable transportation are at a disadvantage right off the bat.”

In other words, it’s pretty easy for me to choose salads and whole grains after walking a mile to the Safeway in my neighborhood. It is less easy to make that choice if the only option within walking distance is a 7-11 and a McDonald’s. And how do you get outside for exercise if you live in the most dangerous ZIP code in town? The “Just lose weight” mantra has a tinge of economic privilege when looked at through that lens.

Everyone benefits from eating fiber-rich foods, including whole grains, legumes and veggies, and less processed foods. The updated American Physical Activity Guidelines say we all need a minimum of 150 minutes of vigorous activity weekly. But, in the end, Hingle explained, “You’re not going to eat your way into avoiding COVID.”

“It’s important to keep stating facts and the facts are, the best way to prevent getting COVID is to be vaccinated, with this safe and effective, science-based vaccine,” she said. “Everyone can benefit from healthy eating and exercise and it will probably help you overall, but from an infectious disease like this one, it isn’t enough.”

Because both health and vaccination are important, how ’bout we head toward Thanksgiving with shots in our arms and a plan to moderate some of that food in our bellies? Then, after our wonderful meals, instead of crashing into a food coma, head outside for a hike in the glorious weather, a bike ride on the Loop or a family game of football. Rinse and repeat throughout the holiday season. Your body will thank you, and you’ll earn that extra slice of cheesecake.