The largest U.S. study conducted on COVID-19, with 4,000 patients in New York participating, found that after age, obesity was a significant factor associated with hospitalization.

The United States Center for Disease Control and Prevention has listed those over 60 years or older, or those who have pre-existing health conditions as being at a high risk of severe illness from COVID-19. Individuals who are clinically obese, or with a body mass index of 40 or over, also have made the list.

In the study, led by Christopher Petrilli from the New York University Grossman School of Medicine and published earlier this month, a team of researchers assessed the factors associated with hospitalization of patients with COVID-19.

The team looked at different characters of each of the 4,103 patients to identify the biggest risk factors for individuals whose outcomes were more severe. Of the over 4,000 participants, 1,999 required hospitalization and 650 were placed on a ventilator, died or were discharged to hospice care, according to the study.

Although age remained the biggest risk factor for hospitalization or critical care, researchers also found that obesity, heart failure and chronic kidney disease were also linked to severe coronavirus cases.

MD Diet Clinic is a Utah-based company with locations in Salt Lake City and Orem. The company’s marketing and operations director, Winston Behle, said he was surprised by the study’s findings.

“We’ve always known obesity is bad for your health,” he said. “Obesity puts you at a higher risk for most diseases, but what I think was most surprising was to find out that obesity put you more at risk for COVID-19 hospitalizations than even those with respiratory or heart conditions or diabetes.”

Behle said prior to the study’s publication, healthcare experts believed prior health conditions, like the ones he listed, were the biggest factors outside of age.

Obesity is known to create chronic inflammation in the body, which can be exacerbated when contracting COVID-19, Behle said. This remains the researchers’ theory on why individuals who fall into the body mass index of over 40 experience greater risk.

Another theory, Behle said, is that those who suffer from obesity have lower oxygen levels than people at a healthy weight.

One of the biggest reasons for coronavirus-related hospitalizations has been decreased oxygen levels. When people are obese, there is more blood to circulate through the body and more areas of the body for it to be dispersed to, head nutritionist Ashley Forsythe said.

“Combining obesity with COVID-19 is really a double whammy when it comes to low oxygen,” Behle said.

Unlike age, obesity has also put young people at risk, he said. According to the CDC, 42.4% of Americans are classified as obese, including 40% of young adults from 20-39 years, 44.8% of middle-aged adults from 40-59 years, and 42.8% of older adults 60 years old or older.

Utah is tied with a handful of other states for the lowest number of deaths. As of Monday, Utah has reported 28 deaths, 268 hospitalizations and 3,213 confirmed cases, according to the Utah Department of Health. Behle said Utah’s limited number of cases, hospitalizations and deaths can be attributed to a number of factors.

“We’re the youngest state in the nation,” he said. “We have the lowest amount of smoking in the nation, the lowest amount of drinking in the nation, and as of 2018, we ranked No. 40 out of all 50 states as far as obesity goes.”

Behle said Utah is a fairly healthy state in comparison to others and one of the healthiest when taking into account the factors that affect the severity of COVID-19.

Generally speaking, Forsythe said, the company doesn’t want people who are obese or overweight to learn about the study and feel helpless. She especially does not want people to panic and go on a crash diet.

If people hoping to lose weight don’t do it the right way, the process of losing weight could be more detrimental to their immune systems, she said. Losing weight in an unhealthy way can also affect lean body mass as well as body fat.

Due to the coronavirus pandemic, MD Diet is currently offering telemedicine services to clients as well as offering a free, virtual nutrition class through the Salt Lake City location. The class gives general tips of what foods people should avoid while in quarantine as well as what to eat and how to eat it.

The Orem location is limited to phone visits, but Utah County residents can still take advantage of the online nutrition classes.

The company uses expertise from nutritionists, nurse practitioners and researchers to design individualized weight loss programs for their clients.