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Covid vaccine efficacy on obese people

Nutrition prof says ,"Will it still work in the obese? Our prediction is no."
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"Will we have a Covid vaccine next year tailored to the obese? No way," said Raz Shaikh, an associate professor of nutrition at the University of North Carolina-Chapel Hill. Scientists know that vaccines engineered to protect the public from influenza, hepatitis B, tetanus and rabies can be less effective in obese adults than in the general population, leaving them more vulnerable to infection and illness. There is little reason to believe, obesity researchers say, that Covid-19 vaccines will be any different.
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i feel like if they don't even know enough about the virus, itself, then how in the world do they know about a vaccine that hasn't even come into fruition yet? starting to wonder what we can and cannot believe these days when it comes to covid.
Interestingly, obesity does seem to be a risk factor for getting worse covid infections.  But there is an easy way to answer this, and that's to run a testing program before drug approval that tests enough different type of people to know.  We also know African Americans are getting worse problems with covid.  So are people with certain other health problems.  So are older people.  So if we don't test the vaccine on a wide enough spectrum of the population around the world -- it's a worldwide disease so if anyone wants herd immunity we will need to vaccinate the world population, not just one country, as people travel and at this moment it appears unlikely this vaccine if one works at all will work forever and so there will be gaps in coverage.  Rushing the vaccine as everyone in the world is doing right now if it means not testing enough of these different populations will raise the risk of it not working for some people and then it won't really work much at all.  

anxiouswhispers    The article explains they know lots about all other vax, and obese human bodies aren't able to make as much use of those vax as non obese. It is true we don't know much about Covid since it is novel, but the human body isn't so I leave it to the scientists to do the projections.        
paxiled and anxiouswhispers I reread the article and note that BMI correlation will be documented, so we will see what the efficacy results say. "The clinical trials underway to test the safety and efficacy of a coronavirus vaccine do not have a BMI exclusion and will include people with obesity, said Dr. Larry Corey, of the Fred Hutchinson Cancer Research Center, who is overseeing the phase III trials sponsored by the National Institutes of Health.
Although trial coordinators are not specifically focused on obesity as a potential complication, Corey said, participants' BMI will be documented and results evaluated."
That's certainly good to hear, but since most of the vaccines being formulated are controlled by private companies and not by the gov't agencies investing in them, there is no actual way to know if this is true until the data is revealed to us, if it is revealed to us.  That also doesn't mean they are going to specifically look for obese volunteers willing to be exposed to covid, as that will be the only way to know if the vaccine works.  So testing BMI of a bunch of thin white people won't tell us what we need to know.  I really don't know how this is going to work, just expressing that none of us know or have any influence how this is going to go.  We do know that China has a vaccine in advanced development, and they mostly have used members of its military as the guinea pigs.  They are likely to be younger, more fit, and less obese than the general population.  We also know that clinical trial involve volunteers in other places, and that isn't a random sample, it's confined to those willing to volunteer.  Still, in the end, it does look like we will have a vaccine, and if it works well and we get herd immunity, that will also protect those who might not be as receptive to it.  That only happens when the vaccine is really really effective, and none of the vaccines being studied so far have been that successful looking, but I'm rooting for a great vaccine and an end to this madness.
The above article said that obese people are not normally factored into flu formulations so anyone in that group has not received good service over the years, although at least this time they are tabulating their results. I'm not in the obese group, so I have no idea if those kinds of people ever got notification from their docs that their flu vax had less chance of success, or whether anyone noted the results in their group. You don't get any choice when you get a flu vax so have to take it or leave it.
I take it from Fauci that there are not any company influences to date as he reaffirmed that this week.
You have to set up endpoints before the trial starts that the company wants to be approved to go on the label.  i.e. If you only test all thin white people then your results state that, so if you are not slim and white, then  your doctor should have more interest in a competitor's drug that had been proven to work on obese people if it happens that 2 drugs are approved in January. It is to the company's advantage to prove as many endpoints as possible, and the independent "invigilators" (for lack of the technical word to describe them)  do the patient selection based on the criteria set out by the company that has to be APPROVED by the FDA before the beginning of the trial, but if the criteria are too wide then you end up with people you don't want in your trial simply because their result will not be able to prove your endpoint - for example if a patient has 10 co-morbidities then just because he did or didn't get a favorable result shouldn't apply to the rest of the 30,000 but their result has to be counted in the stats the FDA uses to decide approval or not.

I'm not an expert on approvals but have followed a few FDA trials over the years. One was a diabetes drug where the company A's CEO told me the invigilating crew surprised him during the trial by providing large numbers of morbidly obese trial patients (not the target market he had in mind for the drug) so the CEO told me all he could do for them was guessing, and he dosed those ones by weight, which didn't turn out well so they messed up the meds overall stats, so he ended up with too many variables to prove anything.
Another CEO from company B told me that was an example of poor planning on A's part, because they should have stated what was allowed in the criteria (FDA advises you how they look at the criteria before you start the trial process, so you can't just cherry pick people that won't prove anything after the trial is complete and expect to get an FDA label for your med - although it seems the flu vaxes are sort of like that since the article says no one pays attention to obese people, but that may be because there is limited competition for that market - who knows?)  and he has set strict patient criteria (multiple listed problems have to exist in each patient) so he will have multiple endpoints - if the med resolves any  of those issues, the reviewers won't be able to say this person was not obese enough, or just had y condition but didn't have x underlying condition so he might have recovered on his own, etc.  
Also followed a kidney device trial where the company "C"'s CEO was also not careful setting up the trial (but he blamed the partially useless problems on someone else) so the results required a lot of interpretation to figure out exactly what had been proven. After the 2 year trial concluded C" only proved a few of his attempted endpoints because there were too many unisolated complicating factors he hadn't thought about in the beginning.
Anyway, we will see what comes up as these trials results are made public months from now. It seems there will be a robust demand for the vax especially if you have to take it every 6 months - who knows?- and just judging by the unprecedented number of studies to date on Covid in general, there will be lots of scrutiny by the docs providing peer review all of which will be well followed in the news.
The truth about FDA approvals isn't pretty.  But this vaccine isn't the normal drug.  On this one our economy depends, so it will be studied by experts in a way they usually don't do.  The FDA has a chronic problem which is two conflicting jobs -- one is to guarantee safety and effectiveness but the other is to get products on the market as health care in the US is a commodity like any other.  Another problem is that virtually everyone who knows enough about this stuff to judge it is in the pay of the pharmaceutical industry.  So they have a very checkered history.  But again, you're right, this vaccine is going to get looked at like no other drug ever.  I would worry a lot less if a certain Administration weren't so involved and it weren't so close to election time, but this is where we are.  The betting money in the business world appears to be on AstraZeneca and Pfizer, while the hopeful money is on Moderna, which was created by DARPA.  We shall all see.
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It hasn't been my experience that the FDA is an arm of the Commerce Dept. In fact, FDA is bureaucratic to the point that it takes years to get an approval for something that is life saving that they already know works (other than oxycontin which was a one-off that for some reason got some kind of special approval without the data to support it, but that was a one in 50 years event and is more complicated than tabulating vax results). The FDA has been the graveyard for many promising technologies that spent years trying to get approvals and ran out of money giving competitors time for a better technology to appear. I watched a sterilizer approval take 5 YEARS that the analyst following it said it should have taken 2 WEEKS maximum since the company had done rigorous testing with their submission and some of the FDA questions that slowed the process down were repeats of previous ones that had been answered.

The independent reviewers for the vax and the invigilators who conduct the human trials are not paid by the pharma company seeking the approval, and the FDA has to review the independent's recommendations - so Dr. Stephen Hahn would have to intervene and override this committee in front of the entire US media. Perhaps the administration will pressure him for vax approval ahead of time - but there are many people following this who won't take the vax if Fauci et al say it's not safe which is not a good vote getter, even if a gamble-approval works better than expected post approval because the election will be over before anyone knows the results of hundreds of millions of injections. So I think the 90% odds of a proper approval per this article sb closer to 100% but we will see.                 https://www.cnn.com/2020/08/11/health/october-surprise-vaccine-nih/index.html
From what everyone is saying, so far, there don't appear to be shortcuts at this point, but everyone is also saying that the time schedule is being driven by the current Administrati0n and pretty much nobody trusts this Administration, which is sad because we're in an emergency.  But certainly the US isn't the only nation pushing much faster than is usually the case.  Russian and China are already administering vaccines that have not even entered Phase 3 trials.  As I've said many times, my info on covid comes largely from watching interviews with epidemiologists in the newspaper and on TV news, so it's from the horse's mouth. and they're the ones who are hopeful but worried.  They are going to watch very closely, but governments have the power under emergency decrees to bypass normal channels, and this is already being done by everyone as we are all desperate for a vaccine and don't want to wait the length of time it usually takes to do this kind of thing.  That doesn't mean they will use shortcuts, but it does create an enormous incentive to do so.  As to the other point, I'm not sure what the point is.  The Commerce department is there to regulate commerce and to act as sales force for American products in general.  They do regulate banks.  But all regulatory approval agencies in all countries have a two-fold mission:  to regulate and to approve.  There are a ton of anecdotal stories from those who feel they had safe and effective products that were blocked by FDA inaction, but since the products aren't out there being used we have no idea if they were blocked for good reason or bad.  It's true the FDA is very slow.  It's true that most physicians are in the pay of the pharmaceutical industry in one way or another.  Sometimes it's small, such as free samples.  Sometimes it's more, such as paid speaking engagements in the Bahamas and the like.  A few years ago good gov't groups successfully pressured the FDA to make sure it's review panels -- these are the groups that are called upon to see if a drug that has already been approved is working and safe, because no matter how much testing the FDA requires pre-approval, the true measure of a medication or device doesn't come out until about a decade of use has passed -- were composed only of experts who weren't paid by the pharmaceutical companies.  They couldn't fill these panels, because they couldn't find enough people who were not in some way paid by the industry, so I think that fell by the wayside.  I have no idea what your personal experience is, I just know when I was in law school studying administrative law that this is how the law actually works.  Personal observation just requires anyone who cares to research the medications that have been approved and see how often companies were found to be lying and had to be forced to put new warnings on their labels and websites.  This is just the truth of what happens when medicine is a commodity like anything else.  Businesses always lie.  Small ones lie, big ones lie.  I spent most of my career managing small businesses, which is what my father did for a living, and working for the gov't as an attorney, and it's just true, you can't sell as much stuff as you want or sometimes need to if you tell the absolute truth about stuff.  The lie can be small, such as, yeah, this is a great toaster when in fact the salesperson has no idea if it is or it isn't.  Stuff happens when humans are involved.  This doesn't at all mean that drugs don't help lots of people, it just means they help less than advertised and harm more people than advertised.  It doesn't mean we shouldn't use them, it does mean we should always only use them when necessary.  I personally have no idea how good the vaccine will be, but like you, I'm guessing that at least in democratic countries the intense scrutiny from the public and the experts will make this vaccine a good process, but it doesn't change that it is a highly ramped up process because it's an emergency and because every world leader is suffering politically from it.  We're not going to be Russia or China.  We will test it.  We all hope it works out for the best.  We all need to keep our eyes wide open to make sure it isn't rushed too much, as so many medical professionals are afraid might be happening but hope isn't.  I'm just saying, keep an eye out.  And don't believe folks who tell you their products were great and it was the FDA that stood in their way.  No way to know that.  The products the FDA has approved do not have a stellar record, so I'm guessing the ones they didn't approve were dicey in some major way.  But again, no way to know.  Peace, all.
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There are several vaccines that are coming out of Phase 3 trials by the end of 2020. Two are mRNA vaccines and one is a recombinant Adenovirus vaccine. by Johnson and Johnson. There is also one in Oxford, England etc. Depending on where you live. The mRNA vaccines will be out by end of the year. These are pieces of molecular material that target the spike protein of the Corona Virus (stable section). This vaccine is new and never before been used on humans. So far it has passed safety and efficacy of phase 1/2 trials and is undergoing phase III. We'll see about the data of that one. I am going to make sure the full data is completed and evaluation and accepted by the FDA before thining about this vaccine that hasn't been tested for very long. As for the J&J vaccine it is a vaccine that is similar to the flu vaccine. These are well know types of technology. i don't have a problem getting that one. It uses a piece of the Adenovirus virus so you can't get the virus and it creates immunity because the body see's it as foreign. That is how all vaccines work. But the way they make this latter vaccine is already known. So if it is safe and effective I am going for it. That one is also around the end of the year , maybe beginning of next year. I hope that they have both the flu and Corona virus vaccines by then.
p.s. the mRNA vaccines are by Moderna and Pfizer. I trust Pfizer over Moderna but just thought I would mention that.
I heard an interview with the head of the Moderna effort a couple days ago on CNBC.  They are not as close to a vaccine as has been reported.  They need 30,000 volunteers, and so far have about 5,000.  They need to have them to about their business and then see how many get the virus in the control group compared to the ones getting the real vaccine.  They need to give a booster, as one shot won't do it.  It sounded like what Fauci has been saying, that it's more likely to be early next year if it works judging from what I heard, but things can always speed up if they go really well.  The Oxford folks are considering exposing volunteers intentionally to the virus, which is very controversial, and I believe they are mostly testing in India.  I don't know why, but the guys who are judging stocks seem to like the Oxford/AstraZeneca and Johnson and Johnson, which we aren't hearing much about.  I again don't know why, as Moderna is ahead and seems to be doing pretty well with it.  If the Moderna vaccine works, and this is actually a gov't created company that has never created a useful product yet which may be why the business handicappers aren't sure about it, my understanding is, this will be a great technology for the future as it is quick, bu they have been trying to formulate effective vaccines for years and have failed so far.  The weirdest thing is the Russians claim they now have an effective vaccine and are giving it to some folks already, but everyone I listen to says this is bogus.  Weird.  And isn't Pfizer just partnering with Moderna to provide them with manufacturing capacity, as Moderna is a small company with no earnings?  It was created by DARPA in the defense dep't, and has venture capital money, so it needed Pfizer in order to make a lot of it.  I think.  The flu vaccine is already available, they have to decide which strains to bet on before the flu actually hits which is one reason that vaccine is never very effective.  It mutates a ton.  But it is already probably made and ready for fall.
Yes I think Early next year or mid year we will have some type of vaccine. I read yesterday that the MRNA vaccines by Moderna and Pfizer are going to have some trouble with mass vaccination . Mostly, maybe Pfizer if I recall correctly. As these two viruses need to Keep their respective vaccines frozen before use. The Moderna one is more like frozen part of our refrigerator Maybe -4 degrees Celsius as for the Pfizer I read it may need -90 degrees (this would require liquid nitrogen). The problem with having to use liquid nitrogen is that most out patient settings don't have the facilities to store liquid nitrogen. I think other vaccines freeze theirs at refrigerator(freezer) temp. The problem with the new vaccines (MRNA) type, is that this technology has never been used before. So there is some concern about long term side effects. But as for the other ones like the recombinant vaccines are already used so that technology is not different but it will take until early next year to get it.
I thought and think that Pfizer is working with Moderna because Moderna is a small company that can't manufacture that much vaccine.  Pfizer of course can.  That's at least what I thought.  But the vaccine that appears is going to win the race is either a Chinese one or the Oxford/AstraZeneca one in England.  I've also heard that none of the vaccines most likely to be first are going to be the best, but they may block further development because they will have won the economic battle and for these companies that's what they're after.  I'm hoping some company will keep working on a vaccine that works longer and doesn't need to be taken twice a year like the Moderna one.  Because pretty much every major pharmaceutical company in the world is funding research into a vaccine, I'm hoping being first doesn't end the hunt for being best.  Peace.
There are 6 vax in Phase 3 trials and "Overall, 165 vaccine candidates have started some forms of trials as scientists all over the world are working around the clock to find a safe, effective vaccine against the novel coronavirus." https://www.timesnownews.com/health/article/who-says-six-covid-19-vaccine-candidates-in-phase-3-clinical-trials/633216          No vaccine that works poorly is going to  " block further development " because that is not how biotechnology companies operate. They are all in a competition to eat each other's lunch and it's looking like that lunch will be a long and repetitive one if a vax will be needed for each person for years should antibodies prove to be short lived.
If a company has more efficacy than the existing gold standard that company will forge ahead in hopes of becoming the new gold standard - that is how biotech companies operate - otherwise no new drugs would ever be invented once the first one was approved.
Well, Anxious, history says different.  Take antidepressants.  When Prozac came out, every pharmaceutical company make an SSRI.  It took awhile before everyone realized they didn't actually fix the problem and then an SNRI was invented, and then everyone invented another one.  It's a me too world out there for large companies, it's much cheaper to tag along than to innovate.  So yes, eventually maybe you're right, but we want a lot quicker than eventually.  I hope you are right, but that's not how large corporations operate, it's how small companies and independent researchers operate but they need money to work and then an alliance with a large pharmaceutical company to market and if all that money has gone into the first vaccines, and it already has, I fear it won't work as you hope it will.  I hope you're right, but again, we've got how many statins out there?  Just go down the line, it's a copy cat world in mega cap corporation world.
"...if all that money has gone into the first vaccines, and it already has,...." ?? That is a stretch - -a very big stretch.  All the money hasn't been spent and never is. Big corps can always dig up money for a better idea. Why do you think 165 companies and government scientists are working on vaccines now if all the money is spent?

I have invested in scores of tiny biotechs over the years ( 8 currently including 2 seed money - ground floor - pure startups) and they all depend on working up their technology enough that a big company will take an interest in their results and buy it or partner with their money - but first these companies have to spend lots of time and money to get results.
They don't fret that "all the money is gone" just because there is a current gold standard for a medical problem. The only thing they keep an eye on outside their own company developments and prospects is the progress of competitors developing something that is better and/or cheaper than theirs.
I should have said debatable instead of stretch. That way anyone can form their own opinion.
Small companies depend a lot on venture capital.  Large established companies do not receive venture capital, but are plugged into the socialist side of every economy, which is gov't contracts and gov't support.  Every affluent nation has spent billions of dollars on vaccines that may never get produced.  The money has already been spent by the gov'ts.  Not necessarily by the companies.  In today's environment, raising money from the gov't is very hard, and the investment banks are not doing great either, so a lot of the usual sources for large established companies is dried up.  Until the covid recession ends there's a limited amount of money out there, and the biggest spender of all, the US, was already in trouble because of years of tax cutting.  "All" the money is never gone, that's true, but certain normally reliable sources of money are not there right now because although there has been tremendous hype about the stock market run, the vast majority of that run is in a few companies (hope you're all invested in Microsoft, Apple, Nividia, Facebook, Tesla, Netflix, Amazon and Google, everyone).  Most of the market is quite bad right now.  It should come back with a vaccine, but it's the vaccine we're talking about right now.  You should also tell folks on here that you must be very very rich, because almost none of those startups  work out.  But you only have to score on a couple to do well.  Now, I don't know what this has to do with anything on here, other than the small point I was making, that often when an initial treatment comes out it freezes other treatments out for at least some period of time as everyone moves to copy what has already proven capable of getting approval.  At some point, that money no longer pushes the stock price higher, and other products have to be found.  Peace.
I only said you must be rich, by the way, because investing in such speculative endeavors requires one to expect to lose their money almost all of the time.  Most of us can't do that, as guessing right takes a lot of different investments in speculative endeavors and is very very risky.  I really mean that if anyone is reading this who is a small investor, as I am, be careful out there.  In the era of Robin Hood, it's important to know.  Peace again.
Sounds like Sanofi has a vaccine that is 70% effective. It is, I believe, the recombinant one used like the flu vaccine. I have to read more about it. But look up that vaccine. I think it looks promising.
Astrazenica, is also going to do a trial on the Oxford vaccine soon.
AstraZeneca/Oxford is already in Phase 3 trials, as I understand.  Some of it is in India.  Some will be in the US.  From what I hear on both business news outlets and the regular news outlets, this one is in the lead as to who will be first.  Johnson and Johnson, which we don't hear as much about, is also pretty far along.  China is far along, if we can believe anything that comes out of China.  Russia is already using one before doing Phase 3 trials, but can't believe anything out of there, either.  I wish the world were better governed at this time of crisis and was working together instead of racing for income and bragging rights.  Now the FDA and CDC have been politicized.  What a bad time for all this nonsense.  Peace.
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I agree with your last statement. I did hear on this last Tuesday the Oxford vaccine trial started phase 3 here in the U.S. I hope for the best for us all. I hope we get our life back. I am going to party like its 1999. LOL
Just saw an interesting article on obesity and covid.  Oddly, it makes it a lot worse, possibly because of the weight pushing on the organs and possibly because of the hormonal and immune system changes obesity brings, but the odd part is, it only seems to make covid worse for younger folks, not the older ones who have the most problems with covid normally.  This is one odd disease, but it does make it important the vaccine trials be better than they are looking so far -- underrepresentation of minorities and the obese and the older folks is already happening.  If the disease affects people so differently they really need to test the vaccine on a wide array of people.  
I did see that they were doing a variety of ages and ethnic groups for some of the trails. I have a friend who is obese and also type  2 diabetic, Latino, and about 62 years old. So she has a lot of pre-existing problems for this virus. She got Covid19 badly and was sick for about 12 days before she got breathing problems. She then went to the hospital and was there for 10 days. They intubated her and she survived. She is doing okay. She got her taste back but her energy is too low to go back to work even after 5 months. I feel sorry for her. Funny thing is her husband is 65 and he only got a sore throat. Very odd indeed. I think there are some genetics involved here and immunity differences. Maybe a lot will come out with all the research going on.
It's the obesity.  I have seen several reports about this lately.  They're not sure exactly why.  As for the trials, I hope you're right.  I have heard the opposite.  Of course, we're all hearing things and most of us are not there doing it so we can't know for certain, but I've just heard a lot of the experts interviewed saying they do have a fear that this is moving so quickly it will be hard to do such a thorough study, and even much longer studies have not done this.  Minorities are usually under-represented in most everything we measure, and it's always bad but especially with covid having so far a much greater effect on certain folks than other folks.  But I do hope you're right.
Avatar universal
I am well-padded :-) so I would like to suggest when they study such issues they also include the variable of the length of the needle when injecting the obese.

I have had flu shots where I swear they hit the bone, flu shots that clearly entered the muscle, and flu shots where the needle was only 1/8" long beyond the syringe (nurse w/bad attitude and my fatty upper thigh site to boot.)  

Guess which shot did not produce my usual allergic reaction, my usual 1 day of flu symptoms, and did not protect me from the flu?  

So... request a longer needle if they come at you with a short one.

As for studies, they need classes training them to identify study biases and gaps before they themselves design a study. I sat in a conference room once with self-esteemed professionals starting a study. I came prepared with a list of questions. It was amazing how little thought they had put into their study's design.  Every time I read a news story about new study findings, I snort.
Well, that one year the shot might also be one of the many years the vaccine didn't guess right and cover the strain that was going around, which would explain why you got the flu that time.  In its best year the flu vaccine was only 40-50% effective.  As for studies, everyone who has an advanced degree in social sciences and in research fields must study statistics, so they do know how to design studies properly.  Most studies are not, however, well designed because most studies aren't serious studies.  Most of them are done by graduate students who need to do one to get their degree, and we don't know that because their professor must sign off on the study.  Some studies are intentionally flawed, because much of the funding of studies and design is done by for-profit companies that only want favorable results -- think the tobacco industry and all the scientists who did studies showing it didn't cause cancer.  It takes a lot of prep and time and a desire to come out with a correct conclusion to perform a good study, and those conditions seldom converge in a study we're going to hear about.  And also consider that news reports of studies often get the results of the study wrong.  A study done a few years ago found, among a lot of other things, that eating butter and coconut and other saturated fat wasn't as harmful as once thought.  The headlines were that those things didn't cause problems.  The writers of the study had to write their own article and appear on talk shows to say that, no, people still should avoid eating too much of those things, they just aren't as harmful as was thought, not benign.  You often have to read original source material if you can understand it, and often it's written in a way that makes it impenetrable, to get the true nuanced results.  Ever read Adam Smith's Wealth of Nations?  We've trained generations of economists who never have, they've just read excerpts, and would be surprised to see he had severe disregard for capitalists.  He was a big fan of the landed gentry, however.  Ever read the actual writings of Karl Marx?   Believed in anarchy and pure democracy.  You wouldn't know that to hear folks talk about communism.  Probably has no chance of ever working, but if any nation ever achieved communism, it wouldn't be a nation anymore.  So yeah, the reporting of studies is often not what they in fact say.  Peace.
Avatar universal
Perhaps efficacy was affected by issues such as length of needle and not the quality of the vaccine?  I always have an allergic reaction to flu shots so when the shot with very short needle caused no reaction, I blamed the needle/fat, not the vaccine.  Way too many people use obesity as a scapegoat. Annoys me to no end when obesity, diabetes, asthma appear as dx codes for completely unrelated health issues.

Today is day 2 post-flu shot 2020 and my allergic reaction is beginning and that needle was loooong lol.  The pharmacy person indignantly informed me that in 25 yrs she has never shot anywhere but the arm. "It has to be in the muscle." I replied that there is a muscle beneath the fat in my thigh so jab and push will work just fine.  I dropped my drawers she asked where I wanted it I pointed and everything was fine. Then I told her she is now trained to inject a thigh lol.  

There was an elderly couple getting theirs right before me that I had chatted with. When the wife came out after, I idly asked her whether they gave them the enhanced flu shot due to their age. She didn't know and asked someone who also didn't know but glanced at their paperwork and said yes. Not sure about that since they didn't appear to know what the enhanced version was and the couple had not specified it.
Everyone knows you can also get a shot in the behind, many prefer that.  You're right, the arm is hardly the only place to get a shot.  I have no idea about needle length, whenever I've gotten a shot I don't look, I really don't want to see the needle.  That's me.  If a needle is truly too short to get to where it needs to go, that's a big problem.  But you really have no way to know if the needle was too short or not.  It is a good question to perhaps pose to an expert, though, because if this happens a lot it's a problem.  I also don't know that fat gets in the way of muscle.  Never really thought about it.  But the reason obesity is mentioned so much is that no matter how we might wish it to be otherwise, obese people have way more health problems than everyone else in general.  Obesity is one of the most aggravating factors for covid.  They're not sure why, but it is.  It's not being cruel to say this, it just is the way things are.  Humans don't do well if they are obese.  But that's a generalization, and I'm not sure they die a lot younger, I don't think they actually do, but they do get a whole lot more chronic health problems.  At any rate, you've raised an interesting question and if you ever find out the answer, share it with us.  I'm sure somebody has studied this.  Peace.
I have rotated shot sites for years, including in the gm. I prefer thigh because I don't have to sit on the reaction lol.

The parameters to judge degree of health, obese or not, is interesting. Do we go by dx codes? (The codes are too closely tied to reimbursement to trust, statistically, imo.) Do we go by number of admissions? Number of surgeries? Number of meds? Test results? BMI? Age at death?  IMO there is a huge prejudice nationwide over obesity. I do not believe it is nearly the problem it is presented to be.  

I did one of those "dot org" life expectancy estimators, answered all questions truthfully, and my prediction was 85yrs old.   Mom's was 90yrs old.  85 sounds excellent to me because my structure is wearing out faster than my internals lol.  

Mom will be 90 in January and sadly is right on track for her prediction.  She is tall slender and I am tall fat (Dad's genes-died at 92 fat and diabetic for 30 yrs.).

My brother is tall fat but all of his test results for bp, cholesterol, arteries, diabetes, etc are normal. However, his structure is wearing out also. So I would agree with you with regards to obesity and structure, but not with regards to internal issues.
I'm not obese or close to it, but I'm 67 and my structure is shot from a lot of factors, partly being really active which is good for you but not so good for your structure sometimes, and the rest from what doctors did to me.  But I can tell you that the correlation between obesity and problems internally is definitely there.  But in our system of modern medicine, they can keep us alive a lot longer than our shelf life would have been otherwise.  The way they do that isn't pretty or fun, however.  I've never thought long life was the goal, health while alive seems to me to be a better guide.  And if you're obese, you are rolling the dice more than you would be if you weren't.  It takes a toll on the liver, pancreas, and heart.  It takes a toll on the immune system.  It takes a toll on pretty much everything.  And despite that, all that is a generalization, and generalizations don't say anything specific about any one person.  So health-wise, no, I don't believe that's prejudice.  I believe there is prejudice every other place, however, including the quality of your healthcare.  But so are many other factors.  If you're Black, you get worse health care.  If you have mental illness, you get wore healthcare.  If you're poor, you get worse healthcare.  Etc.  Doctors and health insurance companies do discriminate in all kinds of ways to make their days easier.  All the best to you and the best of health.
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