COVID-19 is hitting some patients with obesity particularly hard

As part of the
COVID-19 response team at O’Connor Hospital in San Jose, Calif., Nivedita
Lakhera wasn’t prepared to see her intensive care unit filled with so many
young patients. Many of those patients had no medical condition other than

“They are young
and coming to the ER and just dropping dead,” she says.

particularly those over 65, as well as having a compromised immune system are still
major risk factors for being hospitalized with, and dying
from, COVID-19. But some doctors say that some of their sickest patients are
those under 60 who are obese.

The Centers for
Disease Control and Prevention’s list of high-risk individuals includes the
severely obese, defined as people with a body mass index, or BMI, over 40. While
studies on coronavirus often focus on demographic breakdowns such as age, sex
and race (SN: 4/10/20), some
now are starting to track COVID-19 patient BMIs.  

For instance,
of 180 patients hospitalized from March 1 to March 30, the most prevalent underlying condition for adults ages 18 to 49 was obesity.
Of 39 patients in that age range, 23, or 59 percent, were obese, researchers
report in the April 17 Morbidity and
Mortality Weekly Report

“BMI is the
Achilles’ heel for American patients,” says Jennifer Lighter, an epidemiologist
at New York University’s Langone School of Medicine. That could be a crucial
factor in the death toll, particularly for those under 60, she says. “In China
it was smoking and pollution, and Italy had a larger older population, and many
grandparents lived with extended families. Here, it’s BMI that’s the

In the United
States, 42 percent of adults have a BMI over 30, the threshold for
obesity, and more than 9 percent are classified as severely obese with a BMI
over 40, according to the CDC. People with obesity can have other high-risk health
conditions, such as hypertension or diabetes (SN: 3/20/20). But some doctors suggest a high BMI should be a risk
factor in itself.

Lighter and her
colleagues found that patients under 60 with a BMI over 35 were at least twice as likely to be admitted to the ICU for coronavirus than patients with healthy
BMIs, the researchers report April 9 in Clinical
Infectious Diseases
. Those same patients were three times more likely to
die from the infection than those with a lower BMI, she says.

The team tracked 3,615 people who tested
positive for SARS-CoV-2, the virus that causes COVID-19, at a New York City
hospital from March 4 to April 4. Of those, 1,370, or 38 percent, were obese. In
patients over 60, weight did not appear to be a factor in hospital admission or
the need for intensive care, she says.

A hospital in Lille, France, also found that the higher the BMI, the more likely a patient needed to be ventilated. Of 124 patients admitted to intensive care for COVID-19, almost half were obese or severely obese, researchers report April 9 in Obesity. Of the 85 patients who were intubated, nearly 90 percent had a BMI over 35, the data show. 

“The need for invasive mechanical ventilation was associated with
severe obesity and [was] independent of age, sex, diabetes and hypertension,”
the study says.

Sethi, a cardiologist at Columbia University Medical Center, says his hospital is
seeing a surprising number of younger patients with obesity, but no other
conditions such as diabetes or high blood pressure. On April 12, he tweeted that, for obese patients, “the
prognosis is extremely grim. They are NOT dying from comorbidities. They are
dying from COVID-19.”

People with
a high BMI already tend to have problems breathing; they carry more weight on
their chest, which compresses the lungs. Because COVID-19 is mainly a respiratory
disease, that may put heavier patients at a disadvantage, doctors say.

people “already have lower oxygen levels, they are predisposed to pulmonary
dysfunction, and they have decreased chest function because of the weight on
their chest. And many have sleep apnea. So they’re at pulmonary risk
already,” says Samuel
Klein, a gastroenterologist and
the director of the Center for Human Nutrition at Washington University School of
Medicine in St. Louis.

See all our coverage of the coronavirus outbreak

Public health officials say
people with obesity shouldn’t feel stigmatized or avoid seeking medical care;
it’s important to be aware of threat COVID-19 poses. People with high BMIs might want to practice extra caution,
wear a mask outside and have groceries delivered instead of going out into
public, Sethi says.

“I worry this
is going to have even more impact where obesity is more endemic, like in the
South,” he says.   

The data should
be a wake-up call for people with obesity, agrees Donna Ryan, president of the London-based
World Obesity Federation. “If they do develop fever or shortness of breath,
they should not hesitate, call their doctor and get tested.”

Doctors might take specific measures when treating obese patients for COVID-19, says Rekha Kumar, an obesity specialist at Weill Cornell Medical College in New York City. That might include giving them oxygen early or keeping them in the hospital longer.

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