By Christine Woodside
Melanie Stengel Photo.
As the summer’s heat sets in, tailpipe emissions are rising with more vehicles on our highways.
For the 29% of Connecticut adults who live with obesity, summer
brings a difficult form of air pollution. Ground-level ozone is the
colorless, odorless gas formed when auto exhaust reacts with sunlight at
temperatures above 80 degrees. Ozone can be dangerous for people who
have higher body mass indexes.
If the pandemic shutdown were now,
those with obesity and others who suffer from the adverse effects of
ground-level ozone might have caught a break. Officials know that other
forms of pollution dropped significantly during the early spring.
Particulate pollution was greatly reduced briefly, according to a
state Department of Energy and Environmental Protection (DEEP) report,
because so many cars and trucks remained off the roads for weeks. DEEP
reported that nitrogen dioxide levels (NOx) decreased 30% from normal
along Interstate 95 from Washington, D.C., to Boston.
As summer’s heat sets in, tailpipe emissions are also rising as the
state’s economy opens, creating conditions that are ideal for
dangerously high levels of ground-level ozone.
Those trends likely will match those of previous years.
“The heat certainly makes the work of breathing harder just because your body temperature goes up and your metabolism goes up.”
— Dr. John Morton
The American Lung Association’s “State of the Air” report
issued on April 21 rated all Connecticut counties “F” for ground-level
ozone for 2016-2018. That F rating refers to the number of “orange”
days, when at-risk groups—including people with obesity and those with
chronic respiratory illnesses—are warned to limit outdoor activity, and
“red” days, which indicate unhealthy ozone for all. The three counties
with the worst ratings were Fairfield, New Haven and Middlesex.
Obesity rates, especially among Blacks and Latinos, have increased as
the climate has warmed, and scientists find the two are connected in
two different ways: First, hotter summer extreme temperatures worsen
chronic health problems for people carrying extra weight.
On the other hand, researchers have found, the American way of
life—frequent car travel, sedentary routines, and industrial farming–all
contribute to climate change. Large-scale, energy-intensive food
production feeds high greenhouse gas emissions while contributing to
social conditions that promote processed food with poor nutritional
value over access to fresh food.
Obesity And The Risks
Obesity is defined
as a body mass index (BMI) over 30. Severe obesity is defined as a BMI
over 40. Examples of obesity are a 5-foot 6-inch tall person who weighs
186 pounds or more, or a 6-foot tall person weighing more than 221.
Examples of severe obesity are a 5-foot 6-inch person weighing more than
247 and a 6-foot-tall person over 294.
The Centers for Disease Control and Prevention (CDC) said in its most recent national report
that obesity affects 42% of adults, 40% of young adults (age 20-39),
45% of middle-aged adults (age 40-59) and 43% of people age 60 and
older.
When combining data from 2016-2018, non-Hispanic Blacks had the
highest prevalence of obesity at 39.1%, followed by Hispanics, 33% and
non-Hispanic whites, 29.3%, according to the CDC.
In Connecticut, 27% of all adults, almost 12% of children and 14% of
toddlers (2-4) have obesity. In 1990, the rate was 10% of all adults,
reports Connecticut Data Haven in its 2019 Community Health Well-Being Survey.
Scroll
through this gallery to view combined obesity prevalence from 2016-2018
among non-Hispanic Blacks, Hispanics and non-Hispanic whites.
Across all groups, roughly a third of Connecticut’s population, about 1.2 million people, suffer on high-ozone days.In 2019, there were officially 21 high-ozone days. In 2020, two days have exceeded the threshold as of July 7.
Obesity is a disease of inflammation—meaning the body perceives an
invader, and hormones that drive metabolism react. Ozone increases
inflammation in the human body, said Dr. John Morton.
He is a surgeon, obesity researcher, and division chief for bariatric
and minimally invasive surgery for the Yale New Haven Health System and
vice chair of surgical quality for Yale School of Medicine.
“Higher ozone is going to create a double hit,” he said. “You have
the inflammatory response of obesity along with ozone, which will make
it worse.
“We saw that in COVID obesity was a big risk factor in China and
Europe and the United States because of the enhanced inflammatory
response,” he said. “Certainly, ozone and obesity don’t mix.” Obesity
also has been proven to be a response to environmental factors like
chemicals and BPA plastics, and climate change itself is linked to
rising obesity rates because of greenhouse-gas-intensive practices like
raising red meat, Morton said.
Obesity decreases lung function and makes chronic problems like sleep
apnea worse, he said. “The heat certainly makes the work of breathing
harder just because your body temperature goes up and your metabolism
goes up.” Over his 20 years of practice, he said, he has noticed “more
issues with heat and sun.”
“The biggest thing if you are carrying extra weight is to do
something about your weight. We have many different therapies. We
believe obesity is a disease,” Morton said. Those
therapies include six federally approved medications; a modified
bariatric surgery known as a sleeve gastrectomy, which makes the stomach
smaller; cognitive therapy; and other procedures that help with hormone
production.
Morton
said he used to advise that patients visit air-conditioned stores to
walk around on very hot days, although during the pandemic “it’s become
harder” to do that and stay away from crowds. But staying active is
still important, he said. “It helps their heart. It helps their mood.
Social isolation becomes a big risk factor for mortality. People who
carry extra weight become socially isolated.”
He acknowledged that it can be hard to move around in heat, high
ozone, and during a worldwide pandemic. He advises taking a walk during
cooler times of the day. “If it is time to slow down, slow down.
Hydration is really important.”
Scientists say not enough studies have been done on obesity and
climate change in light of the 2.3 billion adults who the World Health
Organization estimates have obesity. In the United States, funding for
climate-related health effects occupies just .004% of the National
Institutes of Health budget, said Dr. Kristie L. Ebi, an epidemiologist at the University of Washington who studies the health risks of climate variability.
“Ozone affects anybody who has any kind of lung issue,” she said in
response to a question during the Metcalf Institute for Marine and
Environmental Reporting workshop in June. “We don’t differentiate
vulnerable groups very well. We tell everyone to do the same thing” when
ozone levels are high. That is to stay inside.”
A University of Michigan review
of 170 studies linked ozone to breathing problems in people with body
mass indexes over 30. The study noted that those with obesity experience
lower lung function in general. It also noted that “few epidemiologic
studies have examined the interaction between excess weight and ozone
exposure among adults.” The authors suggested that as obesity rates
rise, more particular studies of people with obesity are needed to
figure out risks they live with. They added that “recognition of this
susceptibility could help regulators to designate obese populations as
at-risk populations under the Clean Air Act for consideration in
standard setting and public health warnings for air pollution.”
A 2019 study
by California and Colorado scientists found a connection between ozone
exposure and higher triglycerides (fat found in the blood) and lower
“good” or HDL cholesterol. And a 2007 Harvard School of Public Health
study of older veterans concluded that those with obesity and lung
sensitivities suffer more when exposed to ozone.
Dr. Kai Chen
The Institute for Health Metrics and Evaluation’s Global Burden of
Disease study estimated ozone exposure causes 254,000 additional
premature deaths globally each year. For Connecticut,
that study estimated that 231 deaths in 2017 from chronic obstructive
pulmonary diseases (COPD) were due to long-term ozone exposure. “This is
a very conservative estimate,” said Kai Chen,
an assistant professor of epidemiology at Yale School of Medicine who
studies the intersection of climate, pollution and human health,
“because cardiovascular mortality is also related to ozone exposure.”
Ozone is connected to other health conditions, too. For example, a 2017 study by a group of scientists across the United States connected long-term exposure to ozone in Black women, and a study of New York asthma sufferers linked ozone to increased hospitalizations.
Warning Standard May Be Too Lax
Current science suggests that the state’s danger threshold for
ground-level ozone should be stricter, scientists say. It is based on
the Environmental Protection Agency’s unhealthy ozone standard of 70
parts per billion over eight hours using data from the previous three
years. The federal standard was last lowered from 75 ppb in 2015.
“This standard is likely not enough to protect the public health,”
said Chen, who has studied ozone and health in the United States and
China.
Setting a stricter danger threshold would immediately result in many
more “orange” and “red” days, issuing warnings to people with chronic
health conditions like obesity, heart disease and asthma to limit their
movement outside. As the climate warms, ozone levels will get worse not
only in the summer but also in the winter, scientists predict.
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