More overweight Americans are having weight loss surgery to reduce their risk of COVID-19 complications. Studies have shown that obesity is a major risk factor for serious illness and risk of death from the coronavirus.

The Centers for Disease Control and Prevention reports that the risk of hospitalization is six times higher and the risk of death is 12 times higher for COVID-19 patients who have an underlying condition such as obesity.

The rate of obesity has been skyrocketing in America, prompting healthcare experts to refer to its combination with the coronavirus as an “epidemic within an epidemic.” According to Forbes, obesity is the most common risk factor for severe illness from COVID-19 with over 30% of the population affected. Obesity causes several health issues that predispose people to complications. It suppresses the immune system and also severely restricts lung capacity that can make ventilation more difficult, says the CDC.

The CDC reports that rates of adult obesity are increasing. Twelve states have prevalence rates of 35% or higher. Black adults have the highest rates of self-reported obesity, followed by Hispanic adults.

According to The Wall Street Journal, now that medical centers are open for elective surgery, many obese patients have scheduled bariatric or weight loss procedures such as gastric bypasses, laparoscopic bands, and gastric sleeves that reduce stomach size. Statistics show that the numbers of bariatric surgeries performed in the U.S. dropped to zero in April but rebounded in June to a higher level than in the same period the previous year.

Patients are no longer regarding a weight loss procedure as cosmetic, but as a desperate bid for life or death in the face of COVID-19.

“The pandemic has been a wakeup call,” Matthew M. Hutter, president of the American Society for Metabolic and Bariatric Surgery and a gastrointestinal surgeon at Massachusetts General Hospital, told the Journal. “We’ve realized that patients with obesity are at a much higher risk for serious cases of COVID-19, including ICU units and intubation, and even death.”