Obesity and COVID-19

Numerous studies have reported that obesity increases the risk of developing COVID-19 and worse outcomes for patients with obesity. Obese persons are more than twice as likely to require hospitalization. Once in the hospital they are 74% more likely to be admitted to an ICU, and up to 8% more likely to die. This is especially important when you consider that 40% of the adults in the United State are obese.

The increased risk is also seen in obese children. They are three times more likely to require hospitalization. While in the hospital they are 42% more likely than normal weight children to require admission to the ICU. They are also at a similar increased risk for needing mechanical ventilation and of dying.

Obese people are more likely than normal-weight people to suffer from other diseases that are also risk factors for severe COVID-19, including heart disease, lung disease, and diabetes. Metabolic syndrome is also more frequent in obese persons. (abnormal levels of blood pressure, blood sugars and abnormal cholesterol) substantially increased the risks of ICU admission, ventilation, and death.

Even overweight person – weights above desirable but not yet meeting the definition of obesity are at increased risk for severe COVID-19. The increased risk is seen regardless of the person’s age, sex, social class and regardless of whether they have diabetes or heart conditions. This especially important since

32% of people in the United States are overweight.

Overall 77% patients hospitalized with COVID-19 were found to be either overweight (29%) or obese (48%). Clearly weight is not purely a cosmetic issue.

Multiple disease mechanisms make overweight and obese persons more vulnerable to severe COVID-19 infection. 1. Fat in the abdomen pushes up on the diaphragm – the muscle that draws air into the lungs. This interferes with airflow. 2. There is an increased tendency to form blood clots. This is especially a problems since severe COVID infections causes

3. Obesity causes increase levels of inflammation in the body due to the release of chemicals called cytokines from fat cells. This contributes to the increased levels of the inflammatory agents from COVID itself. 5. COVID infects fat cells where it can hide from the immune system, making recovery more difficult 6. Studies suggest that coronavirus vaccines may be less effective in overweight and obese individuals.

Little is known about the best way to treat COVID in obese individuals. Because of the increased risk of blood clots, higher doses of anticoagulants are recommended. It is not known about whether and how to adjust other treatments such as remdesivir and dexamethasone. Our understanding has been hampered by the fact that patients with obesity are often excluded from clinical trials.

Because of the increase risk for disease and poorer outcomes from COVID-19, people with obesity need to be very careful to avoid getting the virus.

IN obese persons, increasing physical activity and weight loss (of any amount) will improve their metabolic health and reduce their risk of severe disease from COVID-19 if they become infected.