Originally Published in Quality Health & Wellness Magazine | Fall 2020
Written by: Lisa Erlinger, PhD, CRNA
Director of Anesthesia Services
Wickenburg Community Hospital
Is There a Link Between Obesity and Severity of COVID-19?
Increasing evidence indicates that obesity is an independent risk factor for severe illness and death from COVID-19. (9) Often a precursor to obesity, overweight is a condition identified as having body fat that exceeds what is considered healthy for an individual’s height. When the human body has an excessive amount of body fat, the condition is identified as obesity. Obesity is a complex disease leading to medical problems that increase the human body’s risk of disease and health conditions. These conditions include, but are not limited to, heart disease, diabetes, high blood pressure, delayed wound healing, and certain cancers. The prevalence of overweight and obese individuals has now reached 70% of the U.S. population.
There are many reasons why some individuals may have difficulty avoiding obesity. The balance between calories-in and calories-out differs for each person, and obesity occurs over time when more calories are consumed than are used. Baring the presence of medical complications such as Prader-Willi syndrome, Cushing syndrome, or others; obesity typically results from a combination of environment and personal diet and exercise choices. (1) Factors that may increase one’s weight include overeating, eating high-fat foods, and not being physically active.
The standard index used to classify obesity in adults is called Body Mass Index (BMI). This simple index of the weight-to-height ratio is calculated by dividing one’s weight in kilograms by the square of one’s height in meters. A high BMI can be an indicator of high body fatness. While BMI can be used as a screening tool, a trained healthcare provider should perform appropriate health assessments in order to evaluate an individual’s health status and risks. (2)
Severity of COVID-19
Researchers have shown a dose-response relationship between excess weight and severity of COVID-19. The relative risk of critical illness from Covid-19 increased by 44% for people who are overweight. The risk of dying from COVID-19 increased with obesity severity, from a 27% higher risk in the first obesity category (body mass index (BMI) 30-34.9; to more than doubling of the risk in the most obese category (BMI) >40. (BMJ 2020;369:m2237). The proportion of patients requiring invasive mechanical ventilation in a study from France increased with increasing BMI and reached 90% in those with BMI > 35.3
A mechanical ventilator is a form of life support. This is used by placing a specialized tube in the airway to assist breathing in patients who are extremely short of breath and have dangerously low oxygen levels. The use of a ventilator is a necessity for some but does not come without risks.
Multiple concerns are explained in the relationship between weight and COVID-19. Studies have found that the adipose tissue of overweight people may be a potential target and viral reservoir, leading to the severity of the infection and longer length of spread to others. Excess body fat has also been shown to alter immune responses. In addition, patients admitted to intensive care are at greater risk during the administration of ventilation measures to improve oxygen saturation levels. This is a result of restrictive patterns imposed by high body weight on the respiratory system and can lead to COPD and sleep apnea. Notably, overweight patients also had a longer hospital stay. (4-6) This is especially important in the recovery from surgery.
Obesity can accompany a multitude of comorbidities that may significantly impact a patient’s recovery from elective orthopedic surgery. Although no strict upper weight limits have been established that would contraindicate elective orthopedic surgery, surgeons understand the unique risks overweight patients face, and how to optimize and treat each of them on an individual basis. According to an article published in the American Academy of Orthopedic Surgeons, it is recommended that patients with morbid obesity (BMI of 40 or higher) should be (7) advised to lose weight before total joint arthroplasty (TJA), offered resources for weight loss before surgery, and counseled about the possible complications and inferior results that may occur if they do not lose weight.
In conclusion, there is a definitive link between obesity and an increased rate of disease and health complications that may also lead to increased risk during the COVID-19 pandemic. The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. Dietary changes; increased physical activity, and behavior changes can improve weight loss efforts.
Now is an excellent opportunity to promote healthy eating and exercise habits. Try incorporating new fresh and unpackaged foods and getting creative with exercise to raise the levels of infection-fighting white blood cells, antibodies, increase circulation, and decrease stress hormones. (8)
COVID-19 Guidance and Information: https://www.wickhosp.com/coronavirus-news/
WCH Nutrition Resources: https://www.wickhosp.com/service/registered-dietitian/
- https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742, https://medlineplus.gov/obesity.html ret. 8/2/2020
- https://www.cdc.gov/obesity/adult/defining.html ret 8/2/2020
- Simonnet, A. et al., Obesity (Silver Spring. Md). 2020; doi:10.1002/oby.22831
- Diego Moriconia, Stefano Masia, Eleni Rebelosa, Agostino Virdisa, Maria Laura Mancaa, Salvatore De Marco, Stefano Taddeia, Monica Nannipieria Obesity prolongs the hospital stay in patients affected by COVID-19 and may impact on SARS-COV-2 shedding. https://doi.org/10.1016/j.orcp.2020.05.009
- Feng Gao, Kenneth I. Zheng, Xiao-Bo Wang, Qing-Feng Sun, Ke-Hua Pan, Ting-Yao Wang, Yong-Ping Chen, Giovanni Targher, Christopher D. Byrne, Jacob George, Ming-Hua Zheng, Obesity Is a Risk Factor for Greater COVID-19 Severity, Diabetes Care May 2020, dc200682; DOI: 10.2337/dc20-0682
- 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. 2020;71(15):896-897. doi:10.1093/cid/ciaa415
- Mihalko, William M. MD, PhD; Bergin, Patrick F. MD; Kelly, Frank B. MD; Canale, S. Terry MD Obesity, Orthopaedics, and Outcomes, Journal of the American Academy of Orthopaedic Surgeons: November 2014 – Volume 22 – Issue 11 – p 683-690 doi: 10.5435/JAAOS-22-11-683
- Lim S, Shin SM, Nam GE, Jung CH, Koo BK. Proper Management of People with Obesity during the COVID-19 Pandemic. J Obes Metab Syndr. 2020;29(2):84-98. doi:10.7570/jomes20056
- Monique Tan, PhD researcher, Feng J He, professor, Graham A MacGregor, professor Obesity and covid-19: the role of the food industry BMJ2020; 369 doi: https://doi.org/10.1136/bmj.m2237 (Published 10 June 2020)Cite this as: BMJ 2020;369:m2237