Obesity – A Greater Risk of COVID-19 Severity?

As we all are aware of the current pandemic situation caused by Covid-19 has attracted worldwide attention. Usually, obesity has many side effects which complicates our physical and mental well-being. Obesity boosts the severity of respiratory diseases, but this is still not clear whether this plays a role in having a greater Covid-19 severity of illness.

For this purpose, a study was conducted in Asia where seventy-five patients diagnosed as ‘obese’ and seventy-five ‘non-obese’ took part, all of them having Covid-19. The severity of Covid-19 was assessed during hospitalization also, obesity was defined as BMI ≥25 kg/m2 in this Asian population. All patients denied a history of active cancer, chronic obstructive or restrictive pulmonary diseases, or other end-stage diseases.

The study has shown association between obesity and higher risk of having severe Covid-19. Each 1-unit increase in BMI was also associated with a 12% increase in the risk of severe COVID-19. To date, the virologic and physiological mechanisms underlying the strong relationship observed between obesity and COVID-19 severity are poorly understood.

It is reasonable to hypothesize that more severe COVID-19 in patients with obesity may be the consequence of underlying low-grade chronic inflammation and suppression of innate and adaptive immune responses.

Also, the mechanical dysfunction caused by obesity can increase the severity of lower respiratory tract infection and contribute to secondary infection. Health care professionals caring for Covid-19 patients should be aware of the likelihood of severe Covid-19 in obese people. Thus, the presence of obesity carries higher risk of severe illness roughly threefold with a consequent longer hospitalization.

On the other hand, the relationship between socioeconomic status and risk of obesity, and the political interventions such as lockdown against Covid-19 might translate into increased obesity occurrence and metabolic diseases in inactive groups and lower socio-economic status.

A reason for this increase is the availability of highly processed, energy-rich, cheap foods which boosts the calorie intake beyond energetic needs, which such foods are preferred and selected by individuals with a lower socioeconomic status who have limited income resources.

The use of lockdown to combat Covid-19 has been successful to a certain extent from an epidemiological perspective, but lockdowns have had negative effect on metabolic health. On the other hand, approaches designed to contain the spread of Covid-19 might promote obesity and associated metabolic diseases.

Accordingly, when considering the use of lockdowns in the future, the potential adverse consequence on metabolic health should be taken into consideration. Also, if potential lockdowns are to occur, the closure of Sporting facilities such as gyms should remain open with caution, which will potentially help people cope with inactivity.

References:

Clemmensen, C., Petersen, M. B., & Sørensen, T. I. (2020). Will the COVID-19 pandemic worsen the obesity epidemic?. Nature Reviews Endocrinology16(9), 469-470.

Dixon AE,  Peters U. The effect of obesity on lung function. Expert Rev Respir Med 2018;12:755–767 Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease 2017

Gao, F., Zheng, K. I., Wang, X. B., Sun, Q. F., Pan, K. H., Wang, T. Y., … & Zheng, M. H. (2020). Obesity is a risk factor for greater COVID-19 severity. Diabetes care, 43(7), e72-e74.

World Health Organization Rolling update on coronavirus disease (COVID-19): WHO characterizes COVID-19 as a pandemic. Published 11 March 2020.

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