With experts expressing the fear that obesity could undermine 100 per cent effectiveness of likely COVID-19 vaccines, MOSES EMORINKEN reports that such individuals should be part of the phase three vaccine trials to ensure that the dose being recommended will work well in their systems.

Pandemics are not new occurrences. Throughout history, many diseases have broken out, even as they have ravaged humanity, crippled economies, altering social interactions, and sometimes threatening to end an entire civilisation.

However, man has risen to the challenge posed by some of these diseases, by developing either a cure or vaccine to inoculate the public from their deadly claws.

Coronavirus, although not a new entrant in the elite league of diseases has shot a new strain of virus called SARS-CoV-2 into prominence and was first reported to the World Health Organisation (WHO) on December 31, 2019, in Wuhan, China.

Since then, many countries have been greeted to a rude awakening of the COVID-19 disease, especially the rate of fatality–such as never been witnessed in the history of pandemics.

Schools, malls, cinemas, relaxation centres, religious institutions, to mention but a few were shut down. It was no longer business as usual.

Lockdown, shutdown, testing, sanitising, symptomatic, asymptomatic, isolation, quarantine, and so on became the popular buzzwords around the world.

The Nigeria Centre for Disease Control (NCDC), being the apex agency in Nigeria saddled with the responsibility of maintaining the public health sanity and curtailing unforeseen epidemic spread in the country consistently echoes that until a vaccine for COVID-19 is developed and circulated, Nigeria’s only hope remains strict adherence to non-pharmaceutical safety measures such as maintaining corporeal distance, avoiding large gatherings, wearing of face masks, and practising good hand hygiene.

As at the time of this report, in Nigeria, at least 50,000 people had been infected and nearly 1,000 had died. Therefore, it seems salvation hinges on a vaccine.

However, one annoying epidemic that not only pre-dates COVID-19 but has been known to undermine the effectiveness of vaccines generally developed, is obesity.

Scientists are in agreement that vaccines developed to protect the public from known diseases such as hepatitis B, rabies, influenza, and tetanus, have been less effective in obese and overweight individuals. They, therefore, are not so optimistic that when a vaccine for COVID-19 is developed, it would be any different.

“Obesity can undermine the 100 per cent effectiveness of likely COVID-19 vaccines,” Prof. Alash’le Abimiku, the Executive Director, International Research Centre of Excellence (IRCE) – an arm of the Institute of Human Virology Nigeria (IHVN) said.

“It is possible and that is why it is important to include such individuals in at least the phase three part of the vaccine trials to ensure that the dose being recommended will work well in these individuals.

“Just as we reduce doses of drugs and vaccines for children; it is possible that the dose or the frequency of vaccination may need to be increased for obese individuals.

“Our immune system works best when we are healthy. So, even for those that are not obese, the ability of their body to mount up a good immune response is optimised or increased when they are healthy: well-rested, exercise and eat well, stay hydrated and so on.

“During clinical trials when the vaccine is tested, it is usually done at different doses to find out the dose that works best in the normal individual. The dose may not be enough for the obese person due to the additional mass. So, it is necessary to include such individuals in clinical trials to ensure that the vaccine dose is adequate also for them as a vaccine should cover all individuals for all of us to be safe.”

X-raying Nigeria’s BMI

Nigeria being the giant of Africa must thread with caution, especially when it concerns its weight – body mass index (BMI). An overweight giant, they say, becomes a burden to itself.

The WHO defines obesity as a body mass index (BMI) of 30 kg/m2 or more. Also, a 2016 data from WHO showed that 26 per cent of Nigerian adults were either obese or overweight.

Children are not left out, as a report by the United Nations Children’s Fund (UNICEF), revealed that in Nigeria, 49 per cent of children below five years of age is not growing well (they are stunted, wasted or overweight).

The rate of obesity in the country, although not as alarming as it is in some developed countries, such as the United States of America, however, demands some level of attention.

Health experts say it seems as though, as the fight against undernutrition is intensified, more and more people, especially women and children, are becoming “over-nourished.”

In a chat with The Nation, the Director of Nutrition, Federal Ministry of Health, Dr Chris Isokpunwu said: “The trend we see in women is that the rate of obesity and overweight is increasing as undernutrition is decreasing. We are beginning to find a shift in women who are overweight and obese. It is as if more and more women are getting out of under-nutrition, while some more are becoming ‘over-nourished.’”

Continuing, he said: “Studies have shown that the effectiveness of vaccines is lower among obese people compared to the general population. Obesity, in this case, means people with a body mass index of 30 and above.

“There are a lot of speculations around it and one of them is that the adipose tissues (fatty tissue) tend to attack the antigens and so make them unavailable for the development of antibodies.

“There is also the other side to it because most vaccines are given intramuscularly, that is, into the muscle or under the skin. It may actually be deposited in the adipose because of the thickness of the skin and the fact that the needle may not get deep down into the muscle. So, they will not even get into the system for antibody development.

“People with comorbidities were most of the casualties around the world, even in Nigeria. Comorbidities such as hypertension and diabetes, among others, are higher among obese people. Therefore, that is already among the high risk that we have.

“Another thing is that obesity itself is now classified as a disease, and it is a chronic one and it is already a predisposing factor.”

How obesity weakens the immune syste

According to the Head of Department of Dietetics, Federal Medical Centre, Jabi, Abuja, Dr. Cosmas Ugwu, in respect to obesity and COVI-19, all of us should know that obesity has a very big impact in our lives as far as health is concerned.

“The WHO reported that 60 per cent of obese people died from COVID-19.

“Towing the line of biochemistry, obesity deranges a lot of metabolism in the system. There is a particular hormone called leptin, which controls a lot of metabolisms, and reduces the function of antibodies in the system. A situation whereby the immune system is diminished, the system cannot work and there is no drug that will be able to handle it.

“Under that condition, at times, that leptin may become resistant and most of the hormones such as the cytokines – which is the major chemical messenger in the system will be giving the wrong information. Even the drugs the patient will use will not be getting to the root of the problem. In that case, you now know that obesity will have a very big adverse effect as far as COVID-19 is concerned.

“Many of those that are obese also have many chronic diseases already, of which we know that obesity is the major vector that disseminates diseases such as diabetes, high blood pressure, cardiovascular diseases, cancer, kidney problems and stroke.

“All these non-communicable diseases and metabolic syndromes which are already on the ground will compound the issue.

“In the same manner, obesity reduces the immune system. Therefore, diseases such as COVID-19 that are infectious will have their way, and now undermine and cripple the entire system.”

Ugwu added: “If a vaccine is developed, and the whole system is not working properly, or some of all the hormones are not functioning well, then they cannot coordinate. The activities of those hormones will still be deranged. There will be no bearing and the whole thing will collapse.

“Although plus or minus, there may be some positivity, but what we should fight first is reducing obesity, which is a major culprit.

“Between the range of between 1.9 and two billion people in the world are obese, and Nigeria as we are, we don’t have statistics so much. But all things being equal, we know that not less than 30 to 40 per cent of Nigerians are obese, including children and adults.”

Charting the way forward

Obese people with a body mass index of 30 or more, known as morbid obesity, are a risk factor for COVID-19.

According to a study carried out in China, and published by the National Centre for Biotechnology Information, heavier patients afflicted with COVID-19 were more likely to die than leaner ones.

“My advice is for people to eat right and ensure that there are adequate nutrients in foods consumed. People should eat more fruits and vegetables; the reason being that it helps to build immunity, strengthen immune capacity and of course, people need that immunity to be able to resist the effects of COVID-19 infection.

“Eating right also ensures that one’s weight is appropriately distributed. People should cut down on calories and engage in an active lifestyle, and also be involved in physical exercises. Exercises don’t have to mean going to the gym or carrying weight. One will be surprised how effective dancing for 30 minutes every day can be on one’s weight,” Isokpunwu said.

Ugwu said: “The only way out is for us to go back to nature by finding our bearing to the common foods that are within reach. Instead of going for all the luxurious foods, we buy from supermarkets, the natural foods in our homes can solve our problems. All refined foods are the major causes of obesity.

“If you watch very closely, most of these refined foods and bottling companies that are producing juices and drinks are the major contributors of this obesity. Many people are literally taking a lot of empty calories.

“Some obese people may even come to the hospital to reduce the level of weight and obesity, but there are still some other hidden factors biochemically that may hamper that if they don’t meet experts or good dietitians. In fact, many people and even hospitals do not know the importance of dietitians.

“Even without COVID-19 vaccines, obese individuals should lose weight and exercise and sleep well for their own general wellness. Our immune system works best when we are healthy. So, these individuals should do what they know they must do – that is, lose weight, exercise, eat nutritious food, sleep well, stay hydrated, and reduce stress,” Prof. Abimiku added.

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