Obesity and COVID‑19

The ongoing COVID-19 pandemic has brought the issues surrounding obesity into the public consciousness. Recent studies are highlighting that people with obesity are at higher risk of developing more severe disease and complications from COVID-19.1-4 Additionally, a recent study suggests that younger patients, who also live with obesity, are more likely to be affected by COVID-19, especially in terms of ICU admissions.5

Risk of developing more severe COVID-19

Preliminary data suggest that people with obesity are at increased risk of developing severe COVID-19.The US Centers for Disease Control and Prevention (CDC) states that people of any age with certain underlying medical conditions are at higher risk for severe illness from COVID-19, and being hospitalised and admitted to critical care units: 2,5,7-10

  • 48.3% of people hospitalised for COVID-19 had a BMI ≥30 (kg/m2)10
  • BMI >40 (kg/m2) was the second strongest predictor of hospitalisation, after age3
  • Patients with obesity and COVID-19 have an increased risk of mortality9

Studies have shown that each 1-unit increase in BMI was associated with a 12% increase in the risk of severe COVID-19.11 In particular, the presence of obesity increases the risk of severe illness approximately threefold with a consequent longer hospital stay.11

For step by step guidance on treating your patients with obesity, download the 5 steps on obesity document.

Additionally, you can also find more information about how to treat obesity here.

Increased risk of other complications

Current data suggest that usually, COVID-19 can result in more severe symptoms and complications in people over 65 years of age, 5,7 and those with other chronic health conditions, including those living with obesity.3 However, in patients with COVID-19 younger than 65, the most common complication is obesity.8 Obesity is already known to be associated with other health complications including cardiovascular disease, diabetes and hypertension, which are also in populations indicated to have a higher risk of more severe COVID-19 complications.1,7,12-14

For more information about the common complications associated with obesity, click here.

Potential pathways

While data investigating the association between COVID-19 and obesity is still emerging, recent studies have suggested the increased severity of COVID-19 in people with obesity are due to specific pathways that link to: 2,3

  • Reduced cardiorespiratory protective mechanisms15

  • Obesity-related complications and other comorbid conditions (such as cardiovascular disease and diabetes)15

  • Metabolic factors (such as hypertension, insulin resistance and dyslipidaemia)2

  • Increased viral exposure / OR Reduced immune response16

More research is needed to draw complete conclusions on the definite causal and pathophysiological relationship between obesity and severity of COVID-19 outcomes.17

The importance of maintaining long-term management

It remains as important as ever to ensure people with obesity are able to maintain or start a healthy weight management plan, as easily as possible.18,19 The current pandemic might contribute to an increase in obesity rates, as weight loss programmes (which are often delivered in groups) and interventions are being severely curtailed.19 The current lockdown measures introduced in some countries, could have an impact on mobility and enforced physical inactivity, even for short periods of time, increasing the risk of metabolic disease.19

This self-isolation has led to many people relying on processed food with longer shelf life (instead of fresh produce) and canned food (with higher quantities of sodium).19 Bariatric medical and surgical procedures have been among those cancelled, and regular appointments of other non-acute patients have been scaled down, which may lead to people with some chronic diseases without the appropriate care they need.19,20 It is important to ensure vulnerable populations, such as people living with obesity, are receiving the best care possible now, to avoid longer-term implications for health systems.18

Truth About Weight™

Truth About Weight™ is an online educational resource where your patients can find information on obesity, including guidance on how to cope with obesity during the current COVID-19 crisis. Click here for truthaboutweight.global

References

1.      World Health Organisation. Information Note on COVID-19 and NCDs. 23 March 2020. https://www.who.int/teams/ncds/covid-19. Last accessed: October 2020.

2.      Naveed Sattar N, McInnes IB, McMurray JJV. Obesity a Risk Factor for Severe COVID-19 Infection: Multiple Potential Mechanisms. Circulation 22 April 2020. doi.org/10.1161/CIRCULATIONAHA.120.047659.

3.      Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospitalization and critica illness among 4,103 patients with COVID-19 disease in New York City. 2020; 2020.04.08.20057794. doi: 10.1101/2020.04.08.20057794.

4.      Simonnet A, Chetboun M, Poissy J, et al. Intensive Care COVID-19 and Obesity study group. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring) 9 April 2020. doi: 10.1002/oby.22831. [epub ahead of print].

5.      Kass DA, Dugal P, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. Lancet. 2020;395:1544–1545. DOI: https://doi.org/10.1016/S0140-6736(20)31024-2.

6.      Stefan N, Birkenfeld AL, Schulze MB, et al. Obesity and impaired metabolic health in patients with COVID-19. Nat Rev Endocrinol 2020. https://doi.org/10.1038/s41574-020-0364-6.

7.      CDC. Groups at Higher Risk for Severe Illness. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html. Last accessed: October 2020.

8.      CDC. ICNARC report on COVID-19 in critical care 31 July 2020. Available at: https://www.icnarc.org/DataServices/Attachments/Download/42ceb4d2-3dd3-ea11-9128-00505601089b Last accessed: October 2020.

9.      Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020; 584:430-436.

10.    Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 - COVID-NET, 14 States, March 1-30, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69:458-464.

11.    Gao F, Zheng KI, Wang XB, et al. Obesity Is a Risk Factor for Greater COVID-19 Severity. Diabetes Care. 2020.   

12.    WOF. Coronavirus (COVID-19) & Obesity. Available at: https://www.worldobesity.org/news/statement-coronavirus-covid-19-obesity. Last accessed: October 2020.

13.    Ryan DH, Ravussin E, Heymsfield S. COVID 19 and the Patient with Obesity – The Editors Speak Out. Obesity 2020;28:847–847. doi:10.1002/oby.22808.

14.    Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clin Infect Dis April 9, 2020 doi: 10.1093/cid/ciaa415. [epub ahead of print].

15.    Dietz W and Santos-Burgoa C. Obesity and its Implications for COVID-19 Mortality. Obesity (Silver Spring). 2020; 28:1005.

16.    Qingxian C, Fengjuan C, Fang L, et al. Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China. SSRN Electronic Journal. 2020.

17.    The Lancet Diabetes and Endocrinology. COVID-19 and obesity—lack of clarity, guidance, and implications for care. Available at: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30156-X/fulltext. Last accessed: June 2020.

18.    Fruhbeck G, Baker JL, Busetto L, et al. European Association for the Study of Obesity Position Statement on the Global COVID-19 Pandemic. Obes Facts. 2020; 13:292-296.

19.    World Obesity Federation. Coronavirus (COVID-19) & Obesity. https://www.worldobesity.org/news/obesity-and-covid-19-policy-statement. Last accessed: October 2020.

HQ20OB00147, Approval date: December 2020

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