The Impact of Obesity on COVID-19

Since the start of the pandemic, many studies have come to a consensus about the one major risk factor that increases the chances of becoming hospitalized with severe COVID-19 symptoms and dying of the virus: obesity. This somber fact has come into sharper focus in recent weeks as a new large population study showed that even being overweight significantly raises the risk of hospitalization and death.

The study, published in August by an international team of researchers, looked at 399,000 patients and found that those with obesity were 113% more likely than those at a healthy weight to be hospitalized with COVID-19. They also found obese patients were 74% more likely to be admitted to an ICU and were 48% more likely to die.

These statistics demonstrate the devastating impact of obesity, particularly in younger people. To make matters worse, the stigma of obesity may also prevent many patients from seeking the medical care they need. Research has shown that many patients with obesity tend to put off receiving medical care or going back for follow-up appointments because they feel judged or unwelcome by the medical community.

Since approximately 70% of adults in the U.S. are overweight (having a BMI of 25-29.9) or obese (a BMI of 30 or greater), this is one likely reason why the virus has had such a severe effect across the nation.

Why is Unhealthy Weight the Top Risk Factor for COVID-19?

In addition to social issues, obesity has been shown to impair the immune system, cause chronic inflammation, and reduce the body’s ability to break down blood clots. All of these factors can worsen COVID-19 symptoms and increase the risk of mortality.

People with obesity are more likely than those at a healthy weight to have other health issues that are independent risk factors for the virus, such as diabetes, heart disease, and lung disease. Obesity also increases the risk of having metabolic syndrome, which causes unhealthy blood sugar and fat levels, as well as high blood pressure. One study from Tulane University found that metabolic syndrome alone significantly increases the risk of ICU admission, ventilation, and death.

Another large study of 17,000 hospitalized COVID-19 patients in the U.S. found that 77% of them were overweight (29%) or obese (48%). Yet another study of 334,000 patients in England found that even though the risk of developing severe COVID-19 symptoms peaked among people with a BMI of 35 or greater, the risks rose as soon as patients hit the overweight category.

Beyond the independent risk factors associated with obesity, the physical pathologies in obese patients can also make COVID-19 more severe. For example, abdominal fat can push on the diaphragm and restrict airflow to the lungs. This can cause the airways of the lower lobes of the lungs to collapse, leading to more blood oxygenation than in the upper lobes. This mismatch of blood oxygenation often leads to a more rapid progression of severe COVID-19 symptoms.

The severity of COVID-19 in patients with obesity also corresponds to the disproportionate toll the virus has taken on some groups. For example, populations who suffer from poverty, a lack of access to health care, lack of health insurance, and less opportunity to exercise have markedly higher obesity rates. The psychological toll of an ongoing pandemic also hasn’t helped with obesity rates. Many people have put on weight since the initial lockdowns due to stress-eating and a lack of exercise.

Treatment for COVID-19 Patients with Obesity

Currently, there is little data available on how to best treat COVID-19 patients with obesity. There’s some evidence that higher doses of anticoagulants help prevent blood clots, but little is known about other treatments, like remdesivir and dexamethasone, because obese patients are often excluded from clinical trials. One of the key things to take away from what we know about COVID-19 is that people who are obese or overweight should take extra precautions to avoid getting sick.

Beyond wearing a mask and avoiding gatherings, there’s evidence that even a small amount of weight loss can improve the metabolic health of someone with obesity and reduce the chance of developing severe COVID-19 symptoms.

If you have difficulty maintaining a healthy weight, you may benefit from a medical weight loss program. Dr. Jennifer Hubert uses a comprehensive, multidisciplinary approach to create a customized plan to help you lose the weight and keep it off, including medical monitoring, behavior modification, and nutritional counseling. Her program has improved the lives of hundreds of Santa Rosa residents. For more information, contact Dr. Hubert’s office at (707) 575-8446.