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Obesity a Major Risk Factor for COVID-19 Complications, Studies Show

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Key Takeaways

  • Research shows a link between obesity and the severity of COVID-19 symptoms. 
  • The Centers for Disease Control and Prevention lists severe obesity as a risk factor for life-threatening COVID-19. 
  • Severe obesity is defined as having a body mass index (BMI) of 40 or above. 

It's well known that older adults and those with underlying health conditions such as hypertension, diabetes mellitus, and cardiovascular disease are vulnerable to COVID-19. But now, researchers and medical experts are looking at other specific conditions that put people at an increased risk of complications and more severe symptoms from the coronavirus. One condition garnering a lot of attention is obesity.

Obesity and COVID-19

According to the Centers for Disease Control and Prevention (CDC), people with underlying medical conditions, such as obesity, might be at higher risk for severe illness and complications from COVID-19.

Kuldeep Singh, MD, FACS, MBA, FASMBS, a top weight loss surgeon in the Baltimore Metropolitan area and Director of The Maryland Bariatric Center at Mercy, says patients with severe obesity are a more challenging population to manage in an intensive care setting, and they’re also more susceptible to COVID-19 related complications.

Kuldeep Singh, MD

It is now increasingly clear with emerging medical literature that severe obesity is an independent factor for serious coronavirus infection.

— Kuldeep Singh, MD

Two categories of obesity can put you at risk of complications from COVID-19: Obesity and severe obesity. If you have a body mass index (BMI) of 30 or above, you are considered obese. A BMI of 40 or above is considered severely obese, which can put you at risk of acute respiratory distress (ARDS), which is a serious breathing problem. The CDC says ARDS, a major complication of COVID-19, creates challenges for doctors when trying to provide respiratory support.

What the Research Says

While we still have a lot to learn about the connection between COVID-19 and obesity, David Cutler, MD, family medicine physician at Providence Saint John’s Health Center in Santa Monica says there are some things we do know.

“A new study published in 2020 in Diabetes Care looked at 383 patients with COVID-19 and severe pneumonia and concluded that you were two and a half times more likely to have severe pneumonia if you were obese than if you were not obese,” he explains.

This was also true in New York, where Cutler says another newer 2020 study published in Clinical Infectious Diseases found that severe obesity was the second most important risk factor for predicting hospitalization in 3,600 COVID-19 patients under the age of 60; age was the first. The authors of this study stressed the significance of these results because patients aged 60 years and younger are generally considered a lower-risk group of COVID-19 disease severity.

But based on their data, obesity appears to be a previously unrecognized risk factor for hospital admission and the need for critical care. “This has important and practical implications, where nearly 40% of adults in the United States are obese with a BMI ≥ 30," explain the authors. 

“Obesity brings with itself a chronic inflammatory state,” says Singh. It also takes away the reserve in the body. And when somebody is very obese, Singh says their lungs don’t breathe long enough. “Their stomach pushes the diaphragm up, and there are technical problems in putting the breathing tube in the patient’s mouth as well as and problems moving the patient to a prone position, which is on the stomach,” Singh said.

If you are obese, Singh says this is a good time to get control of your weight to lessen complications if you were to contract the virus.

Steps You Can Take to Reduce Your Risk

Recognition of risk factors is a critical first step to determine prevention strategies. It’s also a key factor in targeting high-risk populations for potential therapeutics. With that in mind, addressing obesity as it relates to COVID-19 will require a partnership between patients and doctors — and not just one that deals with the medical side of obesity, but one that also takes a deep dive into the mental and emotional impact of obesity.

We need to expand our definition of what makes a treatment team and push to include mental health experts, exercise physiologists, and registered dietitians.

The good news is obesity is a modifiable risk factor. Unlike age and male sex, we have the ability to change our health and vulnerability to COVID-19 by losing weight and decreasing our BMI. 

The National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) explains that common treatments for obesity include: 

  • Losing weight through healthy eating
  • Being more physically active
  • Making other lifestyle changes 

They also stress the importance of setting short and long term goals and having a support system. The people you choose to include in your support system can be friends, family, or medical experts supporting you on your journey. Soliciting the help of medical and mental health experts that are trained in obesity and weight loss can help you identify unhealthy eating and exercise patterns and help you stay on track to meet your goals. 

In addition to diet, exercise, and lifestyle changes, the NIDDK also says that some people may benefit from more structure interventions such as formal weight management programs, weight loss medicines, or weight loss devices like gastric balloon system or a gastric emptying system, or surgery such as bariatric surgery. 

Healthy weight loss, according to the CDC, should be gradual and steady. In fact, they say that people who lose about 1 to 2 pounds per week are more successful at keeping weight off. Plus, adding exercise can also help you meet your goals and keep the weight off. That said, make sure to get the green light from your doctor before engaging in physical activity.

Once you’re cleared for working out, follow the Physical Activity Guidelines for Americans, which recommend that adults should do at least 150 minutes to 300 minutes of moderate-intensity (30 to 60 minutes, five days a week), 75 minutes to 150 minutes a week (15 to 30 minutes, 5 days a week) of vigorous-intensity aerobic physical activity or an equivalent combination of both.

When it comes to dietary modifications, the NIDDK says sticking with an eating plan is often more important than the type of plan you’re following. In other words, find something that works for you and make it a lifestyle change. 

What This Means For You

Scientists and medical experts continue to discover new research to help them better understand COVID-19. In addition to social distancing, safe hygiene practices, and wearing a mask, putting your health first and addressing chronic conditions like obesity can help decrease your risk of experiencing severe symptoms and complications if you get sick with COVID-19. 

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Article Sources
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  2. CDC. Groups at Higher Risk for Severe Illness. Updated May 14, 2020.

  3. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York [published online ahead of print, 2020 May 16]Metabolism. 2020;108:154262. doi:10.1016/j.metabol.2020.154262

  4. Cai Q, Chen F, Wang T, et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China [published online ahead of print, 2020 May 14]Diabetes Care. 2020;dc200576. doi:10.2337/dc20-0576

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

  6. NIDDK. Treatment for Overweight and Obesity. Updated February 2018.

  7. DHHS. Physical Activity Guidelines for Americans. 2018.

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