America’s obesity epidemic appears to be making the coronavirus outbreak more dangerous — and potentially more deadly — in the United States, new research suggests. For younger and middle-aged adults in particular, carrying excess weight may significantly boost the likelihood of becoming severely ill with COVID-19.

The evidence for this comes from thousands of COVID-19 patients who sought treatment in emergency departments in New York, and it’s prompting alarm among doctors and other health experts. In the U.S., 42.4% of adults have obesity, which means their body-mass index, or BMI, is 30 or more.

In one of two new studies released this week, COVID-19 patients who were younger than 60 and had a BMI between 30 and 34 were twice as likely as their non-obese peers to be admitted to the hospital for acute care instead of being sent home from the ER. They were also 1.8 times more likely to require critical care in a hospital’s intensive care unit.