Obesity-related conditions seem to worsen the effect of COVID-19; indeed, the Centers for Disease Control and Prevention (CDC) reported that people with heart disease and diabetes are at higher risk of COVID-19 complications.
Given the extremely high rates of obesity around the globe we expect that a high percentage of the population who will contract coronavirus will also have a BMI over 25. Furthermore, persons with obesity who become ill and require intensive care present challenges in patient management as it is more difficult to intubate patients with obesity, it can be more challenging to obtain diagnostic imaging (as there are weight limits on imaging machines), patients are more difficult to position and transport by nursing staff and, like pregnant patients in ICUs, they may not do well when prone.
Newly published data from New York show that among those under 60, obesity was twice as likely to result in hospitalization for COVID-19 and also significantly increased the likelihood that a person would end up in intensive care. "Obesity [in people < 60 years] appears to be a previously unrecognized risk factor for hospital admission and need for critical care. This has important and practical implications when nearly 40% of adults in the US are obese with a body mass index [BMI] of ≥ 30," write Jennifer Lighter, MD, NYU School of Medicine/NYU Langone Health, and colleagues in their research letter published online April 9 in Clinical Infectious Diseases. Similar findings in a preprint publication, yet to be peer reviewed, from another New York hospital show that, with the exception of older age, obesity (BMI > 40 kg/m2) had the strongest association with hospitalization for COVID-19, increasing the risk more than sixfold. Meanwhile, a new French study shows a high frequency of obesity among patients admitted to one intensive care unit for COVID-19; furthermore, disease severity increased with increasing BMI. One of the authors told Medscape Medical News that many of the presenting patients were younger, with their only risk factor being obesity. "Patients with obesity should avoid any COVID-19 contamination by enforcing all prevention measures during the current pandemic," say the authors, led by Arthur Simonnet, MD, Centre Hospitalier Universitaire de Lille, France. They also stress COVID-19 patients "with severe obesity should be monitored more closely." Those With Obesity Are Young and Become Very Sick, Very Quickly Coauthor of the French article, published online April 9 in Obesity, François Pattou, MD, PhD, told Medscape Medical News that when patients with COVID-19 began to arrive at their intensive care unit in Lille there were young patients who did not have any other comorbidities. "They were just obese," he observed, adding that they seemed "to have a very specific disease, something different" from that seen before, with patients becoming very sick, very quickly. In their study, they examined 124 consecutive patients admitted to intensive care with COVID-19 between February 25 and April 5, 2020, and compared them with a historical control group of 306 patients admitted to the ICU at the same hospital for non-COVID-19-related severe acute respiratory disease in 2019. By April 6, 60 patients with COVID-19 had been discharged from intensive care, 18 had died, and 46 remained in the unit. The majority (73%) were male, and their median age was 60 years. Obesity and severe obesity were significantly more prevalent among the patients with COVID-19, at 47.6% and 28.2%, versus 25.2% and 10.8% among historical controls (P < .001 for trend).