BCMS Medical Record Fall 2020 - 15

a prognosis (Table 1)17, 18, 19. One possible explanation for the
strong association diabetes has with COVID-19 mortality is the
same cytokine storm that was discussed earlier, a theory which
was also put forward with the 2003 coronavirus SARS-CoV that
afflicted hyperglycemic patients in particular6. Though many of
these statistics do not mention obesity per se, the same outcomes
that affect patients with diabetes also often affect patients with
obesity because so many of those who suffer from diabetes also
have obesity, and this overlap surely compounds the already
severe challenges obese COVID-19 patients face.
Obesity's implication in diabetes even without COVID-19
is supported by a study in Mexico that found "obesity mediates
49.5% of the effect of diabetes on COVID-19 lethality"20. Since
hyperglycemia per se is associated with defects in immunity,
for patients who suffer from diabetes mellitus Dr. Gabriely and
Dr. Wexler both stress the importance of optimizing control of
blood glucose to minimize the risk of getting severe COVID-19
disease. Other small changes patients can make based on
associations with lower central adiposity include increasing
protein and fiber intake without raising overall caloric intake
and adding light physical activity when possible; however, the
most successful long-term obesity interventions are medication
or surgery21.

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Berks County, Obesity, Diabetes, and COVID-19
Studying the medical etiology of how obesity and
COVID-19 relate is useful in direct treatment of patients but
is ultimately insufficient in answering why places like Berks
County and certain communities within Berks suffer worse
from these diseases in the first place. Recalling the 2012 ranking
that listed Reading-which is home to over 88,000 of the
approximately 421,000 people in Berks County22, 23-among the
nation's top 10 most obese cities, it is necessary to explore social
determinants of health to identify the roots of this issue. The
impact of large structural issues such as poverty and segregation
cannot be overstated. In 2011 it was estimated that 41.3% of
Reading's residents live below the poverty line24-which was
the worst in the nation. Additionally, based on 2010 data for
the nation's 100 most populous commuting zones, Reading was
listed as being the commuting zone with the highest Latinowhite segregation25. Both poverty and segregation remain
significant issues a decade later. For a city where 64.7% of its
people identify as Hispanic or Latino22, these systemic forms
of inequality pose major challenges. The Latinx community
suffers disproportionately from obesity both nationwide as well
as in Berks County, where in 2013 71.9% of Latino adults were
overweight or obese as compared to 65.6% of white adults26.

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According to social scientist Dr. Adam Geary, "Poverty
negatively impacts health through multiple avenues, including
malnutrition, stress, lack of access to preventive care, lack of
care for persistent infections and disease, more environmental
continued on next page >

FALL 2020

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BCMS Medical Record Fall 2020

Table of Contents for the Digital Edition of BCMS Medical Record Fall 2020

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